Key Takeaways

• Many people with diabetes can safely take part in the Ramadan fast, although this requires some planning.

• Fasting may not be safe for some people with diabetes, including those whose blood sugar is not well-controlled and those who are experiencing complications of diabetes (such as kidney disease).

• There is an increased risk of hypoglycemia (low blood sugar) during fasting. Closely monitoring your blood sugar will help to detect this if it occurs.

• Many people with diabetes need to adjust their medication dose while they’re fasting. Taking their usual dose increases the risk of hypoglycemia.

• When breaking your fast or taking your pre dawn meal, minimize sugar and refined carbohydrates, and focus on eating foods containing protein and fiber. This helps to avoid a blood sugar spike after a meal.

• Ensure that you’re taking plenty of fluids with your meals.

As Ramadan approaches, many Muslims will begin to plan for their fast. For Muslims with diabetes, the practice of fasting can present certain challenges. While some choose not to fast because their medical condition could make it risky for them, others would like to be able to participate in the fast. 

For those whose diabetes is not well-controlled or who are experiencing complications like kidney disease, fasting may not be safe for them, and they may need to avoid participating in the fast in order to avoid causing harm to the body. However, it’s possible for many Muslims who have diabetes to observe the fast if they wish, although there are some important considerations to keep in mind. Proper planning can help people with diabetes to fast more safely during Ramadan.

Monitoring your blood sugar levels

While fasting, there’s an increased risk of having episodes of hypoglycemia (low blood sugar). Because of this, it’s important to make sure that you’re monitoring your blood sugar closely while you’re fasting. This is particularly crucial during the first few days of the fast, so that you can see how your body is reacting. Consider checking your blood sugar more often than you usually do, to ensure that it’s not dipping too low.

If you use a continuous glucose monitor (CGM), you can observe when your blood glucose is trending toward hypoglycemia. This allows you to take action to avoid an episode of low blood sugar.

While fasting, there’s also an increased risk of diabetic ketoacidosis (DKA). This condition occurs when insulin levels are very low. Because insulin is needed for glucose to enter into the body’s cells, a lack of insulin leaves cells without energy from glucose. The body begins to break down fats for energy, and this process produces substances known as ketones. Ketones are very acidic, and high levels of them cause changes in the body’s physiology that can lead to symptoms like nausea and vomiting, abdominal pain, and confusion. If it’s not treated, DKA can be fatal. Fasting naturally causes the body to produce ketones, which can increase the risk of DKA. 

A person in DKA will have a very high blood sugar level (generally greater than 250 mg/dL, or 13.9 mmol/L). Checking your blood sugar on a regular basis will help you to catch a trend towards high blood sugar early. If this occurs while you’re fasting, you might be at risk for DKA. Make sure that you haven’t missed any doses of insulin or another diabetes medication, and contact your care team to discuss what you should do next. It’s possible that you’ll need to go to A&E to get medical attention.

Diabetes medication during fasting

In general, diabetes medications help to lower blood sugar. Your usual dose of diabetes medication has been adjusted according to your usual eating pattern. Once you begin fasting, if you continue with the same dose, this may lead to hypoglycemia.

Many people need to take a lower dose of diabetes medication while they’re fasting. However, if you normally use insulin to treat your diabetes, it’s still important to make sure that you take enough insulin to avoid DKA. Your care team will help you to adjust your insulin dose so that you stay safe.

Talk with your doctor before the fast begins, so you can make a plan for how to adjust your medication during Ramadan. Make sure to stay in touch with your care team during the month of fasting, and let them know about any episodes of low or high blood sugar. They will help you to adjust your medications in order to help keep your blood sugar within a healthy range during Ramadan.

How to break your fast during Ramadan

Another challenge for people with diabetes is how to break their fast. It’s common to experience hyperglycemia (high blood sugar) at this time, so it’s important to plan carefully in order to avoid a blood sugar spike.

Many people choose to break their fast with dates. Although dates do contain a lot of nutrients, they are also very high in sugar. For people with diabetes, this is important to keep in mind. Fortunately, dates also contain a lot of fiber, which helps to slow down the absorption of the sugar somewhat.

A standard serving size is three dates. Although it can be very tempting to eat more than this (especially when you’re quite hungry), try to eat no more than three. Some people choose to break their fast with water alone instead of eating dates, to avoid the sugar that dates contain.

After prayers, you’ll need to pay attention to what you’re eating during Iftar. Many of the foods commonly eaten at this time are very sugary, such as qatayef, baklava, and gulab jamun. In fact, many studies have shown that, on average, there’s an overall increase in carbohydrate consumption during the month of Ramadan. For people with diabetes, this can easily lead to high blood sugar.

Try to avoid eating large amounts of sugar when you’re breaking your fast. Because many people have learned to associate specific holiday foods with positive emotions, these foods can be very tempting. You could have just one or a few bites, so you can enjoy the taste of the holiday food without consuming an excessive amount of sugar.

