—Dr Md Asifur Rahman—

Ramadan, the ninth month of the Islamic lunar calendar, is a period of fasting, prayer, reflection, and community for Muslims worldwide. From dawn (sehri) to sunset (iftar), Muslims abstain from food and drink, embodying discipline and spiritual devotion. For individuals with diabetes, this fasting period presents unique challenges that require careful planning and management to maintain health and wellbeing.

Fasting during Ramadan can significantly influence blood glucose levels, leading to potential risks such as hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), dehydration, and diabetic ketoacidosis (DKA). The abrupt changes in meal timing and frequency necessitate adjustments in diabetes management strategies to ensure safety and effective glycemic control.

The International Diabetes Federation (IDF) and the Diabetes and Ramadan (DAR) International Alliance have developed guidelines to classify individuals with diabetes into risk categories.

High risks are individuals with poorly controlled diabetes, history of severe hypoglycemia, DKA, or those with comorbid conditions are generally advised against fasting.

Moderate to low risks are individuals with well-controlled diabetes and no significant complications may fast under medical supervision and with appropriate adjustments to their management plan.

Fasting alters the body’s metabolism, necessitating modifications to diabetes medications to prevent hypoglycemia and hyperglycemia. Adjustments may include reducing basal insulin doses by 10-20% during fasting days and modifying the timing and dosage of rapid-acting insulin to align with Sehri and Iftar meals. Continuous glucose monitoring can aid in fine-tuning insulin therapy.

Medications such as sulfonylureas, which increase insulin secretion, may require dose reductions or timing adjustments to minimize hypoglycemia risk. Newer agents like DPP-4 inhibitors may be preferred due to their lower hypoglycemia risk profiles.

Diet plays a pivotal role in managing diabetes during Ramadan. During sehri (pre-dawn meal) consuming a balanced meal rich in complex carbohydrates, fibre, and protein can provide sustained energy release and help maintain blood glucose levels. Foods like whole grains, legumes, vegetables, and lean proteins are recommended.

During iftar (evening meal) breaking the fast with dates and water is traditional and provides a quick source of energy. Following this with a balanced meal that includes vegetables, lean protein, and whole grains helps in gradual glucose absorption. Adequate fluid intake between Iftar and Sehri is essential to prevent dehydration. Limiting caffeinated and sugary beverages is advisable.

Maintaining physical activity during Ramadan is important but should be approached with caution. Engaging in light to moderate exercise, such as walking, is best done after Iftar to reduce the risk of hypoglycemia. High-intensity workouts are generally discouraged during fasting hours.

Regular blood glucose monitoring is vital to ensure safe fasting. Checking blood glucose levels multiple times, a day, especially before and after meals, helps in timely identification of hypo- or hyperglycemia. It’s important to note that blood glucose testing does not break the fast and should be performed as needed. Certain situations necessitate breaking the fast to prevent serious health risks. Blood glucose levels below 70mg/dL (3.9mmol/L) require immediate consumption of fast-acting carbohydrates. Symptoms like dizziness, confusion, or significant illness warrant cessation of fasting.

Healthcare professionals play a crucial role in supporting individuals with diabetes during Ramadan. Providing culturally sensitive education on diabetes management, meal planning, and physical activity. Developing personalized management strategies that consider the patient’s health status, preferences, and religious practices. Collaborating with religious and community leaders to disseminate information and support to the broader Muslim community.

Advancements in technology offer additional support. Continuous Glucose Monitors (CGMs) provide real-time glucose readings, aiding in proactive management. Virtual consultations can offer timely advice and adjustments to care plans during Ramadan.

Fasting during Ramadan is a deeply personal and spiritual practice. For individuals with diabetes, it requires meticulous planning and collaboration with healthcare providers to ensure safety and wellbeing. Through pre-Ramadan assessments, individualized care plans, and ongoing support, people with diabetes can observe Ramadan while effectively managing their health.

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Dr Md Asifur Rahman MBBS, MPH, is a Health Manager, Eminence Associates for Social Development.