Ramadan and type 2 diabetes

A practical guide and tips for Muslims who are considering fasting for Ramadan, and who have type 2 diabetes.

February, 2018

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Recent figures suggest that there are around 325,000 Muslims in the UK who have diabetes (types 1 and 2). As a Muslim with type 2 diabetes it is important to understand the health issues that are associated with fasting, so that you can make an informed decision while still observing your faith. This article will cover some of the health issues around fasting when you have Type 2 diabetes, and offers practical tips and advice to help you stay well throughout Ramadan and beyond. For more detailed information, you can download the booklet ‘Ramadan & Type 2 diabetes’ here.


What’s the issue with fasting?

When you have type 2 diabetes, your blood glucose (sugar) is too high. So you are aiming, through diet and medication, to keep your blood glucose at a steady, acceptable level during the day and night. This involves eating smaller, healthier meals more often, and taking your medication as advised.

However, during Ramadan, restricting food and water during daylight hours may mean that you are causing very large dips in your blood glucose during the day, and then when you break your fast at night, you will be causing massive spikes. Both of these are dangerous levels, and can cause serious health issues. That is without the added complication of medication. If your medication is designed to lower your blood glucose, but it is already too low because you are not eating, then it could drop to dangerous levels. And equally, if you have chosen not to take your medication during daylight hours, and then eat a large meal at sundown, then you could cause your blood glucose to rise dangerously.

So, choosing to fast, or not to fast, is a very serious issue, and needs to be planned well in advance of Ramadan.


Talk to your doctor or nurse

You should always get advice from your diabetes doctor or nurse before deciding whether or not to fast. They are experts in diabetes, and have your best interests at heart. It’s really important to be honest with your medical team, so that they can make the most accurate assessment of your state of health and whether fasting would be dangerous for you or not. You may be worried that if you talk to them they will advise you not to fast, and so it would be better to keep your plans secret. But it is much better that you discuss it openly and honestly, so that if you do decide to fast, you can be prepared and are aware of what to look out for. The Quran says that our bodies are an amanah, so we have a duty to take care of our health from a religious point of view.The important thing is to have this discussion in plenty of time before Ramadan so that together you can discuss your needs and decide on a plan for you during Ramadan.


Deciding whether to fast or not

You need to be fit and well to fast

While type 2 diabetes is a chronic and potentially serious health condition, if you look after your health you might feel perfectly well for much of the time, and not consider yourself an ‘ill person’. It can be tough to work out whether you qualify for exemption from fasting for this reason or not. Bear in mind that if fasting (including not taking your medication) would cause you to fall ill, it should probably be avoided from a health point of view.


Reasons for not fasting – you are ill, or might become ill if you fast

The Quran makes it clear that if fasting will damage your health then it should be avoided, in verse 184, chapter 2:

“So whoever among you is ill or on a journey – then an equal number of days [are to be made up]. And upon those who are able [to fast, but with hardship] – a ransom [as substitute] of feeding a poor person [each day]. And whoever volunteers excess – it is better for him.” (Sahih International interpretation)

A large study in 2004 of over 12,000 people across 13 countries found that there was a high rate of medical complications in people with diabetes who fasted during Ramadan, so becoming ill during fasting is a very real possibility. Only your doctor or nurse can help you make the decision that is best for you.


You can take part in other ways

Remember that fasting can be carried out another time if your health improves. Or if you doctor or nurse advises that you shouldn’t fast, the Quran makes provision for people who can’t fast “without hardship” – Fidyah can be given instead. This charitable gift is intended to provide enough food for two meals for one person or one meal for two people. It amounts to around £5 per day – although this is only a rough figure and might change for different areas. It may help to discuss your healthcare team’s recommendation with your religious leader so that they understand your medical reasons for not fasting, and can help you carry out Fidyah.


Fasting – if you decide to go ahead

Talk to your doctor or nurse before you start

As mentioned earlier, it’s important to have a discussion with your diabetes doctor or nurse well in advance of Ramadan. That way you can work with your medical team to come up with a plan for how you will manage your diabetes during Ramadan if you do choose to fast after all. This could include things like:

  • exercise, including taraweeh prayers
  • coping with heat
  • meal planning
  • glucose monitoring
  • dose and timing of any medications you may take

Plan your medications with your team

When talking about Ramadan with your diabetes doctor or nurse, be sure be open and honest about which medications you currently take, so they can advise you properly. There are a number of important factors that they will need to take into account. Remember that they may not be familiar with the observances of Ramadan, so you should carefully explain what fasting entails, in terms of food, drink and also your medication. They may need to help you carefully plan when to take your medication, to comply with your faith, but also to ensure your blood glucose doesn’t fall or become raised to dangerous levels. It is generally accepted that injecting insulin, and monitoring blood glucose (via finger prick) does not break the fast.

It’s not a good idea to change the time you take a regular medicine or the dose, without speaking to a healthcare professional. You should not stop taking any medicines without your doctor’s knowledge.


Remember the calendar

For a number of years, Ramadan has taken place over British summer and will move backwards to spring in the coming decade. This means that the hours of darkness are extremely short: at midsummer (around 21st June) there can be as much as 16-17 hours of daylight every day, meaning that fasting is particularly difficult – especially for people with type 2 diabetes who are trying to keep a steady blood glucose level. The decision to fast in winter, with only 8 hours of daylight, is a much less risky choice for people with type 2 diabetes. So perhaps this is a safer option, and one which allows you to observe your faith, and avoid getting ill.

