The month of Ramadan is considered one of the holiest months of the year for Muslims. During this period, Muslims do not eat or drink anything from dawn until they break their fast after sunset. It is also to cultivate self-control, gratitude, and compassion to those less fortunate. There are some people who are exempted from fasting, this includes pregnant or lactating women, sick elderly, children and people with serious medical condition.
Muslims with diabetes may also be looking to observe this holy month as fellow Muslims. However, there are risks that need to be acknowledged before anyone with diabetes considers fasting during Ramadan.
Risk Associated During Fasting Month among Diabetes Patients
Ramadan fasting causes significant changes in type 2 diabetes (T2D) metabolism, affecting their glucose homeostasis and increasing the risk of:
Muslims in Malaysia usually fast for 13 hours a day. A study found that among the patients with Type 1 and Type 2 diabetes, they are more likely to experience severe hypoglycemia as well as hyperglycemia during Ramadan .
Decrease in the food consumption will increase the risk of hypoglycemia. Hypoglycemia is a dangerous condition for diabetes where the level of glucose drops below normal.
Patients with uncontrolled type 1 diabetes who fasted during Ramadan may experience a wide fluctuation of glucose levels between fasting and eating hours, which will exhibit a greater tendency towards hyperglycemia. [1, 2].
Dehydration occurs when the body loses more water than it takes in. As we know abstinence from food and water means zero fluid intake during the day may cause dehydration. Excessive sweating can worsen the dehydration among individuals living with hot, humid climates and having a heavy physical activity. Worsen dehydration may lead to serious condition such as stroke. Risk of thrombosis may be higher due to increased blood viscosity during dehydration .
Therefore, individuals with diabetes must be alert with the symptoms that may occur during fasting to prevent any complications.
Diet Plan for Diabetes Individuals during Fasting Month
Fasting during Ramadan modifies our eating habits, which may result in fluctuations in your blood sugar levels, leading to either hyperglycemia or hypoglycemia [5, 6, 7]. To maintain an optimal blood glucose level throughout the fasting period, it is crucial to follow a well-planned meal schedule.
This diet plan is designed to help diabetics to achieve better blood glucose control and help in the weight management during Ramadan. Meal plan for diabetes individuals must be well-balanced with the following macronutrient distribution:
Carbohydrates → 55 – 70%
Protein → 10 – 15%
Fat → 15 – 30% 
The meal intake during Iftar and Sahur should follow “Quarter Quarter Half” diet formula as provided and recommended by Ministry of Health, Malaysia [8, 10].
Drink 8 glasses of plain water every day
Getting enough fluid every day is important for your health. Make sure you drink 8 glasses of water per day or at least 2 litres of water per day.
Medication Adjustments During Fasting
Follow the doctor's instructions regarding your medication or insulin regimen. Talk to your doctor or healthcare professional and get their guidance before making adjustments to existing medication.
1. Ahmed, S. H., Chowdhury, T. A., Hussain, S., Syed, A., Karamat, A., Helmy, A., Waqar, S., Ali, S., Dabhad, A., Seal, S. T., Hodgkinson, A., Azmi, S., & Ghouri, N. (2020). Ramadan and diabetes: A narrative review and practice update. Diabetes Therapy, 11(11), 2477–2520.
2. Alfadhli, E. M. (2018). Higher rate of hyperglycemia than hypoglycemia during Ramadan fasting in patients with uncontrolled type 1 diabetes: Insight from continuous glucose monitoring system. Saudi Pharmaceutical Journal, 26(7), 965–969.
3. Salti, I., Bénard Eric, Detournay, B., Bianchi-Biscay, M., Le Brigand, C., Voinet Céline, & Jabbar, A. (2004). A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries. Diabetes Care, 27(10), 2306–2311.
4. Cortés-Vicente, E., Guisado-Alonso, D., Delgado-Mederos, R., Camps-Renom, P., Prats-Sánchez, L., Martínez-Domeño, A., & Martí-Fàbregas, J. (2019, March 29). Frequency, risk factors, and prognosis of dehydration in acute stroke. Frontiers in neurology.
5. Gulati, S., Misra, A., Nanda, K., Pandey, R. M., Garg, V., Ganguly, S., & Cheung, L. (2015). Efficacy and tolerance of a diabetes specific formula in patients with type 2 diabetes mellitus: An open label, randomized, Crossover Study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 9(4), 252–257.
6. Monnier, L., El Azrak, A., Lessan, N., Rochd, D., Colette, C., & Bonnet, F. (2015). Ramadan and diabetes: What we see, learn and understand from continuous glucose monitoring. Diabetes & Metabolism, 41(6), 456–462.
7. Rahman, R., About the Writer Raihan Rahman, Writer, A. the, Rahman, R., Raihan loves psychological thriller books and horror movies but sleeps with a night light, & About the Writer Raihan Rahman. (2022, March 6). Diabetes and Ramadan fasting: Risk, Tips & Management. Homage Malaysia.
8. User manual quality of diabetes care at MOH healthcare facilities ... (n.d.).
9. Recommended Nutrient Intake for Malaysia | Bahagian Pemakanan | Kementerian Kesihatan Malaysia. (2017).
10. Ministry of Health Malaysia. (2022). Malaysian Dietary Guidelines 2020. Bahagian Pemakanan.