03 May Diabetes in Ramadan: “Can I Fast in Ramadan with Diabetes?” Guidelines for Fasting In Patients with Diabetes
“Can I Fast in Ramadan with Diabetes?” Guidelines for Fasting In Patients with Diabetes
Summary! Your ability to fast in Ramadan is highly individual and depends upon many factors. This article discusses these factors as well as presents other considerations when deciding whether or not to fast during Ramadan.
Factors to consider before making the decision to fast during Ramadan:
- The type of diabetes you have been diagnosed with (type 1 versus type 2 diabetes)
- Your medical history (the particulars of your diagnosis and any other medical conditions)
- Your history of diabetes management (eg. through lifestyle interventions, exercise and healthy eating)
- Your willingness & ability to proactively manage your diabetes in Ramadan (eg. self-monitoring of glucose levels, managing complications, maintaining a healthy food diet during Ramadan, exercise.)
Type 1 versus Type 2 Diabetes in Ramadan
Patients with type 1 versus type 2 diabetes may experience different challenges in determining if they are able to fast.
Type 2 diabetes: A patient’s ability to fast depends greatly upon their management, lifestyle, and medical history. In the most optimistic case for a well-managed patient with a normal BMI who maintains a healthy lifestyle and relies on medical counsel, “Ramadan fasting would be acceptable for patients with well-balanced type 2 diabetes who are conscious of their disease and compliant with their diet and drug intake.” (7)
Patients with type 2 diabetes are most at-risk for hypoglycaemia. Each patient must individually consult with their doctor to inquire whether medication adjustment is possible to allow them to fast. See the next sections in this article for guidelines on what to ask your doctor to determine if you are able to fast, and how to safely manage your diabetes while fasting.
Type 1 diabetes: Managing type 1 diabetes in Ramadan poses greater risks:
- Due to the high risk of hypoglycemia, hyperglycemia, and diabetic ketoacidosis, individuals with Type 1 diabetes may find fasting challenging, especially those with poor diabetes control and comorbidities. (6)
Patients with well-managed type 1 diabetes may still consult with their doctor to inquire as to their fasting capabilities. See the next sections in this article for guidelines on what to ask your doctor to determine if you are able to fast, and how to safely manage your diabetes while fasting.
All patients with type 1 and type 2 diabetes are encouraged to assess their level of risk with their doctor before deciding to fast in Ramadan:
Current research guidelines categorise patients with diabetes based on their level of risk when fasting in Ramadan. Low-risk patients may be more likely to be able to fast safely, whereas high-risk patients may be advised to abstain from fasting.
Table 1. Risk Stratification in Patients With Diabetes Who Fast During Ramadan. Note. Reprinted [adapted] from “Management of people with diabetes wanting to fast during Ramadan,” by E. Hui et al. Hui et al., 2010, BMJ, 340, 1407. Copyright 2017 by “BMJ”.
6. Benaji, B., Mounib, N., Roky, R., Aadil, N., Houti, I. E., Moussamih, S., … & El Ghomari, H. (2006). Diabetes and Ramadan: review of the literature. Diabetes research and clinical practice, 73(2), 117-125.
7. Hui, E., Bravis, V., Hassanein, M., Hanif, W., Malik, R., Chowdhury, T. A., … & Devendra, D. (2010). Management of people with diabetes wanting to fast during Ramadan. Bmj, 340(22), 3053-3053.