Can diabetics fast during Ramadan?

It’s a common question here in the Middle East and across the world in homes where Ramadan is observed. After all, the Qur’an requires Muslims to fast during the month of Ramadan from sunrise to sunset.

However, fasting can pose challenges for people with diabetes as it can have a huge impact on blood sugar. There are some medical exemptions to the expectation of fasting during Ramadan, and diabetes is one of them. However, we know that many Muslims with diabetes still wish to fulfill this requirement.

To learn more, we turned to expert Dr. Shadi Tabba, MD from the Dubai Diabetes Centre. Dr. Tabba is certified by the American Board in Pediatric Endocrinology and Diabetes, and is a Diplomate of the American Board of Obesity Medicine.We asked him the question, can people with diabetes fast during Ramadan?

Can diabetics fast during Ramadan?

Dr. Shadi Tabba, MD: American Board of Pediatrics, American Board of Pediatric Endocrinology and Diabetes, Diplomate, American Board of Obesity Medicine, Consultant Pediatric Endocrinologist, Dubai Diabetes Centre

Please Note: The information contained below is not medical advice for your specific condition. Medical advice varies depending on the type of diabetes being discussed, and may vary from person to person. Always consult your physician and your medical support team for appropriate recommendations about fasting.

What is the consensus on medical advice and people with diabetes fasting during Ramadan?

Fasting in Ramadan for someone with diabetes does depend on the specific person, how well their diabetes is managed, what type of diabetes they have, and what medications they take for diabetes. It is generally best for a person with diabetes to coordinate with their physician specifically so that accurate advice may be given for each specific situation.

In general, given the higher risk entailed with fasting, a person whose diabetes is not well managed may prefer to avoid fasting in Ramadan, especially if their dosing regimen is not very accurate.

Can people who are insulin-dependent safely fast? Are there risks?

Fasting does pose challenges for the human body, as there is a prolonged period of time with no food or energy intake, and during Ramadan there is also no water intake. This may be tolerable for someone who is healthy and at an age where the body can withstand these challenges.

However, in a person with Type 1 Diabetes, especially a child, there is additional risk. People with Type 1 Diabetes may be in danger of hypoglycemia (as there is no food intake for prolonged periods) while they are fasting.

They can also become dangerously dehydrated – if they have high blood sugar readings, they are producing a large amount of water as urine which they are not compensating for by drinking.

As such, the majority of children with Type 1 Diabetes and many adults with Type 1 may be better off not fasting during Ramadan, unless they are already in excellent control and their physician tells them the risk is low for a complication. Their physician or diabetes support team will need to give them clear advice and instructions on how to deal with certain situations that may happen.

For example, during the night hours, a person with diabetes will benefit from hydrating thoroughly with lots of water, up to the moment that fasting starts at dawn.

Blood glucose measurements are ideally done throughout the day and evening – not just before meals – to catch any dangerously high or low readings. Treat any low readings that occur while fasting, which will cancel the fast for that day. Low readings while fasting should be treated, which will cancel the fast for that day. High readings will need to be cautiously treated with insulin but without overdoing it as that could lead to hypoglycemia.

These are general thoughts, but specifics need to be discussed with the person’s physician.

How can a person with diabetes prepare before fasting starts?

An extended visit with the person’s physician and dietitian is essential before Ramadan begins to clarify whether the medical status allows for fasting or not, and if so, what insulin and dietary adjustments would be needed.

Planning healthy meals ahead of time is important as there are many unhealthy food options on offer during the month.

Can a fasting person with diabetes expect more hyper or hypoglycemia than usual?

Yes, especially in a person with Type 1 Diabetes who is dependent on insulin.

Does a person with diabetes need to check their blood sugar during the day when fasting?

Blood glucose readings can be checked throughout the day and night to catch any high or low readings. If there are such readings which are not treated on time they may lead to complications and hospitalization.

Some people with diabetes prefer to use sensors/Continuous Glucose Monitoring Systems which will warn them and alarm for high and low readings.

Do people with diabetes still need to take their insulin, even when they are fasting during Ramadan?

A person with Type 1 Diabetes who takes a basal insulin (such as Lantus, Levemir, Tresiba, or basal insulin via pump) will need to continue this regardless of fasting.

The physician supervising the person with diabetes may judge that the insulin dose may need slight adjustment, but it should not be stopped.

Meal coverage boluses are given at meal time, so they will not be given while fasting. However, it remains that high readings during fasting may need to be corrected with insulin.

As for the less commonly used types of insulin like Mixtard, 70/30, 75/25/ or 50/50, these are insulin types that have a specific mode and timing of action which surely would need some insulin adjustment plan to prevent hypoglycemia and complications while fasting.

Ultimately, the person with diabetes does need to discuss fasting at length with their physician to make decisions on whether or not it is safe for them to fast, and if so, what insulin adjustment is necessary.

Conclusion

So if you have been wondering, can a person with diabetes fast during Ramadan, the answer is… perhaps.

If you are a person with diabetes and you’re considering fasting for Ramadan, the critical action that you need to take is to consult your doctor. Diabetes is different for everyone and only a personal assessment with a qualified medical expert can properly answer this one for you.

If your doctor gives you the all clear, you need to be mindful of medications and monitoring. The highs and lows that can result from fasting in a person with diabetes need to be taken much more seriously than for people without diabetes.

Are you planning to fast during Ramadan? Why or why not? Let us know in the comments below.


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