For the main part of your meal, try to focus on eating foods that are higher in protein. Protein will not spike your blood sugar, and will help to slow down the absorption of the carbohydrates contained in your meal. This helps to avoid hyperglycemia. Fiber also helps to slow down the absorption of carbohydrates, so try to eat whole grains, vegetables, and fruits.

It’s also important to pay attention to how much you’re eating. After a day of fasting, it can be very easy to overeat. In fact, it’s not uncommon to gain weight during Ramadan. This is likely to be partly due to eating sugary foods, so focusing on eating foods rich in protein and fiber will help to avoid weight gain. In addition, although it’s tempting to eat a lot of food very quickly when you’re breaking your fast, it’s better to eat more slowly. This gives your body time to sense the food that you’ve eaten and to produce the hormones that signal that you’ve eaten enough. When you start to feel full, stop eating.

It’s also important to ensure that you’re drinking plenty of fluids at Iftar. During the day, you’ll have become somewhat dehydrated as a result of not drinking, and you’ll need to replenish your fluids to keep your body functioning well. Water is also important for the process of digestion.

Try to take at least two large glasses of water with your meal. If you still feel thirsty, drink more. Take your water slowly throughout the meal, to help your body absorb the fluids. If you don’t enjoy plain water, you can choose flavored water or herbal tea. However, make sure to avoid any beverage that contains sugar, because this will very quickly spike your blood glucose level.

Pre dawn meals during Ramadan for people with diabetes

It’s also important to plan Suhoor, to help keep your blood sugar as even as possible throughout the day. Ideally, try to eat your pre dawn meal as late as you can.

The food choices you make should be similar to those during Iftar. Try to avoid eating sugary foods, or those that contain a lot of refined carbohydrates (starches). This will help to prevent a blood sugar spike and later crash. Focus on eating as much protein as you can, which will help to keep you feeling full for longer and will not spike your blood sugar. In addition, including fiber with your meal will help to slow down the absorption of any carbohydrates and will keep you feeling full for longer.

It can be tempting to eat a huge pre dawn meal, because you know that you won’t be eating for a while. However, this can lead to feeling tired and sluggish during the day. Even if you eat a huge meal at Suhoor, you’ll still get hungry partway through a day of fasting. Instead, it’s best to try to eat a meal that’s a similar size to your normal breakfast. You’ll just be eating it earlier than usual.

It’s also important to include plenty of fluids with your meal, since you won’t be drinking again all day. Try to include at least two glasses of water or another non-sugary beverage with your pre dawn meal, to help ensure that you’re fully hydrated before your daily fast begins. 

Things to watch out for

It’s important to watch out for episodes of low blood sugar during your fasting days. People who are experiencing hypoglycemia often develop symptoms, which may include:

• Shakiness

• Sweating

• Nausea

• Pounding heart or rapid heartbeat

• Fatigue

• Anxiety or irritability

• Difficulty concentrating

• Feeling dizzy or lightheaded

• Confusion

• Difficulty completing routine tasks

• Loss of coordination

• Slurred speech

• Blurred vision or double vision

If you’re experiencing these symptoms, you should check your glucose level right away. For most people with diabetes, hypoglycemia is defined as a blood glucose reading below 70 mg/dL (3.9 mmol/L). However, some people need slightly different blood sugar targets; your care team will let you know what blood sugar reading qualifies as hypoglycemia for you. 

If you use a continuous glucose monitor (CGM), keep in mind that the reading on a CGM is a few minutes behind your actual blood sugar level. Sometimes, you may need to check your blood sugar using a finger prick test to be sure that you’re getting an up-to-date reading. If you’re having symptoms that may indicate hypoglycemia, but your CGM doesn’t show a low glucose level, you may want to check by finger prick to be sure. Your CGM can also detect trends in your glucose levels, so it can alert you when your glucose level is falling. This may allow you to take action to avoid an episode of hypoglycemia.

If your blood sugar is low, then you should consume a small amount of sugar to help bring your glucose level back up into the normal range. It’s important not to overcorrect and cause your blood sugar to rise too high. The general recommendation is to consume 15 to 20 grams of carbohydrates. This equates to three to four glucose tablets or about half a cup of juice. After taking this, wait 15 minutes, and then check your blood sugar again. If it’s still low, consume another 15 to 20 grams of carbohydrates.

Some people with diabetes experience a phenomenon known as “hypoglycemia unawareness.” This means that the body has gotten used to having episodes of low blood sugar, so there may not be any noticeable symptoms until blood sugar becomes extremely low. If you don’t always feel it when your blood sugar dips, then you may need to test your blood sugar more often, particularly while fasting.

Talk with your diabetes care team to make a plan for Ramadan fasting

If you have diabetes, and you’d like to fast during Ramadan, it’s best to talk with your doctor before the fast begins. They will help you to adjust your medications if necessary, and to create an eating plan that will help to keep you safe and healthy throughout the month. If they believe that doing the Ramadan fast would be dangerous for you given your current medical condition, they’ll let you know this.

Our NOVI Magnum clients can stay in touch with their care team through our custom NOVI app, which makes it easy to get advice whenever you need it. They also have the help of a nutritionist, which can be very useful when planning your meals during Ramadan.