Ramadan and Diabetes

If you have diabetes and want to observe Ramadan fasting, we recommend that you talk it over with your doctor a month or two before Ramadan begins.

For the estimated 1.1 to 1.5 billion Muslims around the word, the observance of Ramadan is an important religious ritual. However, doing so carries some risk for diabetics. Certain precautions should be taken.

What is Ramadan?

Ramadan, one of the five pillars of Islam, is a holy month requiring the observance of strict fasting from sunrise to sunset. Ramadan is the ninth month of the Muslim calendar, which is lunar based. Consequently, the month of Ramadan changes each year on the Western calendar, as do the number of hours of fasting, which depend on the length of the day.

People with diabetes are exempt from fasting

According to the Quran, diabetes is one of the situations that exempt a person from fasting because of the risks involved. Fasting is not recommended for people with diabetes. Nevertheless, the decision to fast or not during Ramadan remains a personal choice.

Fasting and diabetes: a risky combination

The main risks associated with fasting are: hypoglycemia, hyperglycemia, diabetic ketoacidosis (the presence of ketones in the blood) and dehydration.

Diabetics being treated with insulin or insulin secretagogues* are especially at risk. Likewise are people with poorly controlled glycemia (blood sugar levels), people with frequent hypoglycemic episodes and/or a severe hypoglycemia episode in the preceding three months, and people who no longer feel the symptoms of hypoglycemia. The presence of diabetes complications or an acute illness, as well as some specific situations (e.g., someone’s physical job), also increase the risks associated with fasting.

*Gliclazide (Diamicron® and Diamicron MR®), Glimepiride (Amaryl®), Glyburide (Diabeta®), Repaglinide (GlucoNorm®).

To fast safely, it is essential to plan it with your doctor.

Points to review with your doctor

  • Your general state of health
  • Your diabetes control
  • The risks of fasting
  • Your medication
  • Blood-sugar monitoring

Maintaining healthy lifestyle habits

On top of daily fasting, Ramadan drastically alters your lifestyle habits, especially the link between eating and bedtime. Such changes greatly affect how you manage the disease, so consider the following advice:

When you break the fast

  • Eat your meals at the same times each day
  • Avoid continuous snacking
  • Eat balanced meals
  • Drink lots of water
  • For Sahour (the meal before sunrise), eat foods that contain slowly absorbed carbohydrates (harira, semolina, beans, bread, rice, dhal)
  • For Iftar (the meal that breaks the fast after sundown), start with quickly absorbed carbohydrates (fruit, dates), followed by foods containing slowly absorbed carbohydrates.

At all times

  • Avoid high-intensity physical activity or exercise
  • Monitor your blood sugar frequently
  • If a problem arises, consult a doctor

Abandoning the fast

A diabetic who decides to observe Ramadan fasting must recognize that certain situations might force him/her to stop fasting. Such a situation is the occurrence of hypoglycemia (blood sugar below 4.0 mmol/L) or significant hyperglycemia (blood sugar above 16.5 mol/L).

For an Arabic version of the text, click here.

Research and text: Diabetes Québec Team of Dietitians

May 2016 (updated on August 2018)

©All rights reserved Diabetes Quebec

References:

Al-Arouj et al., “Recommendations for Management of Diabetes During Ramadan,” Diabetes Care (vol, 28, p. 2305-2311), 2015

International Diabetes Federation, Diabetes and Ramadan: Practical Guidelines, April 2016: http://www.idf.org/sites/default/files/IDF-DAR-Practical-Guidelines-Final-Low.pdf

Sievenpiper J, Chan C, Dworatzek P et al. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Nutrition Therapy. Can J Diabetes 2018; 42 (Suppl 1): S64-S79.