Ramadan is a spiritually rewarding month, but for people living with diabetes, fasting can present health challenges that require careful planning and close monitoring. Maintaining blood glucose within safe limits is essential to avoid serious complications such as severe hypoglycemia or hyperglycemia.
Certain blood sugar readings require immediate breaking of the fast to protect health and life. In this medical guide, Dr. Charlotte Abou Elias, Consultant in Endocrinology, Diabetes, Dietetics, Nutrition, and Internal Medicine, explains the critical numbers that require breaking the fast, along with essential medical advice.
🔻 Low Blood Sugar (Hypoglycemia): When to Break the Fast Immediately
You must break your fast if:
Blood sugar is below 70 mg/dL
Blood sugar is below 54 mg/dL (medical emergency)
Symptoms of Hypoglycemia:
Sweating
Trembling
Dizziness or headache
Blurred vision
Heart palpitations
Sudden hunger or confusion
If blood sugar drops below 54 mg/dL, this is an emergency. You must immediately consume a fast-acting sugar source such as:
3–4 dates
Half a cup of juice
1 tablespoon of honey
Recheck your blood sugar after 15 minutes. Do not resume fasting that day.
🔺 High Blood Sugar (Hyperglycemia): When to Break the Fast Immediately
You must break your fast if:
Blood sugar is above 300 mg/dL, or
Blood sugar is above 250 mg/dL with symptoms, such as:
Severe thirst
Extreme fatigue
Frequent urination
Nausea or vomiting
Dry mouth
Severe hyperglycemia may lead to dangerous complications such as dehydration or diabetic ketoacidosis (especially in people with Type 1 diabetes).
In this case:
Break your fast immediately
Drink water
Check ketones (if possible)
Contact your doctor if levels remain elevated
Other Situations That Require Breaking the Fast
Severe dehydration (intense dizziness, low blood pressure, reduced urination)
Persistent vomiting or diarrhea
Feeling faint or losing consciousness
Presence of ketones in urine or blood (especially in Type 1 diabetes)
When Should You Check Blood Sugar During Ramadan?
Before suhoor
Two hours after suhoor
Midday
Before iftar
Anytime you feel abnormal symptoms
Important: Checking blood sugar does NOT break the fast.
When Should a Person with Diabetes Avoid Fasting?
Fasting may not be safe if:
You have Type 1 or uncontrolled Type 2 diabetes
You are on insulin or certain oral medications
You have diabetes-related complications
You have ketones in urine or blood
You experience severe dehydration
You have repeated vomiting or diarrhea
You faint or lose consciousness
Your safety comes first. Breaking the fast due to dangerous readings is not a lack of commitment—it is a necessary act of self-care.
Planning ahead with your doctor before Ramadan significantly improves safety.
Who Is Advised Not to Fast at All?
High-risk groups include:
Patients with unstable Type 1 diabetes
Those with recurrent or unrecognized hypoglycemia
Patients with advanced kidney failure
Pregnant women with diabetes
Elderly individuals with multiple complications
Safe Fasting Tips for People with Diabetes
Before Ramadan:
Visit your doctor to adjust medication doses
Create a clear monitoring and emergency plan
At Suhoor:
Delay suhoor as much as possible
Choose slow-digesting carbohydrates (whole wheat bread, oats, legumes)
Add protein (eggs, yogurt, low-fat cheese)
Drink adequate water
At Iftar:
Start with 1–2 dates and water
Avoid excessive sweets
Divide the meal into two portions if possible
Reduce fried and fatty foods
Focus on protein-rich meals (chicken, meat, fish, egg whites)
Limit refined carbohydrates
Physical Activity:
Avoid intense physical activity before iftar
Light walking after Taraweeh prayers is recommended
Important Awareness Messages
Breaking the fast when reaching dangerous numbers is a medical necessity.
Ignoring symptoms can lead to serious complications.
Do not rely on how you feel—rely on regular glucose monitoring.
Always carry a fast-acting sugar source with you.
Conclusion
Fasting with diabetes is possible in many cases—but it requires awareness, discipline, and medical supervision. Your health comes first. Breaking your fast when blood sugar reaches dangerous levels is not a failure—it is a wise and responsible decision.
For the safest experience, create a personalized fasting plan in consultation with your doctor before Ramadan.
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