Expert-reviewed by Ashwini S.Kanade, Registered Dietician and Certified Diabetes Educator with 17 years of experience
Ramadan is a holy month in the Islamic calendar during which people fast every day from sunrise to sunset. However, long fasting periods can be challenging for people with diabetes, especially because of increased risk of low blood sugar (hypoglycaemia) and lack of proper sugar control. With adequate knowledge about sugar control and with proper medical supervision, one can have a successful and complication-free Ramadan without incurring any harm on oneself.
Risks associated with fasting
Fasting can lead to multiple metabolic complications in people with diabetes, particularly related to sugar (glucose) metabolism. During Ramadan fasting, the risk of developing a hypoglycemic episode (sudden drop in blood sugar) increases as much as four times; on the other hand, the risk of severely increased sugar levels requiring hospitalisation already increases five times.(1)
Other complications include dehydration, the risk of which is particularly high during hot summer months, and imbalance in the normal blood clotting mechanism.
Am I allowed to fast during Ramadan?
The Qur’an exempts the very sick from fasting in order to prevent self-harm. In line with that, the Organisation of Islamic Cooperation recommends that people with type 1 and type 2 diabetes who have additional risk factors should not fast during Ramadan.(1) Some of these risk factors are:
- Having type 1 diabetes
- Poor sugar control
- Diabetic complications of an advanced stage of the eye, kidney, or heart
- Senior citizens who are ill
- Tendency to have low blood sugar levels
- Individuals who’ve had serious diabetic complications—ketoacidosis, severe hypoglycaemia, and hyperosmolar hyperglycemic coma—in 3 months before the start of Ramadan
- Individuals who undertake intensive physical labour as a daily routine
- Any major acute illness or health-risk in addition to diabetes
What to eat?
We have dedicated a separate article to this topic. Read our “Fasting with Diabetes during Ramadan: What You Need to Know” article to learn more.
Avoiding problems during Taraweeh prayers
Taraweeh prayers are long in duration and thus can cause dehydration. Ensure that you have eaten enough starchy and slow digesting food during Iftar and have had enough water. Also, carry water or electrolyte solution with you to Taraweeh.
Smoking during Ramadan
For people with diabetes, smoking increases the risk of a range of complications, from eye to heart. Ramadan is, therefore, the best time to build self-control and quit smoking. Talk to your friends and family about helping you with this. You may also consult a doctor.
Changing your medicine routine for a safer Ramadan(1-3)
Most diabetic medicines (such as metformin, gliclazide, glipizide, glimepiride, repaglinide and nateglinide) are safe during fasting and can be continued without any problems. However, depending on the medication(s), dose, frequency, and level of sugar control, adjustments may need to be made and will vary from person to person. Inform your doctor about Ramadan and check if you need to alter your prescription accordingly.
General care and safety tips for fasting adults
– Pre-Ramadan medical assessment
If you are planning to fast during Ramadan, you should get a general diabetic check-up done. Ideally, it should be done 1–2 months before, so if you haven’t already, schedule an appointment with your doctor right away.
– Self-monitoring during Ramadan
Be aware of changes in your hunger, thirst, feeling of tiredness, drowsiness, etc. Ignoring such changes is likely to cause self-harm. Self-monitoring of blood sugar levels at home, especially if you are taking insulin, is extremely important. You can also monitor your ketones using a simple urine dipstick test. Also, keep a tab of your temperature and breathing.
It is easy to overeat during Iftar meals, especially sweets and fried foods, so plan your meals in advance. You can also seek help from your family and friends to prevent you from over-indulging.
– Recognise your blood sugar imbalance
Hypoglycaemia is more likely to occur 2 hours after the Sehri (Suhur) meal and 1-2 hours before the Iftar meal, although it can happen at any time. If you have one or more than one of these symptoms—feeling of weakness, a hunger that is excessive and does not go away, shivering and cold sweats, any vision problem, drowsiness—check your blood sugar.
Usually, high blood sugar does not have symptoms. However, if you feel excessive hunger, excessive thirst, frequent urge to urinate, and drowsy, then this could indicate very high blood sugar levels. If your blood glucose is more than 300 mg/dL, visit a doctor immediately.
– When to break the fast?
If at any point during the fast, your blood sugar is less than 60 mg/dL, you must break the fast. This limit is 70 mg/dL if detected earlier in the day or if you are taking insulin or sulfonylureas (glibenclamide gliclazide, glipizide, glimepiride, etc.)(3) If you find that your blood sugar level is ≤70 mg/dL before the start of fast, do not fast that day.
– Physical activity
Any rigorous exercise should be avoided by individuals with diabetes, especially during the fasting period. People whose jobs involve strenuous physical activity are prohibited from fasting. That said, light-to-moderate daily physical activity, especially during non-fasting hours, is not only safe but also recommended.
Staying prepared and alert is the best way to avoid self-harm. This Ramadan, take these necessary precautions so you can fast safely and without worry.
- Hassanein MM. Diabetes and Ramadan: how to achieve a safer fast for Muslims with diabetes. The British Journal of Diabetes & Vascular Disease. 2010;10(5):246-50.
- Jaleel MA, Raza SA, Fathima FN, Jaleel BN. Ramadan and diabetes: as-saum (the fasting). Indian journal of endocrinology and metabolism. 2011 Oct;15(4):268.
- AlMaatouq MA. Pharmacological approaches to the management of type 2 diabetes in fasting adults during Ramadan. Diabetes, metabolic syndrome and obesity: targets and therapy. 2012;5:109.