Tayside Diabetes MCN Handbook
Diabetes and Ramadan


What is Ramadan?


Ramadan is one of the pillars of Islam.  It is a time when Muslims fast during the hours of daylight and a time for spiritual reflection, prayer, doing good deeds and spending time with family and friends.


When is Ramadan?

  • The ninth month of the Islamic Calendar.
  • The Islamic calendar year begins with the sighting of the new moon
  • It starts about 11 days earlier each year in the western calendar
  • To find out when Ramadan is each year contact the Muslim Information Service on 0141 574 4700, info@misonline.info .


When can people eat and drink during Ramadan?

  • Muslims can eat or drink as long as the sun has set
  • It is common to have one meal (known as suhur or sehn) just before sunrise and another (known as itaar) directly after sunset.
  • No water is allowed during the day – nothing can be taken orally, even medication or for example eye drops.


Diabetes and Fasting


There are a number of exemptions from fasting:

  • Children under the age of puberty
  • People with learning difficulties
  • Elderly people
  • Travellers journeying more than 50 miles
  • Menstruating, pregnant or nursing women
  • The acutely unwell
  • Those with chronic illnesses for whom fasting may be detrimental to health.  People with diabetes fall into this last category, but may prefer to meet their religious obligations by fasting.


Those Who Should Not Fast

  • Type 1 or type 2 patients with poor glycaemic control
  • Individuals known to be non-compliant with diet or medication
  • Patients with a history of recurrent DKA
  • Pregnant women
  • Patients with intercurrent infections
  • Patients with renal impairment of any severity (risk of dehydration and uraemia)
  • Elderly patients with reduced alertness
  • Those who have previously experienced severe deterioration in glycaemic control during Ramadan

These patients can find it difficult for social and religious reasons not to fast.  It is therefore important to

  • Reassure them that they are not contravening the Islamic Law as they are exempt because of health reasons
  • Highlight that the maintenance of good health is imperative in Islam even during Ramadan
  • Inform them that religious leaders have strongly advised that those with health conditions seek professional medical advice and comply with this before fasting.


 Hazards of Fasting


The alteration of eating pattern without appropriate adjustment to the dosage and timing of insulin and/or oral medication may result in deterioration of glycaemic control. Insulin or sulphonylurea-treated patients run the risk of hypoglycaemia and some type 1 patients may risk DKA. When Ramadan occurs during the summer months prolonged fasting may create greater potential hazards. It is important therefore to discuss the management of hypo and hyperglycaemia. Patients must be advised to break their fast if there is severe deterioration in glycaemic control. It may be necessary to prescribe Hypostop (glucose gel) and/or Glucagon.


Precautions For Those Who Fast


The importance of continued compliance with dietary recommendations should be emphasized. Breaking the fast after sunset is not an excuse for over eating. Healthy eating guidelines should be followed - foods high in sugar and fats should be avoided. Regular meals/snacks with complex carbohydrate/starchy foods should be eaten.

Patients need to monitor blood glucose with adjustment of medication as needed.

Patients who are treated with diet alone should not experience any problems with fasting during Ramadan.


Patients On Oral Medication


Patients taking Metformin alone are at no risk of hypoglycaemia and fasting poses little hazard. If a dose is usually taken at lunchtime it can be taken with the sunset meal.

Patients on a once-daily agent such as Glimepiride with breakfast, should be advised to take it with the sunset meal.

Patients taking a sulphonylurea should use a short acting agent i.e. Gliclazide and the morning and evening doses reversed during the fast. Long acting agents such as Glibenclamide are hazardous and should be avoided.


Patients On Insulin


There should be no need for a drastic reduction in the total dose of insulin. Many patients are insulin resistant and will still require large doses.

Many patients normally use premixed insulin (Mixtard, Humulin, Humalog Mix). It is advisable to reverse the morning and evening dose, if the doses are the same, the morning dose should be reduced by about 50% and a corresponding larger dose taken before the sunset meal.

Patients who are on a basal bolus regime should reverse their bedtime intermediate acting insulin (Insulatard, Humulin I) to the pre-dawn meal and then take their short acting insulin (Actrapid, Humulin S, Novorapid, Humalog) before each meal taken. Further adjustment to insulin dosages are likely to be needed after these initial suggestions have been instituted.

The Diabetes Care Team can be contacted for advice regarding specific management.