Should Diabetics Fast During Ramadan?

| May 19, 2017

Next week, at sunset on 26th May, more than a billion Muslims across the world will start to celebrate the holy month of Ramadan – a central feature of which is fasting each day from sunrise to sunset. But, if you are Muslim and have diabetes, should you fast, and if so, what precautions should you take?

People with diabetes may be unable to keep their blood sugar levels stable during fasting, particularly if they are injecting insulin or taking medication. And with Ramadan currently falling in early summer in the Northern Hemisphere, fasts here can be very long – up to 18 hours a day.

The main risks are hypos (low blood sugar episodes) during fasting, too-high blood sugar following meals before and after the daily fast, and dehydration. There is also a danger of diabetic ketoacidosis for those on insulin medication.

The Muslim Council of Britain recognises the problems that people with diabetes face during Ramadan. They advise that if you have diabetes you are exempted from fasting, and that if you do choose to fast it should be a personal decision made with the help of your diabetes team.

Official advice is not to fast if you need to inject insulin (or use an insulin pump), if you are a woman who has diabetes and is pregnant, if your blood sugar levels are poorly controlled or if you have complications, such as foot ulcers or kidney damage.

Despite this advice, Muslims with diabetes may feel guilty about not fasting during Ramadan, or may come under pressure from family members.1 A survey of 13 Muslim countries found 43 per cent of people with type 1 diabetes and 79 per cent of those with type 2 fasted during Ramadan.2 So, what can you do to make fasting safer, if you decide to go ahead with it?

  • Talk to your doctor or diabetes care team before you start fasting. If you are taking medication, your dosage may need to be adjusted. It is very important to get individual, personalised advice.
  • Monitor your blood glucose frequently, especially if you inject insulin or use an insulin pump – a recent review found that most insulin-dependent diabetics can fast safely, given the right training and support.3
  • If your blood sugar is going too low, you must break your fast and have something to eat. Always carry your blood sugar testing kit and “emergency rations”.
  • Eat a healthy, low GL diet and don’t be tempted to overload on carbs at the evening meal. In the morning, include high-protein foods, fats and slow-release carbs to keep you going during the day.
  • Get as much sleep as you can – an afternoon nap is highly recommended. And you will sleep better at night if your evening meal isn’t too heavy.
  • Drink plenty of water during the non-fasting period and look out for signs of dehydration during the day – such as feeling weak or confused, dizziness, nausea, headache and a fast heartbeat. Dehydration can be very dangerous, so be prepared to break your fast and drink.

There is further advice here on fasting during Ramadan if you have diabetes.

If you have gestational diabetes, you are advised not to fast. Now, scientists have found that this condition can be detected early and that, if you have it, compounds in green tea could help, as I explain in my next blog post.

Wishing you the best of health,

Martin Hum
PhD DHD Nutritionist
for Real Diabetes Truth

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Bear in mind we are not addressing anyone’s personal situation and you should rely on this for informational purposes only. Please consult with your own physician before acting on any recommendations contained herein.


1. Patel NR, Kennedy A, Blickem C, Rogers A, Reeves D, Chew-Graham C. Having diabetes and having to fast: a qualitative study of British Muslims with diabetes. Health Expectations. 2015; 18(5):1698-1708.

2. Salti I, Bénard E, Detournay B et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004; 27(10):2306-2311.

3. Alabbood MH, Ho KW, Simons MR. The effect of Ramadan fasting on glycaemic control in insulin dependent diabetic patients: A literature review. Diabetes Metab Syndr. 2017; 11(1):83-87.

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