Published · Bahria Diabetes Center
In short
- See your doctor 6 to 8 weeks before Ramadan. The doses and timings of diabetes medicines usually need to change.
- Break the fast at once if your sugar is below 70 mg/dL or above 300 mg/dL, or if you feel unwell.
- People at high risk — for example after a severe hypo in the three months before Ramadan — are advised not to fast.
- Eat sehri as late as possible, drink plenty of water between iftar and sehri, and keep fried food and sweet sharbat for once in a while.
Who can fast, and who shouldn't
Islam exempts people who are ill from fasting, and many people with diabetes fast anyway. The International Diabetes Federation and the Diabetes and Ramadan International Alliance (IDF-DAR) wrote their 2021 guidelines to make that as safe as possible.
The guidelines sort people into low, moderate and high risk using a score built from the type and duration of diabetes, the medicines, how well it is controlled, past hypos, complications such as kidney disease, recent illness, and how well the person can manage on their own.
People in the high-risk group are advised not to fast. That includes anyone who has had a severe hypo in the three months before Ramadan, has repeated hypos, or no longer feels the warning signs of a hypo. Pregnant women with diabetes need individual advice before deciding.
Before Ramadan: the pre-Ramadan visit
Start planning six to eight weeks before the first fast, and no later than twelve. At this visit your doctor works out your risk, checks your HbA1c and kidney function, and adjusts your medicines — the dose and the time of day.
Some changes are predictable. Glibenclamide, an older sulphonylurea, is best avoided in Ramadan in favour of newer ones such as gliclazide. Insulin is continued with its doses changed, not stopped. Don't make these changes yourself: the right dose depends on your own readings.
During Ramadan: when to break the fast
- Your sugar is below 70 mg/dL (3.9 mmol/L).
- Your sugar is above 300 mg/dL (16.7 mmol/L).
- You have symptoms of a hypo, of very high sugar or of dehydration — or you fall ill.
Check your sugar more often than usual: before sehri, during the day, before iftar, and whenever you feel unwell. Your doctor will tell you how often. If you worry about testing while fasting, ask a scholar you trust — but the medical guidance relies on these checks to keep you safe.
Sehri and iftar
- Eat sehri as late as possible, not at midnight.
- Open the fast with water and a date or two, then eat a normal meal rather than a feast.
- Keep pakoras, samosas and sweet sharbat for once in a while; sugary drinks send glucose up fast.
- Drink plenty of water between iftar and sehri.
Taraweeh counts as exercise. Heavy exercise during the fasting hours raises the risk of hypos and dehydration, so walk after iftar instead.
Common questions
- Can people on insulin fast?
- Some can, safely, but the doses need changing before Ramadan and many people on insulin are in the higher-risk groups. This is exactly what the pre-Ramadan visit is for.
- What should I do if I have a hypo while fasting?
- Break the fast and treat it straight away: 15 g of fast sugar — 3 teaspoons of sugar in water — then check again after 15 minutes. Tell your doctor, because the plan needs changing.
- Can I just take my tablets at iftar and sehri instead?
- Often, but not always in the same doses — some tablets move to iftar, some are reduced at sehri, and some are swapped for others. Ask before Ramadan rather than rearranging them yourself.
- My sugar is well controlled. Do I still need the pre-Ramadan visit?
- Yes. Good control helps, but your risk also depends on your medicines, past hypos and complications, and only an assessment can place you in a risk group. Whatever the group, break the fast if your sugar falls below 70 or rises above 300 mg/dL.
Sources
- Hassanein M, et al. Diabetes and Ramadan: practical guidelines 2021. Diabetes Res Clin Pract 2022;185:109185. doi.org/10.1016/j.diabres.2021.109185
- Shaikh S, Latheef A, Razi SM, Khan SA, Sahay R, Kalra S. Diabetes management during Ramadan. In: Endotext. South Dartmouth (MA): MDText.com; updated 18 May 2022. www.ncbi.nlm.nih.gov/books/NBK581875/
- American Diabetes Association Professional Practice Committee. 6. Glycemic goals, hypoglycemia, and hyperglycemic crises: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1):S132–S149. doi.org/10.2337/dc26-S006