Diabetes and Fasting during Ramadan

Diabetics Advised to Take Precautions When Fasting, Doha, 17 July 2011

People with diabetes are advised to take necessary precautions and consult their doctor or diabetes educator before fasting during Ramadan. Dr Ibrahim Mohammed, Senior Consultant Endocrinology/Diabetes at Hamad Medical Corporation, said diabetics who want to fast during the holy month should obtain an early diabetic assessment and advice on treatment and dietary adjustments.

“Most people with type 2 diabetes should be able to fast without much problem but will need some adjustments in their treatment by their doctor,” said Dr Ibrahim. “People with type 1 diabetes can also fast but need pre-Ramadan assessment by their doctor or diabetes nurse educator, and advice on insulin regimen change or dose alteration.”

Diabetes mellitus, one of the most common chronic diseases worldwide, is broadly divided into two types. Type 1 diabetes, which requires insulin treatment at all times, results from autoimmune destruction of insulin-producing beta cells of the pancreas, leading to increased blood glucose. Type 2 diabetes occurs when there is deficiency in insulin or the body does not respond correctly to insulin, and is caused by factors such as family history and genetics, low activity level, unhealthy diet and excess body weight.

Dr. Ibrahim advises diabetics who want to fast to observe the following general precautions during Ramadan:

  • Monitor your blood glucose regularly during the fast, especially in the early days. The acceptable blood sugar range during Ramadan is 100-200 mg/dl.
  • Check your blood sugar before Suhoor (pre-dawn meal), three hours after Suhoor, before Iftar (breaking fast at sunset) and three hours after Iftar. This will help you in adjusting your drug or insulin dose if needed. Checking blood glucose or injecting insulin does not break the fast.
  • Delay your Suhoor meal until the latest time, just before dawn and not at midnight. Break your fast (Iftar) at the earliest time.
  • Limit your intake of fried, fatty or sugary foods (e.g. logaimat, mahalabiya, khanfaroosh, samosa, fried kebabs, threed, machboos, harees). Fill up on starchy foods such as pasta, rice, chapatti and bread as instructed, and include fresh fruits, vegetables, and yoghurt in your meals. Limit the dates (tamor) to two or three pieces.
  • Choose water or sugar-free drinks; when needed, use sweeteners (e.g. Canderel, Sweetex).
    If you experience hypoglycemic symptoms, it is advisable to break the fast and make up for it after Ramadan.
  • Avoid exercise during the day, and take rest when possible to help avoid lowering of blood glucose levels.

“People whose diabetes is controlled by diet and physical activity alone should be able to fast safely. However, food and drink at the break of fast should be carefully planned, using low-calorie drinks, and limiting sweets and fried foods,” Dr. Ibrahim explained. Patients on tablets or insulin, including those with type 2 diabetes, are advised to check with their physician or diabetes educator as to special precautions needed for their medication or insulin.

Type 1 diabetics who have brittle diabetes or those with poor control are advised not to fast, as well as those with low blood sugar (hypoglycemia) unawareness, frequent low and high blood sugar, severe kidney and eye complications, poorly controlled hypertension, or unstable angina, and those prone to frequent diabetic ketoacidosis, as they are at high risk of developing severe complications.

Diabetics who should avoid fasting also include those with poor diabetic control who are non-compliant in terms of following advice and treatment, very elderly patients with type 1 or type 2 diabetes who are on insulin and have any degree of alertness problem, children under the age of puberty, those with learning disabilities, or are acutely ill, or very old and frail, and breastfeeding mothers with type 1 or type 2 diabetes who are on insulin.

All pregnant women who are on insulin, whether they have type 1, type 2, or gestational diabetes, are also advised against fasting, as mild disturbance of blood sugar which occurs with fasting is extremely dangerous to the fetus. “However, pregnant women with gestational diabetes who are well-controlled on diet alone can fast with close follow-up of their diet and blood glucose,” said Dr Ibrahim.

Dr. Ibrahim added that a hotline from the Qatar Diabetes Association will be made available during Ramadan.