Fasting during the sacred month of Ramadan is considered obligatory for all healthy muslims after puberty. Some people who are suffering from chronic diseases or are weak and have a chance of deteriorating their health during fasting are exempted. For example people suffering from diabetes, heart disease, pregnancy.

As people have to abstain from all eatables and liquids for many hours, at some places even 18 hours, even a medically fit person may have problems. Diabetes mellitus is a major hinderance in following Ramadan in true essence because fasting during Ramadan can cause many complications.

Complications of fasting in a diabetic-

Here are some common problems that a diabetic patient can face while fasting-

1. Fluctuation in blood glucose level- Both hypoglycemia and hyperglycemia may occur.
   1. Hypoglycemia may occur in a person who eats less, misses a meal especially suhur meal and continues to take his medicine as earlier.
   2. Hyperglycemia may occur if a person eats more specially sugary foods and skips taking medicine.
2. Dehydration and thrombosis- Dehydration occurs if fluid intake is not sufficient specially in hot and humid climate and if a person is involved in laborious task. This increases the clotting factors in blood and the risk of thrombosis (clot formation in blood vessels).
3. Diabetic ketoacidosis- This may be a problem in type 1 Diabetes and Type 2 diabetic person on insulin, specially if glycemic levels were grossly uncontrolled before fasting.

All these complications can cause symptoms like headache, dizziness, fatigue, tiredness, disorientation.

Still many people with diabetes chose to fast. Decision for fasting is personal and should be made only after consultation with your doctor. If you adopt proper measures and carefully follow these guidelines, then even with Diabetes, you will be able to observe fasting healthily.

Here are some tips about ideal management of Diabetes during fasting in Ramadan month.

Before Fasting 

It has been recommended that you should consult your doctor at least 6- 8 weeks before the beginning of fasting. This is important so that you can be evaluated for your glycemic status ( controlled or not), severity of illness and other complications like kidney disease.

Based on these, your doctor may inform you whether you may or may not fast. You should not fast if you have type 1 Diabetes mellitus, type 2 diabetes mellitus on insulin, grossly uncontrolled glycemic status or kidney disease.

Please do not fast if your doctor advises so.

If your doctor gives you a go ahead for fasting, then get the dose, timing and type of your medication adjusted for fasting.

During Fast

During fasting, there is a change in eating habit. So your glucose levels may fluctuate.

1. You need to check your blood sugar frequently. As per International Diabetes Federation-
   1. People with very high risk, should check blood sugar at least 3-4 times a day.
   2. People with moderate-low risk should check it 1-2times a day.
2. Medication- Take your medicine adjusted by your doctor for fasting. Do not skip medicines or insulin in the fear of breaking fast. These will not break your fast.
3. Diet- Follow these rules-
   1. Divide daily calories between Suhur and Iftar and 1-2 snacks.
   2. Take a well balanced meal including plenty of vegetables, salads and fruits. Prefer high fibre foods.
   3. Low intake of saturated fat like samosa, pakora, ghee.
   4. Take plenty of fluids during non fasting hours. Take at least 8-10 glasses of water and non sweetened beverages. Avoid sugary drinks, caffeine and desserts.
4. Exercise- Light to moderate exercise should be continued regularly. Even activities involved in Tarawih prayers like bowing, kneeling and rising are considered a part of daily exercise.
5. Break your fast if
   1. Blood sugar is <70mg/dl or >300mg/dl. If blood sugar is between 70-90mg/dl, then recheck it in 1-2 hours.
   2. You experience symptoms of hypoglycemia ( like tremors, sweating, palpitations, hunger, dizziness, confusion), symptoms of hyperglycemia (high blood sugar) , dehydration (dizziness, confusion) or acute illness like fever, pain, vomitings, etc.

After Fasting

1. Do not delay berbuka (breaking of fast).
2. Avoid overeating especially sugary food or sweets.
3. Visit your doctor for re-adjustment of your medicines.

Due to ongoing COVID-19 pandemic, also take these precautions-

1. Avoid gathering in groups for prayers.
2. Maintain social distancing (Distance of at least 6 feet) from people with whom you don’t live.
3. Do not shake hands hug others.
4. Use a mask if it is essential to go out of your home.

Stay home, Stay safe.

ALL THE BEST!!