Diabetes and Ramadan 2023

Fasting when you’re living with diabetes, especially for long periods, could be dangerous and cause health problems.
If you want to fast during Ramadan, make sure you speak to your healthcare team well before Ramadan starts. You can work together to agree your own personal plan to fast safely.

I have diabetes – how can I fast?

Choosing to fast or not is a very personal decision. For some people with diabetes, fasting can be dangerous or cause problems to your health, especially if you’re using medications that increase your risk of hypoglycaemia, also known as hypos. People can also be exempt from fasting if they:

  • are children (under the age of puberty)
  • are elderly
  • are sick or have a certain health condition
  • have learning difficulties
  • are travelling
  • are pregnant, breastfeeding, or menstruating.

If you’re fasting during Ramadan, getting a vaccine, like the Covid-19 vaccines does not break your fast.

Risks of fasting

If you have diabetes, your risks when fasting will depend on:

  • the type of diabetes you are living with
  • if you are currently keeping your average blood sure level (HbA1c) in a healthy range for you
  • the type of medication you use to manage your diabetes
  • if you take medications that put you at risk of hypos, such as sulphonylureas or insulin
  • if you’re living with diabetes complications such as poor vision, nerve damage, heart or kidney disease.

Speaking to your healthcare team

Meet with your healthcare team such as a GP before the fast. It’s important to discuss a plan so you can fast safely. Not doing so is contrary to the Qur’an, which clearly states that you must not act in a way that harms your body (Al Baqarah Verse: 195). You may discuss:

  • checking your blood sugar levels more often than usual and making sure you have enough test strips to do this
  • what to do if your blood sugar is too low or too high, or if you become unwell
  • adjustments to your diabetes tables, when to take them and if the dose or type needs adjusting when fasting
  • adjustments to your insulin.

Tips for fasting

There are things you can do before and during Ramadan to help you fast safely.

  • Try to fast a couple of days in the month before Ramadan to see if you can fast without complications
  • If your diabetes medications put you at risk of hypos, make sure you have hypo treatments available and always carry them with you
  • Have diabetes identification prepared, such as a medication bracelet, if you choose to wear it or have information about your diabetes medication so you can carry it with you.

Safe blood sugar levels

Test your blood sugar regularly to check your levels are in a healthy range. This will not break your fast.

You will need to break your fast if your blood sugar is too low (less than 4.0mmol/l). Treat the hypo with your preferred sugary food or fluid. This could be glucose or dextrose tablets, a glass of sugary non-diet drink or a small carton of fruit juice, for example.

After treating a hypo, you should eat a snack containing slow-acting carbohydrates such as a piece of fruit, a glass of milk or a slice of wholemeal toast. You may choose to make up your fast later if it is safe to do so.

Before choosing to fast, ask your healthcare team what a high blood sugar level is for you. If you go above that level during fasting, you must break your fast by drinking water and seek medical advice. Call 111 immediately if you cannot reach your healthcare team. If left untreated, high blood sugars can lead to diabetic ketoacidosis (DKA) which requires hospital treatment

Do I need to wake up for Suhoor (Sehri)?

Long hours without eating increases the risk of hypos. It will be easier to balance your blood sugar through your fast if you eat a meal at Suhoor, just before sunrise, rather than at midnight.

What types of food should I eat at Suhoor (Sehri)?

At Suhoor, you should choose higher fibre carbohydrates which release energy slowly, such as multigrain bread, oat-based cereals, basmati rice together with beans, pulses, lentils, fruit and vegetables.

Other foods which will keep your blood sugars more stable include wholemeal pitta bread, chapattis made with wholemeal flour and semolina.

Be aware of portion sizes of the starchy foods and make sure you eat plenty of vegetables too. This extra fibre will keep your blood sugar levels in the healthy range.

What types of food should I eat at Iftar?

Remember to eat sensibly and healthily all year round but also in Ramadan. Eating more fried food high in fat and sugar makes it more difficult to manage your diabetes and lead to weight gain over time. If blood sugars are frequently high, this increases your risk of diabetes complications.

Fried, oily and sugary foods should be eaten less frequently, as a treat and in modest portion sizes to keep your energy levels balanced. Choose higher fibre starchy carbohydrates, pulses, and vegetables.

What types of drinks can I have?

Fasting can put you at risk of dehydration with long hours of fasting. Drink enough sugar-free, uncaffeinated fluids, particularly water at Suhoor and with Iftar.

A glass of unsweetened milk is a healthy option for breaking the fast. Be aware that fruit juices can make your blood sugar levels go up very quickly and so are not the best option.

If you become dehydrated, end the fast immediately and have a drink of water.

Can I pray Taraweeh?

Taraweeh can be a tiring activity and you could become dehydrated or be at risk of hypos. To avoid problems during Taraweeh, make sure you:

  • eat starchy foods with Iftar as they are digested slowly
  • drink enough water following Iftar
  • take a bottle of water and hypo treatment with you to Taraweeh if your diabetes medications put you at risk of hypos.

If you can’t fast

If you’re not able to fast, you can still observe and gain the benefits of Ramadan by offering charity or providing food to the poor. Speak to your local Imam for more information about this.

If you can’t fast this Ramadan, you might be able to make the fast at a later date, perhaps during the winter months