Fasting during the holy month of Ramadan is an important spiritual practice.  When you have diabetes, you may be wondering how fasting will affect your diabetes.  There is a lot of misinformation about diabetes and Ramadan.  
 

Does everyone have to fast?

No.  This is based on the Holy Quran as well as the teachings of Islamic religious scholars over centuries. The Quran states that there are groups of people who do not have to fast, especially if it puts their health at risk.  This includes children, pregnant or breastfeeding women, the elderly and anyone who might make themselves ill by fasting.  This also includes people who may be struggling with their glucose management, women who are pregnant, people with type 1 diabetes who take insulin or type 2 on a mixed insulin regimen or those who often have erratic glucose levels.  
 

I know many people with diabetes who fast and don’t have a problem.  Is it okay for me?

It is true, many people with diabetes can fast safely, but each person is different.   Part of the decision you will make with your healthcare provider has to do with the kind of diabetes medications you need to manage your glucose levels.   It is important to schedule an appointment 2-3 months before Ramadan to discuss how fasting might affect your diabetes.  Your healthcare provider may suggest a change in your medication plan. 

What risks should I be aware of?

These are the key risks:

• Low glucose (or hypoglycemia) – The risk of glucose levels going too low is highest in people taking insulin or certain diabetes pills. Limit physical activity during fasting hours and be more active after sunset. Talk with your healthcare provider to find out if your medicine puts you at risk for la ow glucose and discuss how to prevent it.  
• High glucose (or hyperglycemia) – While low glucose levels may happen during the day after the fast is broken, there is a greater risk to overeat. Watch out for eating too many sweets and keep the portion sizes moderate.   Even though Ramadan is known as a time of fasting – it is not uncommon for people to gain weight during this month, as in some families, every evening meal is a celebration. 
• Dehydration – This is especially a problem during the longer and hotter summer days. Aim to drink water, plain seltzer, sugar-free and caffeine-free drinks frequently throughout the evening and before dawn. 

I was told to not monitor my glucose during the day as it will break the fast. Is that true?

Monitoring your glucose level will not break a fast!   It is important to monitor glucose levels especially to identify a low or high glucose level.  A fast will have to be ended if glucose levels fall too low (below 70 mg/dl) as you will need to treat the low glucose level.

How is low glucose treated?

If glucose levels do fall below 70 you may need to eat some quick-acting glucose in the form of glucose tablets. General recommendations are to eat approximately 15 grams of carbohydrate: 4 glucose tablets, 6 oz regular soda, 4 oz fruit juice or 1 tube glucose gel.  Wait 15 minutes and recheck again.  Follow with a snack if the evening meal is not for more than an hour.  

Do I stop taking medicine during Ramadan?

No.  You should continue taking your diabetes medicine, but you will take it at different times.  Your dose may also change.    This is one reason why it is very important to talk with your healthcare provider before Ramadan so you can plan ahead for how your diabetes medicines may need to change.

How do I plan my meals since I’m only eating twice a day?

The dawn meal (Suhoor) should contain a balance of whole grain sources of starchy carbohydrates as well as some protein and fat to help slow the digestion and help the feeling of fullness last as long as possible into the day.   Healthy breakfast options for Ramadan include: 

• Whole-grain cereal, low-fat milk, cottage cheese with sliced peaches topped with toasted almonds
• Plain Greek Yogurt flavored with blueberries and cinnamon, whole wheat toast with nut butter.
• Foul (a hearty middle eastern breakfast dish made of lentils or fava beans), a small serving of sliced fruit
• Whole wheat roti (unleavened bread) and egg khagina (a southeast Asian dish)

Traditionally the fast is broken (Iftar) after sunset and begins with the eating of dates and drinking water.  Limit dates to 1-2 each evening.  Drink plenty of water and sugar-free beverages though out the evening. 

While the Iftar meal is a celebration time, aim to not overeat.  Discuss a plan with your dietitian.  Keep sensible portions in mind and follow the same guidelines for healthy eating that you do the rest of the year with an emphasis on whole grains, lean sources of meat, fish and poultry, small amounts of heart-healthy fats and limit added sugars.