Safe Fasting for Diabetic Patients During Ramadan: A Comprehensive Guide

Ramadan is a spiritually significant month, but fasting can pose health challenges for people with diabetes. Maintaining blood sugar within safe ranges is essential to avoid serious complications such as hypoglycemia, hyperglycemia, or dehydration. Here is a practical guide with medical insights from Dr. Charlotte Abou Elias, consultant in endocrinology, diabetes, nutrition, and internal medicine.

1. Blood Sugar Levels That Require Breaking the Fast Immediately

Hypoglycemia (Low Blood Sugar)

Below 70 mg/dL: Take a fast-acting source of sugar immediately.
Below 54 mg/dL: Emergency situation; consume 3–4 dates, half a cup of juice, or one tablespoon of honey immediately. Fasting should not continue.
Warning symptoms: Sweating, tremors, dizziness, headache, blurred vision, heart palpitations, sudden hunger, confusion.
Recheck blood sugar after 15 minutes and do not resume fasting that day.

Hyperglycemia (High Blood Sugar)

Above 300 mg/dL or above 250 mg/dL with symptoms (severe thirst, fatigue, frequent urination, vomiting, dry mouth).
Break the fast immediately, drink water, check for ketones if possible, and contact your doctor if high blood sugar persists.
Severe hyperglycemia may cause dehydration or diabetic ketoacidosis, especially in type 1 diabetes.

Other Situations Requiring Breaking the Fast

Severe dehydration: dizziness, low blood pressure, minimal urination.
Frequent vomiting or diarrhea.
Fainting or presence of ketones in urine or blood.

2. When to Check Blood Sugar During Ramadan

Before Suhoor (pre-dawn meal).
Two hours after Suhoor.
Midday.
Before Iftar (sunset meal).
Whenever you feel unusual symptoms.

Note: Checking blood sugar does not break the fast.

3. Who Should Avoid Fasting

Uncontrolled type 1 diabetics.
Those with frequent or unrecognized hypoglycemia.
Patients with advanced kidney failure.
Pregnant women with diabetes.
Elderly patients with multiple complications.