Ramadan and diabetes: fasting safely, with your doctor’s advice

Many Muslims with diabetes are keen to fast in Ramadan, and most of them do: according to an estimate published in 2015 by the authors of the international CREED study, more than a hundred million Muslims with diabetes worldwide may fast during Ramadan. For some, it is possible without danger, provided they prepare with their doctor; for others, fasting carries a risk of serious complications, and the religion exempts them. This article is based on the “Diabetes and Ramadan” practical guidelines published in 2021 by the International Diabetes Federation (IDF) and the DAR (Diabetes and Ramadan) International Alliance. It is no substitute for a consultation: every situation is different.

What Islam says: health comes first

Fasting in Ramadan is an obligation for every Muslim who has reached puberty, is of sound mind and is able to bear it: “O you who have believed, decreed upon you is fasting as it was decreed upon those before you that you may become righteous” (Quran 2:183). But the very next verse provides the exemption: “So whoever among you is ill or on a journey [during them] – then an equal number of other 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” (Quran 2:184). And the Quran concludes: “Allah intends for you ease and does not intend for you hardship” (Quran 2:185).

In practice, scholars distinguish two situations:

• a temporary illness: the missed days are made up later, when health allows;
• a chronic illness that permanently prevents fasting: a compensation (fidyah) is given, which means feeding a poor person for each day not fasted. Its form and amount vary between schools and countries, so ask your mosque or a scholar.

Not fasting for medical reasons is no failing. Prophet Muhammad ﷺ said: “When a servant falls ill or travels, there is written for him the like of what he used to do when he was healthy and at home” (Sahih al-Bukhari 2996). The IDF-DAR guidelines, drawn up with the involvement of religious scholars, stress the same point: people who do not fast because of their health should not feel guilty. Conversely, many scholars consider that fasting against medical advice, at the risk of serious harm, is religiously blameworthy: “do not throw [yourselves] with your [own] hands into destruction” (Quran 2:195). Pregnant and breastfeeding women, whether or not they have diabetes, may also be exempt, especially if they fear for their own health or their baby’s (Sunan Abi Dawud 2408, graded hasan sahih by al-Albani).

What are the risks of fasting with diabetes?

The guidelines list four main complications:

• hypoglycaemia (blood sugar too low), especially in people treated with insulin or with certain tablets such as sulphonylureas, particularly towards the end of the day;
• hyperglycaemia (blood sugar too high), often after very rich meals at iftar or an excessive reduction in treatment;
• diabetic ketoacidosis, a serious complication that mainly threatens people with type 1 diabetes;
• dehydration, which can encourage blood clots (thrombosis), especially in hot weather and on long fasting days.

Assessing your risk before Ramadan

It all starts with a consultation, ideally six to eight weeks before Ramadan. Ramadan 2027/1448 is expected to begin around 8 February 2027: this is a forecast, as the official date is announced after the sighting of the crescent moon (see our page on the beginning of Ramadan). So book your appointment early enough.

Since 2021, doctors can use a risk score that adds up points for a number of factors, including:

• the type of diabetes (type 1 carries more risk) and how long you have had it (more than ten years);
• a history of hypoglycaemia, especially if severe, recent or not felt (hypoglycaemia unawareness);
• how well controlled the diabetes is, as measured by HbA1c (above 7.5%, and even more so above 9%);
• the treatment: multiple daily insulin injections and certain sulphonylureas carry more risk than other medicines;
• self-monitoring of blood glucose, depending on whether it is done properly or not;
• ketoacidosis or a hyperosmolar coma in the past twelve months;
• complications: cardiovascular disease, kidney disease;
• pregnancy, frailty or cognitive impairment, age (over 70 without support at home);
• intense physical work, a bad experience during a previous Ramadan, and the length of the fast (sixteen hours or more).

The total places the person in one of three categories:

The score should be worked out again every year: fasting successfully one year does not guarantee the same the next. Your doctor makes the final judgement, taking your personal circumstances into account.

Getting ready: education and adjusting treatment

The pre-Ramadan consultation is also the time to learn how to manage the fast: how and when to check your blood glucose, how to recognise warning signs, when to break the fast, and how to organise your meals and physical activity. The guidelines consider this education essential, and suggest that a few trial fasts during Sha‘ban can help you prepare.

Treatment often needs adjusting: doses, timing, sometimes a change of medicine to reduce the risk of hypoglycaemia. Only your doctor can do this. Never change your doses on your own and never stop insulin on your own initiative, as this can lead to hyperglycaemia or ketoacidosis.

