Ramadan is a holy month observed by practicing Muslims based on the lunar calendar. It’s a time of deep spiritual reflection that involves fasting from sunrise to sunset. In addition to abstaining from food, fasting includes not drinking any liquids, smoking, chewing gum, and engaging in any sexual activity from sunrise to sunset.
Who is Exempt from Fasting?
Fasting is not meant to create excessive hardship on anyone. The Quran exempts the sick from fasting, especially if it might lead to harmful consequences for the individual's health. People with diabetes and cancer fall into this category, as well as pregnant and nursing women, young children, and older adults with chronic health conditions. Anyone who participates in fasting and is at risk or living with a chronic condition should talk to their healthcare provider. It’s crucial to be safe and manage health conditions during this time.
Breaking the Fast: Iftar
The pre-prayer evening snack at sunset that breaks the fast is called Iftar. It’s tradition and recommended to break the day’s fast by consuming three Medjool dates and water, as the prophet Mohammed did.
Why Iftar is important for people with Diabetes: This practice is important because it raises glucose levels and helps prevent hypoglycemia symptoms such as lightheadedness and dizziness during prayer. Since Muslim prayer involves a lot of movement such as bending over and standing up, this amount of activity combined with low blood sugar could lead to symptoms, so having a snack before prayer is encouraged.
- Nutrition facts of dates: Three medjool dates have approximately 46 grams of carbohydrates (40 grams of sugar) and 4.5 grams of fiber. Dates have a low glycemic index (GI) and a low glycemic load (GL) when consumed in a small amount and are considered a safe practice for people with diabetes.
The Main Meal: Suhur
Suhur is the main meal which is eaten before sunrise. It is customary to wake up and eat a large meal before dawn to help carry you through the day. It’s important not to overeat, especially carbohydrates, to avoid lethargy, elevated blood sugar, and weight gain. Instead, aim to have structured meals and be consistent with your eating pattern to help better manage your weight and blood sugar.
Note For People with Diabetes
You might need to modify your exercise, diet and/or medications to help keep your blood sugars in a healthy range. As always, please consult with your physician before making any major changes to your medication, fluid, diet, and exercise routines.
Time to Celebrate!
Ramadan is not just a time of restrictions. It’s a time of celebration and joy to be enjoyed with family and friends. The Muslim holiday, Eid al-Fitr, commonly known as Eid, marks the end of Ramadan. In Arabic, it translates to “festival of breaking the fast,” which is a celebration that lasts for one to three days when the new moon is sighted. Similar to Christmas, people gather to enjoy a feast, exchange gifts, have a good time, and give thanks to God.
Fun facts about Eid celebrations:
- The Eid greeting is to say “Eid Mubarak” which means “Blessed Eid.”
- After exchanging Eid greetings, it’s customary to embrace three times.
- It’s customary to buy new clothes and look your best.
- Green is a holy color and popular for Eid decorations.
What People with Diabetes Need to Know During Ramadan:
1. Watch out for low blood sugar (hypoglycemia).
Symptoms of low blood sugar can include shakiness, racing heart, sweats/chills, intense hunger, numbness/tingling, drowsiness, blurry vision, dizziness, difficulty concentrating, confusion, anxiety, nausea, and headache.
The risk of glucose levels going too low is greatest in people taking insulin or diabetes medications, especially those that have a side effect of low blood sugar. Limit physical activity during fasting hours and plan for it to take place after enjoying the sunset meal to help reduce your risk of low blood sugars. Talk with your healthcare provider to find out if your medicine puts you at risk for low blood sugar and discuss how to prevent it. (Learn more about type 2 diabetes medications and their side effects.)
Note: If you experience a low blood sugar of less than 70 mg/dL (3.9 mmol/L), you will want to immediately end the fast by treating it appropriately. (Learn more about handling low blood sugars.) While fasting, it is likely that blood sugars will continue to drop, especially if insulin or blood sugar-lowering medications have been taken.
2. Watch out for high blood sugar (hyperglycemia).
Symptoms of high blood sugar include dry mouth, increased thirst, hunger, fatigue (weak, tired feeling), nausea/vomiting, abdominal pain, shortness of breath, fruity-smelling breath, blurry vision, headache, and dizziness.
While low blood sugar levels may happen during the day, after breaking the fast, there is a greater risk to overeat and experience elevated blood sugar levels. Even though you refrain from food and drink all day, it is not uncommon for people to gain weight during this time, as the evening meal(s) are a celebration.
Tips for avoiding high blood sugar during Suhur:
- Survey all the offerings before you start filling your plate.
- Be mindful of your portion sizes of carbohydrates, such as fruit, pita bread, rice, and sweets.
- Practice the plate method: fill up half your plate with non-starchy veggies, one quarter with lean protein, and the last quarter with grains and starches.
- Plan ahead if you will eat one or two meals. If eating two meals, adjust portion sizes accordingly.
Note: If you experience a blood sugar reading over 300 mg/dL (16.6 mmol/L), experience vomiting or test positive for ketones, you will want to end the fast and follow instructions from your doctor. These elevated blood sugars can increase the risk for DKA (diabetes ketoacidosis) or HHS (hyperosmolar hyperglycemic state). Possible reasons for DKA or HHS events include dehydration and inaccurate adjustments of insulin and medications.
3. Stay hydrated.
Symptoms of dehydration include dry mouth, increased thirst, fatigue (weak, tired feeling), very yellow urine, dry skin, headache, and dizziness.
Dehydration is a big concern during Ramadan as water and fluid intake are restricted during daylight hours. This is very different from intermittent fasting, in which water and no-calorie fluids are highly encouraged during periods of not eating. Dehydration is especially a concern during hot summer days. Individuals taking certain diabetes medications (like SGLT2s) are at increased risk for dehydration and developing ketones. Aim to drink plenty of water between sundown and sunrise and limit caffeinated drinks.
Note: Fasting on days that you are sick can increase the risk of dehydration, DKA, or HHS and is not advised. Talk to your doctor about a plan for handling sick days during the month of Ramadan.
If You’re Taking Diabetes Medications
Your doctor can assist you with medication adjustments for fasting safely during the month of Ramadan. Consider asking them the following questions:
- Do any of my diabetes medications have a side effect of low blood sugar?
- Should I continue with my usual medication schedule?
If You’re Taking Insulin
Your doctor can assist you with making insulin adjustments for fasting safely during the month of Ramadan. Consider asking them the following questions:
- Will I need to take my fast (rapid) acting insulin during the day?
- Do I need to adjust my basal insulin?
- Is there a feature on my insulin pump that can help?
Frequent blood sugar checks and monitoring for trends can reduce risks of lows and help ensure insulin adjustments are appropriate. CGM (continuous glucose monitor) technology can provide helpful insights into blood sugar patterns, including alerts and alarms for high and low readings for those who are wearing a CGM.
Always be sure to communicate with your doctor about the patterns and trends you are seeing, including notifying them right away if more adjustments are needed or if you are experiencing high or low blood sugars.
Remaining mindful, keeping in touch with your healthcare provider, and taking the appropriate precautions can help you enjoy a happy and healthy Ramadan.