News & Events

Ramadan Fasting and Diabetes

If you are diabetic, review the below general guidelines for fasting during Ramadan, you should always consult your physician before starting to fast or implementing a change in treatment.

Diabetes and fasting

If you are diabetic, you should meet with your physician before starting to fast to assess if your health condition status for fasting or if you need to modify your therapeutic plan. In general, some diabetics may be advised to not fast for fear of complications, including those with Type 1 Diabetes, and those with Type 2 Diabetes who have significant hyperglycemia and hypoglycemia or other significant diabetes complications or comorbidities. Also, fasting is not recommended for pregnant and lactating women.

Diet for diabetics during fasting

• Maintain the quality and quantity of food daily as specified by the nutritionist.
• Divide the amount of food specified daily into two main moderate meals that are Iftar and Suhoor in addition to a light meal in between.
• It is advised to delay Suhoor until just before dawn. (imsak)
• Do not consume a lot of beverages and foods that contain a large amount of simple sugars (table sugar) or saturated fat.

Therapeutic approach

1. If you are treated by diet alone, there is no need for a major diet change apart from what is mentioned above since the possibility of hypoglycemia is very low.
2. If you are being treated with oral hypoglycemic agents, such as the drug metformin or the drug Acarbose, the same guidelines will apply to you as for diabetics that are treated by diet alone. It is not a must to make a change in the dosage of the drug since they usually do not cause hypoglycemia.
3.  If you are treated with Sulphonylurea including Glipizied, Glimepiride, and Glibenclamide, you must make the following changes:
   • The usual morning dose is to be taken after sunset, preferably 15 minutes before Iftar.
   • The usual evening dose is to be reduced by half and taken 15 minutes before Suhoor.

4. If you are on oral hypoglycemic agents like Linagliptin, you do not need to make a change since it does not usually cause hypoglycemia. You can take the tablet just before Iftar.

5. If you are being treated with insulin, you need to discuss how to manage that with your physician, but a general approach for the adjustment needed is as follows:
   • If you are on one daily dose of intermediate or long acting insulin, you can take your dose before Iftar.
   • If you are on two daily injections of premix insulin, you can take the usual morning dose before starting your Iftar, after sunset and half the usual evening dose before Suhoor.
   • If you are on four daily injections, you must discuss the treatment needed with your physician.

As a diabetic, you are advised to break your fast if you have the following conditions:

1. In case of documented hypoglycemia or symptoms of hypoglycemia.
2. If you have Type 1 Diabetes, and your blood sugar is more than 250 mg/dl with the appearance of ketones in the urine or blood analysis, you are advised to break your fast and seek medical assistance
3. If you have Type 2 Diabetes, and your blood sugar level is more than 300 mg/dl with symptoms of excessive urination, you are advised to break your fast and seek medical assistance.
4. If you develop dehydration or other conditions such as fever or diarrhea, then you should break your fast and drink a lot of water and also seek medical assistance.

If you are exercising, you should do it three hours after Iftar and not while you are fasting. If you are faced with unexpected findings related to any adjustment done in your treatment during fasting, discuss it with your physician.