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Diabetes and Ramadan Fasting

Risk stratification, medication adjustment, and education are essential for safe fasting in diabetic patients during Ramadan.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Diabetes and Ramadan Fasting?

Ramadan fasting is a religious obligation that approximately 50 million diabetic Muslims worldwide want to observe. The 14-16 hour fasting period creates risks of hypoglycemia, hyperglycemia, DKA, dehydration, and thrombosis.

IDF-DAR (International Diabetes Federation - Diabetes and Ramadan) risk classification: very high risk (severe hypoglycemia in last 3 months, recurrent DKA, hemodialysis, T1DM with poor control, pregnancy, advanced complications), high risk (T2DM with poor control, sulfonylurea, isolated CKD), moderate risk (well-controlled T2DM with sulfonylurea), low risk (T2DM controlled with diet/metformin).

Pre-Ramadan visit: risk classification, education (signs of hypoglycemia, when to break fast), medication adjustment. Iftar = main dose, suhoor = reduced dose. SGLT2 inhibitors should not be initiated within 30 days of Ramadan (DKA risk). DARE study: liraglutide is safe and effective.

Symptoms

Hypoglycemia: tremor, sweating, hunger
Hyperglycemia: polyuria, polydipsia
DKA: nausea, vomiting, ketotic breath
Dehydration: orthostatic dizziness
Headache, fatigue
Mood changes

Risk Factors

T1DM (very high risk)
Severe hypoglycemia (last 3 months)
Recurrent DKA, HHS history
Sulfonylurea use
CKD stage 3-4-5, dialysis
Pregnancy, advanced complications

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pre-Ramadan visit (1-3 months before)
  • Severe hypoglycemia (break fast immediately)
  • Blood glucose >300 (consider breaking fast)
  • DKA symptoms (urgent)
  • Severe dehydration
  • Persistent headache, weakness

Treatment Methods

01
IDF-DAR risk classification (mandatory)
02
Pre-Ramadan education (CGM training)
03
Metformin: 2/3 dose at iftar, 1/3 at suhoor
04
Sulfonylurea: avoid (gliclazide MR safer)
05
DPP4: continued, GLP-1 RA: titrated dose
06
Basal-bolus: 25-30% reduction in basal at suhoor

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.