RAMADAN: Information For people living with diabetes
Ramadan Mubarak
Fasting during Ramadan is amongst the five pillars of Islam, and is considered a religious obligation by the Muslim population. Depending upon which summer month Ramadan falls, each fasting period can last up to 22 hours. Muslims will abstain from all food and drink (including water) during daylight hours (dawn to sunset) and eat only two meals per day.
There are approximately 2.7 million Muslims in the UK, with a large proportion living with diabetes. Many of these people may find it difficult to know how to best manage their health during the fasting.
This page provides some key information for people living with diabetes in preparation for Ramadan. However, If you are unsure about fasting please seek advice from your local diabetes team
Exemptions to fasting
Living with diabetes means that you may not be required to fast, particularly when you:
Use diabetes medication.
Live with a diabetes related complication(s) (eye problems, kidney problems or nerve problems).
Have an HbA1c (average glucose level over 12 weeks) that is out your target range.
If you have any of the following health conditions & circumstances you are also not required to fast:
Under the age of puberty.
Elderly or frail.
Unwell or living with a mental health condition.
Living with learning difficulties.
Traveling long distances.
Pregnant, breastfeeding or menstruating.
Preparing for Ramadan
Preparing for fasting can support you to have a safer Ramadan.
To enhance your preparation it is recommended that you contact your GP practice two months before Ramadan.
To have a safer Ramadan, consider whether:
You will fast this year
Your medication or insulin/ doses will need to be changed
You will make some changes to your food choices.
Physical activity will affect your diabetes during Ramadan.
Risks
It is important for you to be aware of the following risks that can occur during Ramadan:
Hypoglycaemia (low blood glucose levels)
Hyperglycaemia (high blood glucose levels)
Severe hyperglycaemia (e.g. Diabetic Ketoacidosis)
Information on each of the above risks and other risk are provided in more detail at within this resource and as well as Diabetes UK.
Glucose Monitoring
Remember: blood glucose monitoring does not break the fast.
It is important that you know how to check your blood glucose levels.
During fasting you should check your blood glucose levels regularly.
Breaking the fast
Please STOP your fast if you experience any of the following:
Blood glucose level below 4.0 mmol/L.
Blood glucose level above 16.6mmol/L.
Symptoms of hypoglycaemia, hyperglycaemia, dehydration or acute illness.
Remember: If a fast is broken please drink plenty of non-sugary, caffeine free drinks. Please, also promptly contact your local diabetes team or GP.
Diet
It is important for you to have a balanced diet during Ramadan, with daily calories split between the two meals:
Suhoor - the meal before dawn (beginning of the fast).
Iftar - the meal at sunset (at the end of the fast).
During Ramadan your diet should be similar to what it will be for the remainder of the year.
Often the type or amount of food eaten changes during the month of Ramadan which can affect your blood glucose levels and weight.
It is important for you to make diet choices which minimise the effect on your blood glucose levels and weight.
Top tips:
Avoid drinks containing sugar, grains and caffeine.
Drink plenty of water and non-sweetened beverages in order to stay hydrated, particularly at the start of Iftar.
Take 1-2 dried or fresh dates at Iftar to safely raise blood glucose levels.
Physical activity
Being active or inactive will have an effect on your blood glucose levels and weight.
During fasting physical activity increases your risk of hypos, especially if you are on treatment with insulin or Sulphonylureas (e.g. Gliclazide).
Physical activity also increases your risk of dehydration, especially if you are on treatment with an SGLT-2 inhibitor (e.g. Dapagliflozin, Canagliflozin, and Empagliflozin).
Light to moderate exercise is encouraged during Ramadan.
Excessive or strenuous exercise should be avoided.
The ‘Taraweeh’ (night prayer) can be part of your physical activity regime.
Top Tips:
Regular blood glucose monitoring should occur during exercise.
Carry water and hypo treatment during exercise (e.g. Glucose tablets 4-5).
Consider being physically active after eating.
Smoking
Remember: If you smoke then you must stop during the fasting period (including Vaping, Shisha and any form of tobacco consumption).
Smoking increases your risk of heart disease when living with diabetes.
Ramadan provides an opportunity for you to give up smoking.
Please seek support from your General Practitioner, who can direct you to local stop smoking services.
For further information on stopping smoking:
Please click on the following link: https://www.nhs.uk/live-well/quit-smoking/nhs-stop-smoking-services-help-you-quit/
Diabetes Medications
Remember: Insulin has no nutritional value so it will not break the fast.
It is important that you speak to your local diabetes team prior to the start of Ramadan.
This is because your diabetes medication may need to be changed in order to reduce the risk of your blood glucose levels going too low or too high.
If you have Type 2 Diabetes and are on insulin, your local diabetes team may instruct you to stop your insulin during Ramadan in order to reduce your risk of hypoglycaemia.
If you have Type 1 Diabetes, you should never stop insulin.
Post Ramadan Advice
Eid ul-Fitr:
Post fast 3 day festival to mark the end of Ramadan.
Please be aware of the risk that over indulgence has on causing hyperglycaemia.
Post-Ramadan debriefing:
It is important for you to have a follow-up with your local diabetes team once Ramadan has finished in order to:
Consider medication readjustments.
Discuss about your health and wellbeing during the fasting period.
Create an action plan in order for you to cope better with future fasts.
Remember: Your ability to fast should be discussed and assessed with a healthcare professional annually, two months before Ramadan.