Checking your blood glucose does not break the fast

A false and dangerous idea still circulates: that pricking your finger to check your blood glucose breaks the fast. The IDF-DAR guidelines are clear: neither blood glucose testing nor insulin injections invalidate the fast. This is also the position of the International Islamic Fiqh Academy, for which non-nutritive injections and blood tests do not break the fast. If you are unsure about your own situation, ask a scholar, but never give up monitoring.

The recommended times for checking your blood glucose are:

1. before suhoor;
2. in the morning;
3. at midday;
4. in the middle of the afternoon;
5. before iftar;
6. two hours after iftar;
7. at any time if you have symptoms or feel unwell.

People at low or moderate risk may need only one or two checks a day, as advised by their doctor; those at high risk should check several times a day. Continuous glucose monitoring sensors are encouraged where available.

When should you break the fast?

According to the 2021 guidelines, everyone with diabetes should break their fast in the following situations:

Signs of hypoglycaemia include trembling, sweating or chills, palpitations, hunger, headache and confusion. Signs of hyperglycaemia include extreme thirst, frequent urination, severe tiredness, nausea or vomiting and abdominal pain. For hypoglycaemia, the guidelines advise taking a small amount of fast-acting sugar, for example a small carton of fruit juice, then checking your blood glucose again 15 to 20 minutes later. Your doctor may set personal thresholds for you: follow their instructions, and contact them if these situations keep recurring.

Breaking your fast to protect yourself is not a sin: it is applying the exemption provided by the Quran. The day is simply made up later.

What to eat during Ramadan

The guidelines set out a full nutrition plan, in line with our advice on healthy eating during Ramadan, with some extra points for people with diabetes:

• Take suhoor as late as possible, especially when the fast lasts more than ten hours, with low-glycaemic-index, high-fibre carbohydrates (wholemeal bread, oats, pulses) and protein (eggs, dairy, cheese).
• Break the fast with plenty of water and one to three small dates. As a guide, two large dates contain about 20 g of carbohydrate, roughly the same as a piece of fruit.
• Spread your intake: the plan suggests about 30 to 40% of calories at suhoor, 40 to 50% at iftar and 10 to 20% as a snack, rather than grazing all night.
• Favour complex carbohydrates: vegetables, pulses, whole grains. Harira, rich in lentils and chickpeas, is a good choice, as long as you watch the amount of bread that goes with it.
• Strictly limit sugary desserts (chebakia, honey pastries, sellou), sugary drinks and juices with added sugar. Fried foods (briouats, doughnuts, msemen) should stay occasional.
• Stay well hydrated between iftar and suhoor with water or unsweetened drinks, avoiding caffeinated and sugary drinks.

As an illustration, a day might look like this, to be adapted with your doctor or dietitian:

The IDF also publishes a short patient leaflet, Ramadan and diabetes: guide to a safe fast, and Diabetes UK has a page of practical advice on Ramadan.

Physical activity and tarawih prayers

You are advised to keep up your usual physical activity while avoiding strenuous effort during the fast, especially in the last hours before sunset, when the risk of hypoglycaemia and dehydration is highest. Light activity after iftar, such as walking, is better. The guidelines point out that the movements of the tarawih prayer (bowing, prostrating, rising) count as physical activity: remember to check your blood glucose and drink enough if you pray for a long time.

After Ramadan: Eid and follow-up

Eid al-Fitr is a time of celebration, but also of risk: the guidelines warn against overeating during these days after a month of fasting. A consultation after Ramadan is advised to readjust treatment and review the month. If you want to fast the six days of Shawwal, ask your doctor about this too.

Diabetes in figures

According to the IDF Diabetes Atlas (11th edition, 2025), 589 million adults aged 20 to 79 were living with diabetes in 2024, about one in nine, and this number could reach 853 million by 2050. Some 252 million of them do not know they have the condition. The Middle East and North Africa region is the most affected in proportion: about one adult in six has diabetes there, almost 85 million people. Type 2 diabetes, by far the most common, is linked to excess weight, physical inactivity and a diet too rich in sugar and fat: Ramadan can be a chance to adopt better habits, with your doctor’s support.

In short

• See your doctor six to eight weeks before Ramadan to assess your risk.
• If your risk is moderate or high, medical advice is not to fast, and Islam exempts you, with no loss of reward.
• If you fast, have your treatment adjusted by your doctor; never change it yourself.
• Check your blood glucose regularly: it does not break the fast.
• Break the fast below 70 mg/dL (3.9 mmol/L), above 300 mg/dL (16.6 mmol/L) or if you feel unwell.
• Take suhoor late, break the fast with water and a few dates, limit sweets and drink enough.

Main source: International Diabetes Federation and DAR International Alliance, Diabetes and Ramadan: Practical Guidelines 2021.