Preparing to fast safely during Ramadan

If you’re taking insulin or medications that can cause low blood glucose levels, fasting can be very high risk and cause problems to your health. You may be at risk of:

•  hypoglycaemia “hypo” for short (low blood glucose levels)
• hyperglycaemia (high blood glucose levels)
• diabetic ketoacidosis
• dehydration
• blood clots.

Did you know?

The Holy Quran states that certain groups of people do not have to fast, especially if it puts their health at risk. This includes people who are living with diabetes.

“Those among you, who witness it, let him fast therein. Whoever is sick or on a journey, then a number of other days. God desires ease for you, and desires not hardship…” (Al-Quaran, 2:185).

If you’re not able to fast, you can complete your duties by offering charity or providing food to those less fortunate. You may speak to your Iman for more information about this.

We understand your commitment

Many diabetes health professionals respect and acknowledge that you have a commitment to fasting and may choose to fast even though you have diabetes. Your diabetes health care team which can include a diabetes educator (nurse), endocrinologist, dietitian and GP, have a ‘duty of care’ to make sure that you are safe; they may advise against fasting, especially if you have been having lots of hypos recently. If you are fit and well, they will want to work with you to make this Ramadan safe and enjoyable.

How can my diabetes team help me fast safely this Ramadan?  

If you are fasting during Ramadan, speak with your diabetes health care team about how best to manage your diabetes. It's a good idea to tell your team about any difficulties experienced in previous fasts and how you coped with them. Your diabetes educator (nurse), endocrinologist and/or GP will be able to advise on any adjustment of medication that may be required to enable you to fast safely.

In order to make Ramadan an enjoyable and safe experience, here are some important tips:

If you are on insulin or medications that can cause hypos, check your blood glucose (sugar) levels often.

• Check your blood glucose levels every 4 to 6 hours during the day and night. This will not break your fast.
• Check your blood glucose level if you feel unwell at any time during the fast.

Always carry hypo treatment and manage hypos quickly!

• Always carry hypo treatment with you 
• If your blood glucose level is less than 4.0mmol/L, end the fast and treat the low blood glucose level. 
• If your blood glucose level is less than 4.0mmol/L at the start of the fast and you are on insulin or medication that can lower your blood glucose level, do not start the fast and follow these steps to treat your hypo: 
  • STEP 1 – most important! 
    • Have some fast-acting carbohydrate right away, an example of this is: 6–7 jelly beans OR ½ can of soft drink (not diet) OR 3 teaspoons of sugar or honey OR ½ glass of fruit juice.
    • Re-check your blood glucose level in 15 minutes. If your blood glucose level is above 4.0mmol/L. go to step 2. If your blood glucose level is still below 4.0mmol/L, repeat step 1. 
  • STEP 2 
    • If your next meal is more than 20 minutes away, eat some longer acting carbohydrate. Examples are: A slice of bread OR 1 glass of milk or soy milk OR 1 piece of fruit OR 2–3 pieces of dried apricots or other dried fruit OR 1 tub natural low-fat yoghurt.  

Act quickly if blood glucose (sugar) levels are high 

• If your blood glucose level is above 15mmol/L, end the fast right away and drink plenty of water. Your body can become dehydrated very quickly as blood glucose levels rise. Contact your diabetes educator (nurse), endocrinologist and or GP for advice.  
• If you have type 1 diabetes, check for ketones.
• This may become a medical emergency, so don’t leave it too late to stop the fast and ask for help- if you are feeling too unwell to care for yourself call 000. 
• Important: If you are using insulin, never stop taking your insulin. It is important to speak with your diabetes educator (nurse), endocrinologist and or GP as you may need to change the time and dose of your insulin during Ramadan. 

Consider reducing exercise or physical activity during Ramadan 

• Avoid being too active e.g. going to the gym, running, housework or gardening as you risk having a hypo or becoming dehydrated. 
• Tarawih uses a lot of energy just like going to the gym does. Make sure you take a bottle of water and hypo treatment with you. You may need to consider reducing the dose of your insulin during this time or eat more long lasting carbohydrate foods such as lentils or couscous.

Please note: This information has been created as a guide and should never replace visiting your diabetes health care team.

Guidelines for health professionals

The International Diabetes Federation and Diabetes and Ramadan International Alliance have created practical guidelines to help people manage their diabetes during Ramadan. The guidelines, designed for health professionals, provide relevant background information and practical recommendations: diabetesresearchclinicalpractice.com/article/S0168-8227(21)00545-3/fulltext

Other helpful resources: 

• Diabetes and Ramadan: Practical guidelines (International Diabetes Federation) 
• Healthy eating tips for Ramadan (Diabetes Victoria) 
• Diabetes and Fasting (NDSS)

Ramadan Mubarak!