Do you suffer with diabetes and plan to fast or look after somebody with diabetes who also wishes to fast too? If so then do you know what to do to ensure you stay safe and ensure you stay well?
Fasting is an important spiritual aspect of many religions but it can lead to major health problems for some people with diabetes. If you are showing any symptoms of COVID-19, it’s best not to fast.
You may find the following webinar on Diabetes and Ramadan a useful watch:
Listen to a series of talks done at the British Muslim Heritage Centre in 2019 on Diabetes and Ramadan from experts talking about how to look after yourself or loved one.
Can you fast if you have diabetes?
Yes in some circumstances, but it depends on how healthy you are.
Ultimately, it is a personal choice whether or not to fast. However, if you do choose to fast, then you must consult your doctor or healthcare team, to make sure that you are able to look after yourself properly. We’ve got lots more information about fasting and how to do it safely.
Know your risk before you decide to fast
As per the Holy Quran, there are groups of people who might make themselves ill by fasting. Based on medical and religious advice, it is recommended to visit your doctor 6-8 weeks before Ramadan to understand your risk category before deciding to fast. If your doctor advises not to fast, you will get the same Thawab (reward).
Exemptions to fasting
Anyone who is putting their health at serious risk by fasting is usually exempt (doesn’t have to take part). For example, you won’t usually be expected take part in religious fasting if you treat your diabetes with insulin or have diabetes complications such as damage to your eyes, kidneys or nerves in your hands and feet. Speak to your healthcare team for advice if you aren’t sure if you should fast and your spiritual leader for guidance.
Other groups that usually don’t have to fast include children, the sick, the elderly and pregnant women.
If you have type 1 diabetes, there is also a danger that your blood glucose levels may run too high (known as hyperglycaemia) and result in a build-up of ‘ketones’. This could potentially result in a serious condition known as ketoacidosis. The symptoms of high blood glucose levels might include feeling very thirsty, passing a lot of urine or extreme tiredness. If your blood glucose levels stay high and you experience these symptoms, speak to your healthcare team.
You may find the following table useful for exemptions to fasting:
Getting the BEST from the practice and be prepared for Ramadan
Learn about how we in the practice are supporting patients who have diabetes and see Diabetes Care by clicking here
We recommend that you should have access to your GP electronic health records and get a better understanding of your healthcare needs. Please click here if you have not yet done so.
If you are unsure what to do or would like your medication reviewed for Ramadan then please contact your nurse or doctor.
Controlling your blood sugar levels through Ramadan
- It is advisable to test your blood sugar levels more often than normal through Ramadan.
- Be aware of the symptoms of high and low blood sugar
- Have your testing kit ready if you notice you may be either too high or low on sugar.
- If you are taking blood glucose lowering medication, make sure you have a form of quickly absorbed sugar with you.
- See below for which foods are good options for eating at Iftar (the break of fasting).
Fasting with diabetes complications can lead to that include:
- Low blood glucose (hypoglycaemia)
- High blood glucose (hyperglycaemia)
- Diabetic ketoacidosis (DKA), in people with type 1 diabetes
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.
Available in English, French, Bangla, Arabic, Turkish and Urdu
Medication adjustments during fasting
Talk to your doctor about the adjustments required to the dose, timing or type of medication to reduce the risk of low blood sugar.
It is important to know that measuring your blood glucose and injecting insulin will not break your fast.
When to break the fast?
All people with diabetes should break the fast if:
- Blood glucose is lower than 70 mg/dl (3.9 m mol/L). Re-check within one hour if blood glucose is in the range 70-90 mg/dl (50- 3.9 m mol/L)
- Blood glucose is higher than 300 mg/dl (16.6 m mol/L)*
- If you experience the symptoms of a hypo, such asfeeling shaky, sweaty and disorientated, you must break the fast immediatelyand treat it with your usual hypo treatment, likeglucose tablets, a sugary drink or GlucoGel, followed by a snack such as a sandwich or a bowl of cereal.
Exercising during Ramadan
Perform regular light-to moderate exercise. Rigorous exercise is not recommended during fasting because of the increased risk of low blood glucose and/or dehydration. Physical exertions involved in Tarawih prayers, such as bowing, kneeling and rising, should be considered part of your daily exercise activities.
When the month of Ramadan ends
Avoid over-eating (especially sweets) during Eid-al-Fitr, as it may lead to high blood glucose. Visit your doctor to obtain guidance on changing the medication back to the previous schedule.
Dietary advice for people with diabetes during fasting
COVID-19 and fasting with diabetes
The currently available data shows that people who fast do not report higher rates of infections or hospitalisation. There is therefore no evidence that fasting could lead to reduced immunity and higher risk for infection.
However, people with diabetes and complications, such as renal impairment or foot problems, are at high risker of infections. It is therefore important that they follow medical advice and do not fast to avoid increasing their risk of contracting COVID-19.
Fasting and managing diabetes during Ramadan factsheets
Download our factsheets about fasting and managing your diabetes during Ramadan, developed in partnership with the Muslim Council of Britain’s Diabetes Advisory Group:
- Fasting and managing your diabetes during Ramadan: English(PDF, 576KB)
- Fasting and managing your diabetes during Ramadan: Arabic(PDF, 125KB)
- Fasting and managing your diabetes during Ramadan: Bengali(PDF, 143KB)
- Fasting and managing your diabetes during Ramadan Urdu(PDF, 91KB)
If you are an Imam and would like more information on advising people with diabetes during Ramadan, download our short guidance document(PDF, 65KB).
- Speak to your healthcare team if you are planning to fast.
- If you test your blood glucose levels at home check your levels more often.
- Continue a varied and balanced diet.
- Include more slowly absorbed foods that have a lower glycaemic index.
- Try not to have too many sugary and fatty foods.
- When you break the fast, ensure you drink plenty of sugar-free and decaffeinated drinks to avoid dehydration.
Web resources for professionals helping to manage patients with diabetes who wish to fast
- BMJ: Management of people with diabetes wanting to fast during Ramadan
- Managing diabetes during the Muslim fasting month of Ramadan
- Diabetes and Ramadan: Practical Guidelines(17.7MB – International Diabetes Federation in collaboration with the Diabetes and Ramadan International Alliance)
Diabetes and Ramadan: Practical Guidelines (17.7MB – International Diabetes Federation in collaboration with the Diabetes and Ramadan International Alliance)
Learn about the Women’s CHAI Project (based in Oldham)
Care, Help And Inspire
Download the free book “Chapatti & Chat – Food made with love” developed with the support of Oldham Council to help raise awareness and creatively educate in the prevention of diabetes in adults from South Asian communities
Please note these are patients’ own views of their diabetes. You should always consult with your own doctor or nurse when determining the best course of action for your own diabetes but this may help patients to understand based on their experience.
with thanks to Dr Jawad Haq (ST2 GP trainee 2022) who helped to contribute to this webpage