Fasting During Ramadan: Managing Diabetes Safely

On February 28, the Muslim fasting period, Ramadan, started this year. For 30 days, there is no eating or drinking between sunrise and sunset.

However, blood sugar can quickly plummet. What this means for Muslim people with diabetes.

Qur’an: “He who is harmed by fasting is free”

Anyone who is physically harmed by fasting is exempt from it, according to Qur’an interpreters. This applies not only to many chronically ill people, but also to pregnant women.

ramadan safe fasting

In Germany, for example, around 180,000 Muslims live with a diabetes diagnosis. However, type 1 diabetics, women with gestational diabetes or people with type 1 diabetes, poorly controlled blood sugar or diabetic complications such as kidney or heart problems are threatened with dangerous consequences when fasting.

Type 1 diabetics are particularly at risk

The long duration of the meal breaks is particularly problematic. For type 1 diabetes, but also for poorly controlled type 2 diabetes, the following applies: “The risk of severe hypoglycaemia during Ramadan is almost five times higher than in the rest of the year,” warns diabetologist Dr. Alain Barakat, deputy chairman of the Diabetes and Migration Working Group.

In such cases, doctors advise against fasting. “Nevertheless, many decide to do so – which is understandable for religious and social reasons,” explains Professor Dr. Ina Danquah, Chairwoman of the Diabetes and Migration Working Group of the German Diabetes Society.

“If you still want to fast, you should only do so under close medical supervision and with continuous glucose monitoring,” advises Barakat. The intake of medication must also be adapted to the changed eating habits and discussed with the doctor. Patients with an insulin pump have a lower risk of severe hypoglycaemia.

Sugar spikes when breaking fast

People with type 2 diabetes can fast as long as their levels are well controlled, their health risk is low, and they keep a close eye on their metabolism. “Nevertheless, the risk of hyperglycaemia and hypoglycaemia increases significantly,” explains Danquah. “Especially after iftar, the breaking of the fast, blood sugar can rise sharply if many sweet or fatty foods are consumed.”

To avoid this, diabetics should eat as few simple carbohydrates as possible (such as sweets or white flour products) when breaking the fast and make sure they eat balanced meals with whole grain products, legumes, vegetables and lean protein.

Bread, potatoes and rice as well as sweet baklava or sweetened drinks should only be consumed in small quantities. This would also make it easier to adapt medication because they produce fewer blood sugar spikes.

Important tips for fasting with diabetes

Diabetics who still want to fast can take the following tips to heart:

  • Adapt therapy: Four to six weeks before Ramadan, diabetes therapy should be checked and adjusted by a doctor.
  • Measure blood sugar regularly: Control is important throughout the day and helps to avoid hypoglycemia and hyperglycaemia.
  • In case of hypoglycemia and hyperglycaemia, act immediately: If the blood sugar drops below 70 mg/dl or symptoms such as tremors or dizziness occur, the fast should be interrupted immediately. The same applies to frequent urination, fatigue, confusion, nausea and a blood sugar increase to over 300 mg/dl.
  • Pay attention to fluid balance: The risk of dehydration is particularly high in warm regions. Plenty of water or unsweetened tea after sunset will help to meet fluid needs.
  • Consciously design meals: Suhoor (the meal before sunrise) should contain long-filling, fiber-rich foods such as oatmeal or whole grains. When it comes to iftar, foods rich in fat and sugar should be avoided.

Ramadan & Fasting in the UAE

In the UAE, people with diabetes who wish to fast during Ramadan have access to medical guidance, community support, and healthcare services to help manage their condition safely. The country’s hospitals, clinics, and government health authorities actively educate and support diabetics during Ramadan.

Medical Support and Guidelines

  • Government Awareness Campaigns: Organizations like the Dubai Health Authority (DHA) and Abu Dhabi Department of Health run awareness campaigns on fasting with diabetes.
  • Free Health Screenings: Many clinics and hospitals offer pre-Ramadan check-ups and guidance on whether a person with diabetes should fast.
  • Medication Adjustments: UAE doctors provide tailored advice on adjusting insulin or oral diabetes medications to accommodate fasting schedules.

Workplace & Legal Consideration

  • Shorter Working Hours: By law, working hours are reduced during Ramadan, which helps diabetics manage their energy levels.
  • Exemption from Fasting: Islam allows individuals with medical conditions, including diabetes, to skip fasting if it poses a health risk. The UAE upholds this religious exemption, and diabetics can opt to pay Fidya (feeding a needy person per missed fast) instead.

Diabetes – Friendly Iftar & Suhoor in the UAE

  • Healthy Options Available: Restaurants, hotels, and Ramadan tents often provide diabetes-friendly meal options, such as sugar-free desserts and balanced meals.
  • Home Delivery: Many meal services cater to people with diabetes, offering low-glycemic and well-balanced Iftar and Suhoor meals.