Quran specifically exempt sick people from fasting, but many diabetes patients who are well apart from taking medicine (tablet or insulin) fast during Ramadan or in intend to fast, worldwide.
This information leaflet is for those people with diabetes who wish to fast.
Risk associated with fasting
- Low blood sugar level (hypoglycemia)
- High blood sugar level, especially after Iftar and Sahoor.
- Short of water in body (Dehydration).
Diabetes patients who are advise not too fast.
- All sick patients for example having fever, diarrhea and vomiting, chest infection and burning in urine etc.
- Those whose blood glucose is not well controlled.
- Patients with serious compilations for example, heart failure, uncontrolled high blood pressure (hypertension), and unstable angina. (coronary artery disease)
- Elderly patients who are frail, living alone and problem with mental alertness.
- Patient with established kidney failure.
Diabetes patients who can fast with low risk of complications after consulting their doctors.
All people with diabetes, should keep in mind that desire to fast is their own personal desire that should be used in line with religious exemptions.
- All people with types 2 diabetes who are well controlled with diet or oral medicine or insulin.
- 2 Patients who are willing to accept medical advice regarding diet, drug adjustment, exercise and close monitoring (especially during initial few days)
Blood glucose should be checked especially for initial few days.
- Before sahoor (per down meal)
- At mid-day (12 noon)
- Before Iftar
- 3 hours after evening meal
Advice on diet:
- It should not be different from that taken before Ramadan.
- 1-3 dates can be consumed at Iftar time
- Avoid large amount of food rich in carbohydrate and fats. At Iftar time and Sahoor.
- Increase fluid intake during non-fasting hours.
- Pre-dawn meal (sahoor) should be taken as late as possible.
Advice on Exercise
- Light to moderate exercise 2-3 hours after Iftar (past sunset meal)
- Taraweh prayer could be part of the exercise regimen.
- Avoid strenuous physical activity during the day time or prolonged walking especially in the afternoon as it may predispose to hypoglycemia (low blood glucose).
When to break the fast:
It could be risky to continue the fast if blood glucose drops to
- 60 mg or low
- 70 mg especially after starting fast.
- If blood glucose level goes up to 300 mg.
Manifestations of low blood glucose (hypoglycemia)
Feeling hunger, palpitations, cold sweats, hand tremors, trembling of body, confusion, restlessness and loss of consciousness some time people will lose consciousness without any symptoms. In case it happens then patient has to be taken at nearest hospital as soon as possible for appropriate management.
Manifestations of high blood glucose (hyperglycemia)
Increase thrust, passing urine more frequently and fatigue, tiredness and drowsiness
Patient may also lose consciousness in case the blood glucose goes very high. In that case patient needs to be taken to the nearest hospital as soon as possible for appropriate management.
- Patient should get advice regarding diet and drug adjustment during his/her last visit before Ramadan.
- Try to keep adequate nutrition and hydration after iftar and before sahoor.
- For people with diabetes whose blood glucose is controlled by diet alone, there should be no problem in fasting during Ramadan, avoid overeating and eating food rich in carbohydrates and fat at sahoor and iftar.
Few examples are given. It’s not possible to cover all combinations of medicines.
In principle, higher doses of drugs which are taken routinely in the morning should be taken at Iftar time.
Patient can take 2/3 dose of medicine at Iftar time and 1/3 dose of medicine at sahoor time.
Patients taking 1 tablet daily in the morning before Ramadan, can take the same medicine at Iftar time.
If someone takes tablet metformin 500mg twice daily before Ramadan, he/she can take the same tablet at Iftar time and not to take it at sahoor time.
Patients taking once daily insulin (basal insulin) in the evening can continue the same dose as before after Iftar time.
If someone is taking Premix insulin (such as 30/70), 30 units in the morning and 20 units in the evening before Ramadan, then he/she can continue morning dose of insulin 30 units at Iftar time and Reduce the evening dose at sahoor time by 20-30%.
Patient on blood pressure medicines:
Consult their doctor for drug adjustment. Take higher dose at Iftar time and reduce the dose at sahoor time to avoid the low blood pressure during fasting period.
People with diabetes who have got heart problem and they are stable on medicines, can consults their doctor whether they can fast during the month of Ramadan.
Pregnant ladies with diabetes:
So far there are no formal recommendations/guidelines on fasting for women with pregnancy and diabetes.
However, my experience/observations during my work in UAE & Saudi Arabia, many pregnant ladies wish to fast during Ramadan even if they have developed diabetes.
Pregnant ladies whose diabetes is controlled either by diet or small doses of medicines normally do not get any problem, but they have to consult their doctor for any drug adjustment in case they wish to fast.
Dr. Gulshad Hasan
Consultant endocrinologist Bahria International Hospital Lahore.
Member society for endocrinology (UK)
Professional Member (Diabetes, UK)
Ex-division Head endocrinology, King Abdullah Medical city Makkah, Saudi Arabia
- Diabetes and Ramadan Practical Guidelines, International Diabetes federation (IDF), In collaboration with the Diabetes & Ramadan (DAR) International Alliance, April 2016.
- ADA (American Diabetes Association) statement for management of diabetes during Ramadan (2010).
- Epidemiology of diabetes and Ramadan Study, 1422/2001 (EPIDIAR).