Ramadan – Fasting and Diabetes

Ramadan is based on the ninth month of the lunar calendar, so this year it is expected that the fast of Ramadan will commence at the sunset on 19th July 2012 and will last for 29 or 30 days.

During this month it is expected that Muslims who participate will abstain from food, water, beverages, smoking, oral drugs and sexual intercourse from sunrise to sunset. Ramadan moves forward each year by about 11 days which means the length of fasting is greater at certain times of year than others. The length of fasting has special consequences for people with diabetes, especially those taking insulin and the risk of complications increases with longer periods of fasting.  

People with diabetes who fast during Ramadan can have acute complications, such as hypoglycaemia, hyperglycaemia, diabetic ketoacidosis and dehydration, most of which are as a result of a reduction of food and fluid intake.

There are no evidence-based guidelines for safe fasting so people have to rely on expert advice from doctors and their personal experiences. However, a recent study in people with Type 1 and Type 2 diabetes carried out in Pakistan, has shown that with active glucose monitoring, alteration of drug dosage and timing, dietary counselling and patient education, the majority of patients did not have any serious acute complications during Ramadan. [Diab. Med. 29, 709-715 (2012)  

Two educational sessions were given to patients, one about drug dosage and timing and one about dietary and lifestyle modifications. Patients were asked to test their blood glucose levels twice daily for at least 15 fasting days with one test being during the fasting period. Following these education sessions and the advice given the researchers found that the majority of people did not have any serious acute complications – none developed diabetic ketoacidosis and the highest frequency of hypo- and hyperglycaemia occurred before dawn.

The findings of this and other studies suggest that people with Type 1 and Type 2 diabetes should have an assessment before Ramadan with their diabetes team about drug/insulin adjustments, exercise and awareness of the risks of hypo- and hyperglycaemia.