Fasting during the month of Ramadan is one of the five pillars of Islam and is obligatory for all Muslims.
Before Ramadan starts it is important that you seek advice from either your GP or Nurse on how to manage your diabetes including changes to your medication during this time.
Useful points to remember when fasting with Diabetes:
- Islam states that anyone who would be putting their health at serious risk by fasting are exempt i.e. people with diabetes. If you cannot fast, you can make up the fasts by offering charity according to Islamic practice.
- If you experience a hypo you will need to be prepared to break your fast. (A hypo is a blood glucose level of less than 4mmol/l)
- Blood glucose monitoring does not break your fast. So make sure you regularly test your blood glucose to keep safe.
There may be a risk of hypoglycaemia (where the blood glucose levels fall to less than 4 mmol/l) you could also experience high blood glucose levels during this time, which could lead to health problems in the short and long term.
What to Watch out For
The human body enters a fasting state after 8 hours of not consuming food. At this point, the body will start to use its stored sources of glucose to try and regulate blood glucose levels. This can be challenging for patients with diabetes and more so for patients who are having trouble managing their diabetes.
If you’re fasting with diabetes, watch out for:
- Hypoglycaemia (low blood glucose)
- Hyperglycaemia (high blood glucose)
- Dehydration and thrombosis (formation of blood clots in the blood vessels)
Staying Safe whilst Fasting
Here are some ways you can stay safe whilst fasting:
- Speak to your GP or diabetes team as early as possible. They’ll be able to tell you if it’s safe to fast, and advise you on any changes you need to make to your medication.
- Test your blood glucose levels regularly, it does not break your fast and is permissible during Ramadan.
- Eating a meal at Suhoor, just before sunrise. The long hours without eating can increase your risk of experiencing a hypo. Eating at the last permissible time will help keep your blood glucose levels more balances.
- Drinking plenty of (sugar-free) fluids, particularly water, at Suhoor and after Iftar.
Fasting and Insulin
If you choose to fast and use insulin, it is important to remember the following:
- You should never stop your insulin
- You will need to alter your regime
- Regularly monitor your blood glucose levels
- If you have a hypo you must break your fast
If you are on a basal bolus insulin regimen
(e.g. background insulin either once or twice a day and, quick acting insulin with meals)
- You may need to make alterations to your insulin. For example; the dose of background long acting insulin and the timing and amount of quick acting insulin in relation to meals may need to be altered.
If you use pre-mixed insulin
(e.g. Novomix 30, Humulin M3, Humalog Mix 25 or Humalog Mix 50)
- You will need to seek advice from your GP or Nurse on how to alter the doses and timings of your insulin.
- You may need to change to a different insulin regimen during Ramadan.
Fasting when taking Metformin
If you take just one dose of metformin tablets in the morning;
- You can continue with the same dose during Ramadan
- But the tablet should be taken at the time of breaking your fast in the evening with your main meal.
If you take twice daily doses;
- Continue to take these two tablets during Ramadan
- But you may need to change the time you take them and the quantity. For further advice talk to your GP or Nurse.
If you take tablets three times a day;
- You should speak to your GP or Nurse as the dose and the timings of the tablets will have to be adjusted.
Whether you’ve been recently diagnosed or you’ve had diabetes for years, we’re here to help with information about your condition and the best way to manage it to stay healthy, happy and active.
When Should You Not Fast or Break Your Fast
You should try to avoid fasting, or break your fast, if you experience any of the following:
- Your blood sugar level falls to, or below, 3.3mmol/l at any time of the fast
- Your blood sugar levels is at 3.9mmol/l at the start of your fast and your are taking insulin or sulfonylureas (e.g. gliclazide)
- Your blood sugar level is higher than 16.7mmol/l
- If you start to feel dehydrated: increased thirst, dry mouth, headache, dizziness, it’s best to stop fasting and have a drink of water
- If you start to feel unwell, disorientated, confused or if your faint, it’s best to stop fasting, have a drink of water and check your blood glucose levels
How to Manage Hypos
A hypo, or hypoglycaemia, is when your blood glucose levels fall below normal (less than 4.0mmol/l). People will often experience hypos differently, but some common signs to watch out for are:
- Trembling and Shaking
- Going Pale
- Heart Palpitations
- Feeling Dizzy
You should treat a hypo immediately with one of the following:
- Three blood glucose or dextrose tablets
- Five (halal) jelly sweets
- A small glass (150-200ml) of sugary (non-diet) drink
- A small carton (150-200ml) of pure fruit juice
- A tube of glucose gel
After 10 minutes, check your blood glucose levels again and if it’s still below 4.0mmol/l, repeat one of the above treatments.
After a hypo, it’s best to eat 15-20g of a slower-acting carbohydrate to stop your glucose levels going down again. You could try:
- A sandwich
- Piece of fruit
- Bowl of cereal
- Glass of milk
Food choices during Ramadan
During Ramadan your eating patterns are different to normal. It’s important to eat a balanced diet, include foods from all the food groups and to be sensible with portion sizes.
Some dietary suggestions are:
- Fibre rich foods which are digested slowly, such as: bran, cereals, whole wheat, grains and seeds, potatoes with the skin on and vegetables such as green beans and most fruits including apricots, prunes, figs
- Wholegrain carbohydrates foods at Suhoor to try to reduce hunger and keep blood glucose levels more stable during the fast; such as wholegrain bread with seeds, porridge, semolina, bran flakes
- Avoid processed foods, and foods with refined carbohydrates (white sugar, white flour)
- Limit sugary foods, replace with fresh fruit
- Avoid fried foods, try baking or grilling foods instead
- Reduce your salt intake
Whilst you are fasting, exercise will increase the risk of hypos, especially if you’re managing your diabetes with insulin and sulfonylureas. Exercise can also increase the risk of dehydration, especially if you’re on SGLT-2 inhibitors and diuretics.
The Taraweeh prayers that take place during Ramandan can involve exercise, this could increase your risk of hypos and dehydration. Make sure you:
- Carry a glucose treatment and water with you
- Eat your evening meal before going to Taraweeh prayers
- Include starchy carbohydrate foods in your meal to prevent low blood sugar levels
How your Pharmacist can help:
At LloydsPharmacy, we are rolling out a new toolkit to help our pharmacists understand more about Ramadan and fasting when you have diabetes. Visit your local LloydsPharmacy to find out how they can help and support you in managing your diabetes during the month of Ramadan.