Continue to check your blood sugar

If you have a blood glucose meter, you should carry on using it throughout the fasting period to keep an eye on how your body is doing. If your blood sugar drops to 4 mmol/L or below, you are hypoglycaemic and you will need to break your fast.

Pricking your finger to test your blood glucose has no nutritional value, and does not mean you have broken your fast. If you don’t currently use one, it may be worth discussing this as an option with your medical team.


Take care with taraweeh prayers

Taraweeh prayers can be quite strenuous and may last for up to 2 hours, so they can really take their toll on your energy levels and your health. These extended prayer sessions could affect your body like any other exercise movement, so stay hydrated, and if you monitor your blood glucose check it beforehand and afterwards.

As with any exercise, if you start to feel dizzy, faint or unwell in any way you should stop until you feel better.


Stay cool and keep hydrated

Even in the UK, we can have unseasonably warm weather in the spring and early summer. Going for long periods without water, especially when the weather is warm, can make you dehydrated and unwell. The signs of heat exhaustion are similar to the signs of unstable blood glucose, so if in doubt it might be a good idea to check your blood sugar levels (if you have a monitor), or speak to a medical professional.


Signs of heat exhaustion include:
  • Headaches
  • Dizziness
  • Nausea
  • Vomiting
  • Tiredness
  • Muscle cramps
  • Stomach cramps
  • Pale skin

Remember to have plenty of water as soon as you can, and for as long as you can, to keep you going during the day.


Be sure you know the symptoms of a hypo

If your blood sugar drops too low, it’s known as a hypo (short for hypoglycaemia). You can read more about what to do when you have hypoglycaemia here . You may have a blood glucose monitor to check your levels, but you should always try to remember the symptoms of a hypo so that you can take action straight away if it happens. The symptoms of a hypo are:

If you get any of these symptoms, don’t dismiss them as the usual feelings that come with fasting, be extra vigilant as having type 2 diabetes means your health is different to those around you and you need to take extra care or you could become very ill.

Watch your diet

It’s tempting to eat large amounts of sweet, starchy and fatty foods before and after the day’s fast. But, just as you wouldn’t eat too many of these foods if you’re trying to be healthy at any other time, it’s still not advisable for Ramadan. For instance medjool dates, which are a traditional part of the iftar meal, contain about 18g of carbohydrate EACH, of which 16g is sugar! Foods that release their energy slowly might be more useful at Suhur, to sustain your energy and blood sugar levels throughout the day. Try and see if you can substitute the following slower-release foods into your traditional dishes where possible:

  • Fruit and vegetables (fresh, frozen or canned)
  • Starches (wholegrain bread, wholewheat pasta, brown or wild rice)
  • Proteins (meat, fish, eggs, pulses, beans and nuts)
  • Dairy produce (milk, yoghurt, cheese)

Don’t forget about the sugar in drinks too – a glass of fruit juice sounds healthy, but contains very little fibre and can contain as much sugar as a fizzy soft drink.


If you feel unwell, stop

If you become unwell during Ramadan, you are not required to fast and may need to break your fast for the good of your health. You can always give Fidyah for days you are unable to fast or add time to the end of Ramadan, and return to fasting when you are completely well. If in any doubt as to whether you should stop your fast or not because of ill health, talk to a healthcare professional straight away for advice tailored to your situation and your exact symptoms. You could contact:

  • Your GP during working hours
  • Your diabetes specialist nurse during working hours
  • Your local out-of-hours service
  • The national 111 phone service, if available in your area
  • If you become severely unwell, call 999
Go easy at Eid ul-Fitr

The festival of Eid is usually marked with festivities, eating and drinking, often with rich dishes high in fat and sugar. Don’t forget about the risks of having high blood glucose (sugar), though – over-indulging at this time is tempting, but just as risky for your health as at any other time. Focusing on wholegrains, proteins and vegetables with minimal portions of sweetened, refined or deep-fried foods is more likely to stabilise your blood glucose than sudden, large amounts of sweets. Well-meaning friends may not understand what type 2 diabetes involves, and may encourage you to take part in unhealthy dishes. Only you can decide what’s right for you, and what risks you are willing to take. Don’t forget that Islam encourages good health, so reducing your intake of unhealthy foods (or avoiding them altogether) is still observing your faith.


Get back on track as soon as you can

After Ramadan and Eid are over, it’s a good time to have a fresh start with your health. Ideally you will have spoken to your doctor or diabetes nurse well before Ramadan to work out a plan of action for how you will manage over Ramadan and how you will get back to normal afterwards. Generally, you will be aiming to get back to your usual routine, taking your medications at the normal time again. Why not take the opportunity to re-focus on managing your type 2 diabetes at this time, and make a commitment to living more healthily? You’ll find a number of articles to help you get motivated on the ‘Motivate me’ section of this website.

If you have any questions about Ramadan and type 2 diabetes, please speak to your doctor or nurse, who can help you work out what’s best for you.

About the words used in this article

Writing Arabic words in English often leads to different spellings in different communities, so you may not recognise some of the spellings we have used here. Some of the alternative spellings are laid out below:

Spelling used in this article:Other spellings include…
AmanahAmana
FidyahFidzah, fidya
Eid ul-FitrEid al-Fitr
SuhurSuhyr
TaraweehTarawih, tarawi
IftarIfter, iftur
QuranQur’an, Koran