Ramadan and diabetes management

Can I fast during Ramadan, if I have Diabetes?

Yes, more than 80% of people with diabetes can successfully keep Ramadan fast. Read further the importance of Ramadan fasting with diabetes and must follow guidelines to practice safe fast.

In addition to highlighting the potential risks, this section will provide recommendations on how to manage diabetes during this holy month of Ramadan.

Fasting during Ramadan

It is estimated that there are more than 1.3 billion Muslims worldwide, comprising 18–25% of the world population. Most of them keep fasting during Ramadan, which is an obligatory duty for all healthy adults.

Depending on the geographical location and season, the duration of the daily fast may range from a few to more than 16 hours.

Individuals who fast during Ramadan must abstain from eating, drinking, use of oral medications, and smoking from predawn to after sunset; however, there are no restrictions on food or fluid intake between sunset and dawn. 

In individuals without diabetes, there is a delicate balance between body insulin and counterregulatory hormones that help maintain glucose concentrations in the physiological range. 

  • Insulin secretion in healthy individuals is stimulated with feeding, which promotes the storage of glucose in the liver and muscle as glycogen.
  • In contrast, during fasting, circulating glucose levels tend to fall, leading to decreased secretion of insulin. 
  • The low levels of circulating insulin allow increased fatty acid release from adipocytes.
  • Oxidation of fatty acids generates ketones that can be used as fuel by skeletal and cardiac muscle, liver, kidney, and adipose tissue, thus sparing glucose for continued utilization by the brain and erythrocytes.

However, fasting might lead to harmful consequences for the individual – especially in individuals with diabetes or associated chronic metabolic disorder.

Must read l Health tips for healthier and Happier Ramadan

Ramadan and Diabetes

Absolutely, patients with diabetes may place them at high risk for various complications if the pattern and amount of their meal and fluid intake are markedly altered during long fasting.

  • In patients with diabetes, insulin secretion is disturbed by the underlying pathophysiology and often by medications for insulin secretion.
  • In patients with type 1 diabetes, glucagon secretion may fail to increase appropriately in response to hypoglycemia. Epinephrine secretion is also defective in some patients with type 1 diabetes due to a combination of autonomic neuropathy and defects associated with recurrent hypoglycemia.
  • Patients with type 2 diabetes may suffer similar perturbations in response to a prolonged fast; however, ketoacidosis is uncommon, and the severity of hyperglycemia depends on the extent of insulin resistance and/or deficiency.
  • In patients with severe insulin deficiency, a prolonged fast in the absence of adequate insulin can lead to excessive glycogen breakdown and increased gluconeogenesis and ketogenesis, leading to hyperglycemia and ketoacidosis. 

Changes occur in daily routine

  • Sleep cycle disturbance.
  • Changes in eating patterns
  • Less physical activity
  • Stress due to Diabetes
  • Change in doses & time schedule of drugs.

These changes can create metabolic disturbances in our bodies. They could be;

  • Inadequate insulin and/or oral drugs can increase blood glucose.
  • Long-time hunger state may increase the risk of low sugar attack.
  • Less water intake may cause dehydration, which increases the risk of clot formation in blood vessels.
  • Hyperglycaemia & Dehydration may precipitate Diabetic Ketoacidosis in Type1 Diabetes and can increase the risk of Hyperosmolar Hyperglycaemic State in elderly people with T2DM.

Ramadan and management of diabetes

Thus, every person should Consult their Doctor 1-2 months before Ramadan, and discuss the changes in medications. Extra precautions should be taken for…

  • Elderly People with diabetes
  • People with a long duration of DM
  • Those taking high doses of insulin and/or multiple doses of oral drugs
  • People with uncontrolled Blood Pressure, poor heart pumping (Heart Failure), associated Heart, Kidney, Brain disease, etc.
  • Those having Hypoglycaemia Unawareness
  • Those with a recent history of hospitalization, Acute Heart Attack, Paralysis attack, Kidney Failure or someone who underwent major surgery etc.
  • People who have had a recent episode of Severe Hypoglycaemia or Ketoacidosis, etc.

Nowadays, there are many oral glucose-lowering drugs and newer insulins available, which give effective control of diabetes with less risk of hypoglycemia. Your Doctor may shift you on these safer drugs before you start Ramadan fast.

People with diabetes should take certain precautions to practice safe Ramadan fast.

  • Adjust your medication by consulting your doctor.
  • The doctor may shift your morning dose of medicines to evening (Iftar). The evening doses of medicines may need to be reduced and shifted at Sehri (Suhur) time.
  • Regular Sugar check-up by glucometer is a must for all people with diabetes, who are taking medicines.
  • Blood glucose monitoring doesn’t break your Roza. 7-times blood glucose testing is recommended by IDF guidelines, the frequency of testing can be individualized under the guidance of the treating doctor.
  • You should also check your glucose, whenever you have symptoms of high or low sugars.
Source: International Diabetes Federation

Who to avoid fast during Ramadan, if you have diabetes?

  • If your sugar is too much uncontrolled.
  • If you have severe complications of diabetes.
  • During Pregnancy
  • In old age having comorbidities

When to break the fast?

As per the Global IDF guidelines (2021), if your blood sugar goes below 70 mg/dl or above 300 mg/dl during Roza, you should break the fast and consult your doctor immediately.

Must read l Have you experienced Hypoglycemia ever?

Final Words

Due to the metabolic nature of the condition, people with diabetes are at particular risk of complications from marked changes in food and liquid intake (1).

It is therefore important that the decision about whether to fast is made on an individual basis in consultation with a healthcare provider, taking into account the severity of illness and the level of risk involved. 

  • Consult your doctor before planning for Ramadan fast.
  • Check associated co-morbidities and get your risk assessment done.
  • Adjust appropriate medications & their doses.
  • Monitor blood glucose regularly during Ramadan.
  • Take tips for healthy diet during festival.