Fasting at Ramadan and Diabetes: Summary

Summary

Diabetes Canada believes that people with diabetes should have the best information available to guide their choices about diabetes management. Knowing the most current research and recommendations will help Muslims with diabetes to avoid risks if they decide to fast during Ramadan.

Background

Fasting from dawn to dusk during Ramadan, including abstaining from water and food, is one of the pillars of Islam and is observed by most Muslims. This requires changes in eating and sleeping habits. During Ramadan, the predawn and sunset meals are different from regular meals and often include more carbohydrate-containing foods that may cause a rapid rise in blood sugar. In addition, individuals tend to consume larger-than-usual portions during these meals, especially at the sunset meal when they break the fast.

Canadians living with diabetes who fast during Ramadan should work with their health-care team to clearly identify key safety issues during Ramadan.

If an individual has blood sugar levels in the target range prior to Ramadan, they are more likely to keep them in the target range during the period of fasting. For individuals with both type 1 and type 2 diabetes, fasting during Ramadan is associated with an increased risk for severe episodes of low blood sugar. However, some people with type 1 diabetes may also have episodes of high blood sugar.

Individuals with diabetes who are otherwise healthy and have stable blood sugar levels may fast safely if they regularly test their blood sugar and check in with their health-care team.

Fasting can be done safely for those who take insulin, if the treatment is individualized and adjusted. Other diabetes medications used by people with type 2 diabetes may need to be adjusted one to three months before Ramadan.

Considerations

Long hours of absolute fasting during the daytime and eating during the night can increase the risk for complications, such as dehydration, low blood sugar (hypoglycemia), and high blood sugar (hyperglycemia) for individuals with diabetes. Muslims living in Muslim-majority countries may have some flexibility in terms of working hours during Ramadan, but these accommodations are less typical in Canada, adding to the challenge of observing fast, especially for those with diabetes.

Recommendations

1. People with diabetes should receive guidance by their health-care provider about changes to diet, blood sugar monitoring, and adjustments of diabetes medications, so they can remain healthy and safe while fasting and beyond Ramadan.

2. Adults with type 1 or type 2 diabetes who intend to fast should receive individualized assessments one to three months before Ramadan to consider if fasting is safe for them and to create individualized management plans.

3. People living with type 2 diabetes, who are taking metformin, GLP-1 receptor agonists, insulin secretagogues or SGLT2 inhibitors before Ramadan should break their fast and seek immediate medical attention if any of these symptoms develop: vomiting, diarrhea, and orthostasis (drop in blood pressure from standing or sitting up quickly).

4. Individuals fasting during Ramadan who use insulin should monitor their blood sugar more often to reduce rates of hypoglycemia.

5. After Ramadan, individuals should follow-up with their health-care provider to review any concerns with diabetes management and to plan a strategy for future fasting.

For people that would like more information, Diabetes Canada’s position statement on People with Types 1 and 2 Diabetes Who Fast During Ramadan gives an overview of the latest evidence about this annual religious tradition as it relates to diabetes.