There is an epidemic of type 2diabetes worldwide, and particularly sub-Saharan Africa is bearing the brunt. Zanzibar is not exempt, where the literature points out a steadily increasing public health problem. The literature shows that diabetics in sub-Saharan Africa struggle coping with this chronic disease. No study has explored coping among diabetics in Zanzibar, which justifies the current one. This entails the fact that no studies in the region have looked at coping among diabetics in a Muslim society, and especially with regard to Ramadan fasting. The overall objective was to increase understanding of local diabetes care and coping mechanisms among diabetics in Zanzibar. A qualitative methodology was employed; where in-depth interviews were carried out with a heterogeneous group of persons representing useful insights on the topic. The data collection took place in Zanzibar from June to September 2013; which includes the month of Ramadan. The study has found that there is a web of interconnected factors at play. Modern diabetes care as well as awareness and acceptance of the biomedical explanation of the disease is on the rise in this society. Though, there are still constraints, which are related to the multiple explanatory models of sickness still circulating on the isles. This is reinforced by the still limited access to modern diabetes care, as well as continued poor regulation and unempowerment of the traditional sector; leaving the latter to strive for legitimacy, reflected in among others their largely inadequate utilization of biomedical equipment and terminology. This reality can be viewed as a matter of power struggles, using Foucault’s terms. The diabetics move in between; driven by the distinct poverty and the hope for cure. The western, modern way of life is in many ways perceived negatively by the locals; it permeates the society in ways that are hard to cope with. The structural violence is obvious, this social machinery of oppression against the poorest of the world; which is believed to create resistance and reinforce the society’s traditional, largely Islamic based world-view; which, in addition to maintain the existence of the traditional sector; also implies norms that the diabetics struggle with, such as the stigma related to refrain from Ramadan fast. The vicious cycle keep spinning; where disease exacerbation, complications and premature deaths is still the sad fact. The study concludes that continued efforts need to be undertaken to tackle this increasing epidemic in the Zanzibari society, both locally, but equally important through global efforts; where empowerment is a key word.