Fasting during the month of Ramadan is one of the pillars of Islam and a duty for every Muslim. In this article, Dr Sueziani Zainudin, Consultant, from the Endocrinology Service at ​Sengkang General Hospital (SKH), and Dr Daphne Gardner, Senior Consultant, from the Department of Endocrinology at Singapore General Hospital (SGH), both members of the SingHealth​ group, share guidelines for those with diabetes on how to manage Ramadan fasting.

Before you fast​

  1. Know that there is no compulsion to fast when you’re not healthy

    Surah Al Baqarah Verse 184 - 185 provides a clear guide that fasting during Ramadan is not compulsory if you have chronic diseases, or where fasting endangers or is harmful to your life (e.g. if you’re on insulin, have renal failure, or are pregnant).

    You can make contributions to the poor or needy in lieu of fasting during Ramadan.

  2. Make the decision to fast with the doctor treating your diabetes 2 months before Ramadan

    3. It is important to discuss fasting with your doctor up to 2 months before Ramadan as you will need to know:

    • ​How to fast safely
    • Whether adjustments to your diabetes medications may need to be made beforehand.

    Do not self-adjust or stop medications on your own.

  3. Have a trial run of fasting before Ramadan

    4. A "trial run" of fasting before Ramadan (i.e. Puasa Sunat) may be done to identify possible problems during fasting for Ramadan. Please discuss this with your doctor.

    During your fast​

  4. Don’t skip Sahur (your pre-dawn meal)

    5. You must not skip your Sahur (pre-dawn) meal. Have a well-balanced meal in the morning and take an appropriate amount of insulin for that, taking into consideration that you will not be eating through the day until sunset. Should you miss your Sahur meal, you should not fast.

  5. Choose foods with low glycaemic index (GI) to prevent your blood sugar from fluctuating too much.
    For example, basmati rice has a lower GI than regular white rice.         

  6. Drink 8 glasses of sugar-free fluids

    7. Try to drink adequate fluids (choose sugar-free fluids) during Sahur and Iftar (sunset-meal) to replenish fluid loss during the day. Aim for 8 glasses a day.

  7. Monitor your blood glucose levels when you are fasting

    8. Self-monitoring of blood glucose during fasting is allowed during Ramadan. In fact, it is necessary for a successful fast.

  8. Check for high blood glucose, low blood glucose levels or severe dehydration

    9. You must be able to recognise when you have high blood glucose levels, low blood glucose levels or severe dehydration.

  9. Signs you should stop fasting

    10. You MUST terminate your fast immediately if you encounter these problems. Skipped fasting days can be replaced in the future.

    Blood glucose levels
    • Blood glucose < 4.0 mmol/L during fasting
    • Blood glucose > 16 mmol/lL
    Signs of hypoglycaemia (low blood glucose)
    1. Feelings of tremors
    2. Sweating
    3. Palpitations
    4. Hunger
    5. Dizziness
    6. Confusion
    Symptoms of severe dehydration
    1. Dizziness (feeling faint)
    2. Confusion

    After your ​fast

  10. Break your fast promptly and eat in moderation
    Breaking of fasting (berbuka) should not be delayed. When breaking fast, drink plenty of fluids and have a healthy meal. Try not to go overboard when you buka puasa!

Ref: O17

Check out other articles on Ramadan fasting:

Best Foods to Eat for Suhoor (pre-dawn meal)

Best Foods to Eat for Iftar (break fast)

Taking Medication During Ramadan

Exercising During Ramadan: How to Do It Safely