Is it obligatory to make up 60 days of fasting from previous Ramadans due to pregnancy and breastfeeding, despite unstable blood sugar, or is it permissible to pay expiation (kaffarah)? And is it permissible to pay the expiation in another country, and by what value should it be calculated?

If a trustworthy doctor informs a diabetic patient that fasting will not harm them, and will not cause them an unbearable hardship, then they must make up the days they missed from Ramadan 2019 before the next Ramadan. Otherwise, expiation (fidyah) will become obligatory upon them. As for what was missed from Ramadan 2017 and 2018, if the delay in making up the fasts was without a valid excuse until the subsequent Ramadan began, then both making up the fasts and expiation for each day are obligatory. However, if the delay was due to a valid excuse, then only making up the fasts is required.

If a trustworthy doctor informs the patient of the danger or extreme hardship of fasting, then the patient is not obligated to fast the missed days. Instead, they must feed a needy person for each day with one mudd of food (approximately 750 grams of rice or the staple food of the local people). It is permissible to give 60 mudds to one poor person or to several poor people. It is preferable to give the food itself, but it is permissible to pay its monetary value if that is more beneficial for the needy.