Ramadan requires Muslims to fast during the ninth lunar month of the Islamic calendar, but this is an issue of debate regarding people with diabetes.

While the date varies on the western (Gregorian) calendar, if Ramadan falls upon a summer month where fasts can last 17 hours or longer, this can put people with diabetes at risk of hypoglycemia and dehydration.

People with diabetes are exempt from fasting, if they so wish, as they have a medical condition, but it is a personal choice to be made.

Should people with diabetes fast during Ramadan?

It is not recommended for people to fast if this could negatively affect their health, while those with existing diabetic complications, such as kidney disease, are at greater risk.

Ultimately, the decision lies with the individual. You can speak to your Iman for more information on fasting with diabetes, as there may be other ways for you to respect the fasting period.

If you decide to fast, you must consult your doctor or health care in team in advance of Ramadan. This is to assess how best to look after yourself properly as the Qu’ran states that you must not act in a way that harms your body.

How can I stay safe during fasting?

There are a number of aspects of diabetes management that need to be considered if you choose to fast.

Blood glucose-lowering medication

If you continue to take blood glucose lowering medication during the daylight hours of fasting, you may increase your risk of hypoglycemia.

You should therefore see your doctor to discuss whether it is safe for you to do this, and if any precautions should be taken to prevent hypoglycemia or hyperglycemia.

Insulin, sulfonylureas or glinides

People taking insulin should not stop treatment as this could lead to diabetic ketoacidosis, a dangerous short-term complication which can lead to diabetic coma.

However, whether you are on insulin or another medication – such as sulfonylureas or glinides, which can make you susceptible to hypoglycemia – you should see your diabetes consultant before Ramadan for advice.

Controlling blood glucose levels through Ramadan

It may be harder to maintain normal control of your blood glucose levels during Ramadan, which is why it is important to do the following:

  • Check your blood glucose levels more often
  • Familiarise yourself with the symptoms of low and high blood sugar
  • Always keep your blood glucose meter on you in case you feel low or high
  • Keep some quickly absorbed sugar, such as an energy drink, on you at all times if you are at risk of hypoglycemia

What should I eat at Iftar (the fast-breaking meal)?

Iftar is the fast-breaking meal at which Muslims end their daily fast during Ramadan. It is important for people with diabetes to eat the right foods at Iftar.

The body may need to take in more food than normal during this period in order to keep nourished. However, this could lead to higher blood glucose levels while you sleep. This is why sweet foods are not advised to be eaten during Iftar.

Carbohydrates with a low glycemic index (which are slowly absorbed), such as whole grain bread, nuts and brown rice are beneficial as they provide a prolonged release of energy.

Conversely, foods with a high GI, such as potatoes, biscuits and white bread are not advised as these will affect your blood glucose levels more. You are also still likely to feel hungry before your next meal.

Otherwise, proteins are a good source of energy that are absorbed slower than carbohydrates, while foods that increase your HDL cholesterol can be eaten at Iftar, such as olives, oily fish and avocados.

You should also consume plenty of sugar-free and decaffeinated drinks during this time to prevent dehydration when you start fasting again.

I’m having problems, should I stop fasting?

If you are on insulin, sulfonylureas or glinides and you experience the symptoms of hypoglycemia or get a blood glucose levels of 70 mg/dl or lower, it is important that you end your fast for the day and treat the hypo.

If you are having issues with consistently high or low blood glucose levels, you doctor may advise that you stop fasting.

Moreover, if you have a diabetes-related complication that you feel is getting worse during the fasting period, you should see a member of your health care team as a matter of urgency.