Ramadan and Diabetes: Practical Guidelines for Safe Fasting

Ramadan, the month of the Holy Quran, is an important event for Muslims across the globe. During this month, Muslims fast from dawn to dusk to exercise self-control and to inculcate within themselves the value of compassion towards others. The annual observance of Ramadan not only commemorates the Prophet Muhammad (PBUH)’s first revelation, but it is also regarded as one of the Five Pillars of Islam. This year in 2021, Ramadan in Singapore will begin in the evening of Monday, 12 April, and end in the evening of Wednesday 12 May.

During fasting, Muslims refrain from food and drink, tobacco products, sexual relations, and other sinful behaviour. Each day during Ramadan, Muslims eat suhoor, or a pre-dawn meal, before fasting till iftar, or the evening meal to break their daily fast. 

While Muslims are expected to observe fasting to fulfil their religious obligations, those with chronic medical conditions such as diabetes are exempt from fasting. They may instead opt to pay fidyah — a religious donation of money or food to those in need in lieu of fasting. It is only natural, however, for Muslims with diabetes to still wish to observe fasting during Ramadan out of piety. 

Here at Homage, we recognise the sanctity of such pious desires and how important it is to safely affirm and encourage them. We have thus prepared accordingly, some practical guidelines for Muslims with diabetes fast safely during Ramadan. 

Before Fasting

Before you fast, you should: 

1. Know the Risks 
2. Consult a Medical Professional 
3. Conduct a Trial Run 

1. Know the Risks

You should be reminded again that Muslims with chronic medical conditions like diabetes are not obligated to fast, or to make up for the days missed, and may instead pay fidyah. Your decision to fast should also be a fully-informed decision. Here are some risks of fasting with diabetes that you should know before making your decision:  

• Hypoglycaemia, or low blood glucose
• Hyperglycaemia, or high blood glucose 
• Dehydration
• Diabetic ketoacidosis (DKA), or excessive breakdown of fat in people with Type I Diabetes

The risks of such possible complications can only be adequately assessed on a case-by-case, individual level, which is why it is important to consult a medical professional before you decide to fast.

2. Consult a Doctor

Before you decide to fast, you should consult a medical professional. They will be able to help evaluate the severity of your diabetes and after assessing your risk levels, advise you on whether fasting is an appropriate decision to make. 

Ideally, you should be visiting your doctor to discuss fasting at least 6-8 weeks before Ramadan to understand the risks involved for your particular medical situation. This will also provide ample time for you to learn from your doctor: 

• How to fast safely 
• Whether any adjustments to your diabetes medication needs to be made beforehand

Together with your doctor, you should figure out an appropriate dietary plan and medication regime, suitable for your fasting. It is important to also remember that you must not self-adjust or stop medication on your own.

If you are strapped for time or find yourself busy preparing for Ramadan celebrations, you can arrange for a fuss-free and easy consultation with Homage’s doctors online and get started on planning your fasting at your own convenience. 

3. Conduct a Trial Run 

If you have decided to fast, consider conducting a ‘trial run’ of fasting before Ramadan to help identify any issues that you may face during your fasting for Ramandan. You should consult your doctor about this beforehand.

During Fasting

During your fast, you should:

1. Check your blood glucose regularly
2. Adjust your medication accordingly
3. Know when to break fast

1. Check Your Blood Glucose Regularly

You should know that blood glucose monitoring and insulin injections do not invalidate your fast, and are important for managing your diabetes. Your blood glucose levels will tell you if your body is able to handle fasting. Changes in eating habits during Ramadan can affect your blood glucose levels adversely. Therefore, it is crucial to check your blood glucose levels  regularly during your fast. 

If you are at high risk, you should check your blood glucose levels 3-4 times a day

If you are at low risk, you should check your blood glucose levels 1-2 times a day

2. Adjust Your Medication Accordingly

Talk to your doctor about the adjustments that need to be made for the dose, timing, or type of medication to lower your risk of low blood sugar during your fast. It is perfectly fine to consult your doctor as and when you require during the month of Ramadan as well to adjust your medication as needed. 

3. Know When to Break Fast 

Of course, part of observing fasting safely while having diabetes is to know when to break fast. You should break fast under the following conditions: 

• Your blood glucose is lower than 70 mg/dl
  • Check again within one hour if your blood glucose is between 70-90 mg/dl
• Blood glucose is higher than 300 mg/dl (16.6 m mol/L)*
• Symptoms of hypoglycemia, hyperglycemia, dehydration or acute illness occur

The table below shows you the signs you should watch out for specifically during your fast: 

Other than breaking fast, you should also consult a doctor as soon as possible if you find yourself experiencing these symptoms during your fast.

Remember, there is no shame in breaking fast when necessary to keep you healthy and safe. You can always choose to make up for it by paying fidyah if you wish to do so, and even then, there is no obligation for you to do so. If you happen to be on your period, here are same safe guidelines to follow while fasting. 

After Fasting

After your fast, you should: 

1. Break your fast on time and eat moderately 
2. Arrange for a follow-up consultation with your doctor

1. Break Your Fast on Time and Eat Moderately

During Ramadan, you should not delay breaking your fast and consume your iftar, or evening meal, on time. You should also pay attention to your nutritional intake. 

Here are some dietary tips for you to observe during Ramadan:

• Divide your daily caloric intake between suhoor and iftar
• Try to drink 8 glasses of sugar-free fluids between suhoor and iftar
• Don’t skip suhoor
• Ensure your meals are well-balanced, with 45%-50% carbohydrates, 20%-30% protein and less than 35% fat
• Include plenty of fruit, vegetables and salads
• Avoid foods high in saturated fat
• Use less oil while cooking 
• Stay hydrated between your two main meals by drinking water 
• Avoid caffeinated, sweetened drinks and sugary desserts
• Eat low glycaemic index, high fibre foods that release energy slowly before and after fasting, like whole-wheat bread, beans and rice

After Ramadan, you should also avoid eating too much during Eid-ul-Fitr, or “The Festival of Breaking the Fast”, as excessive food consumption can lead to a surge in blood glucose levels. 

2. Arrange for a Follow-up Consultation with Your Doctor

Once Ramadan is over and celebrations have concluded, it may be prudent to consider arranging a follow-up consultation with your doctor just to check-in and readjust your dietary plan and medication regime. This will also allow you to better assess your diabetic condition following your fasting, and your fasting experience during Ramadan. A post-fast reflection with your doctor would be useful for you to understand your body and help you prepare better for next year’s Ramadan.

Now that you know more about what to consider for fasting with diabetes before, during and after Ramadan, you’re better informed about whether you should be fasting during this year’s Ramadan with diabetes. Once again, however, we would like to remind you that fasting during Ramadan with diabetes is not a decision to be taken lightly and you should always consult a doctor before making any decision. 

Homage sincerely wishes everyone a safe and happy fasting experience during Ramadan. 

From Homage with love, Ramadan Mubarak!