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Fasting safely this Ramadan - expert advice for Muslims with diabetes

Ramadan, the ninth month in the Islamic calendar when Muslims devote themselves to their faith and fast from sunrise to sunset, starts on Sunday 5 May.

Lasting until Tuesday 4 June, the Ramadan fasting period is obligatory for almost all Muslims.  Although certain groups are exempt for health and other reasons, some people with diabetes are keen to observe the fast, although the long daylight hours in the UK at this time of the year makes it a challenging time, even for those without medical conditions. 

Diabetes UK has highlighted that: “long fasts of 15 hours or more can put people at higher risk of hypoglycaemia and dehydration, which can make you ill”. 

To help people to fast safely, the diabetes clinical steering group from Hertfordshire and West Essex Sustainability and Transformation Partnership (STP) is encouraging people to seek advice from their GP and Imam before starting their fast and has encouraged people to bear in mind this practical advice:

  • Appropriate portion sizes (for example 1-2 dates are the recommended amount to break the fast due to high sugar content)
  • Reduced carbohydrate content (this has the most impact on blood glucose levels)
  • Glycaemic index (low GI foods e.g. brown/basmati rice or porridge/shredded wheat help keep blood glucose stable)
  • Cooking methods (baking rather than frying)
  • Using healthier options where possible (balanced meals with vegetables and salad)
  • Hydration (sugar content should also be considered in drinks)

Jenne Patel, Diabetes Quality Improvement Manager, Hertfordshire and west Essex Sustainability and Transformation Partnership, added:
“People with diabetes who fast are at risk of experiencing high and low blood glucose levels.  They also need to be aware that there are changes to the body during fasting, so they may need to change when and how they take any medication that they rely on. Speak to your community pharmacist for individual advice.”

Professor Jim McManus, Director of Public Health at Hertfordshire County Council, said: 
“Fasting can be good for us, as many faiths will attest; it can however also have risks if you have ongoing health conditions. You may be exempt from fasting but even if you’re exempt and want to fast, particularly if you have diabetes, you should get medical advice before you fast, and take care when you break the fast.”

Useful links: 

Notes 

Ramadan this year starts on the evening of Sunday 5 May and ending in the evening of Tuesday 4 June.

The Qur’an states that those who are exempt from fasting include:

  • Children
  • Women who are menstruating
  • Elderly or frail patients
  • Those suffering with a severe mental illness or condition
  • Those suffering with a chronic illness, where fasting can cause detriment to health

Table of risks and associated advice 

High risk conditions – where fasting is not advised

  • Type 1 diabetes
  • Poor glycaemic control (defined as HbA1c > 69mmol/mol (> 8.5%))
  • Hypoglycaemic unawareness
  • Severe episodes of hypoglycaemia (loss of consciousness or requiring third party assistance) in three months prior to Ramadan
  • Recurrent episodes of hypoglycaemia in three months prior to Ramadan
  • History of diabetic ketoacidosis in the three months prior to Ramadan
  • History of hyperosmolar hyperglycaemic coma in the three months prior to Ramadan
  • Comorbidities: advanced macrovascular complications, renal disease, liver disease, cognitive dysfunction, uncontrolled epilepsy
  • Acute illness, including a diabetic foot infection or foot ulcer
  • Pregnant women
  • Frequent intense physical labour

Moderate risk – May fast if patient and health-care professionals are happy, with collaboration of care between all involved

  • Moderate glycaemic control, defined as HbA1c 58 to 69mmol/mol (7.5 to 8.5%) and no major complications of diabetes
  • Well-controlled diabetes, defined as HbA1c <58mmol/mol (< 7.5%) treated with sulphonylurea, short-acting insulin secretogogue, insulin, or treated with a combination oral or oral and insulin treatment

Low risk - Should be able to fast with advice

  • Diet-controlled diabetes
  • Diabetes well-controlled with monotherapy (Metformin, DPP-4 inhibitors, Acarbose, GLP-1 agonists, SGLT2 inhibitors or thiazolidinediones) and otherwise healthy

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