This year, Ramadan runs from Wednesday 22nd March until the 20th April. Fasting is one of the five pillars of faith in Islam, and during Ramadan, Muslims fast during daylight hours. However, some Muslims are exempt and can choose not to fast, including those with chronic illnesses such as diabetes.
Fasting can put strains on the body and the risk of fasting for those living with diabetes can vary depending on the type of diabetes, blood sugar levels, medication taken and any other diabetes-related conditions. According to Diabetes UK, more than 4.9 million people in the UK have the condition.
Sophie Turigel is one of SWGP’s dietitians and has been with us for around four months, joining SWGP in December 2022. Sophie is based in Leamington PCN (Primary Care Network) and previously worked at Heartlands Hospital as a gastro specialist dietitian.
We spoke to Sophie about diabetes and how someone with the condition can be affected when taking part in Ramadan. Sophie describes diabetes to us:
“The pancreas produces insulin, a hormone that helps to deliver glucose from the blood into the cells so that it can be used for energy whilst the cells carry out important functions. It is normally released each time we eat food. In diabetes, this function no longer works properly for various reasons, and the level of glucose in the blood runs too high. Longer term complications of high blood glucose include kidney damage, eyesight issues, heart attacks and peripheral nerve damage.”
The NHS states many people in the UK have blood sugar levels above the normal range, but not high enough to be diagnosed with diabetes. This is known as non-diabetic hyperglycaemia, or pre-diabetes. They also suggest that people in this group are at greater risk of developing type 2 diabetes; but this risk can be reduced through lifestyle changes.
There are many different types of diabetes. According to Diabetes UK, around 90% of people with diabetes have type 2 and around 8% of people with diabetes have type 1; with the remaining 2% having rarer types.
Sophie said:
“Type 1 diabetes is often diagnosed in young children or young adults and involves the inability of the pancreas to produce insulin. Type 2 diabetes is mostly diagnosed in mid-later life and involves the body becoming resistant to the insulin made by the pancreas and requiring more to be produced to have the same effect.”
Fasting during Ramadan means abstinence from all food or drink. This includes water and chewing gum, from dawn to sunset. It is recommended before sunrise, Muslims eat a prefast meal known as suhur. This meal often resembles breakfast, but in some cultures, it may include more dinner-like foods.
Even for those without diabetes, maintaining good health and wellbeing while fasting and balancing day-to-day responsibilities can be challenging. But there are specific risks associated with fasting for those with diabetes:
“The cells rely on a regular source of glucose to maintain daily activities and if the timings of this glucose availability change, the pancreas must change its work too. Fasting whilst still being active during the day requires glucose stores to be broken down instead. If not enough glucose is around, a person with diabetes can experience a “hypo” where they feel dizzy, weak and shaky. The treatment of a hypo is to have glucose in its pure form, followed by glucose in a slow release-form such as rice, potato, bread, or oats.”
Dietitians can help advise patients on how best to manage their condition during Ramadan and what to watch out for. Sophie continued:
“Advice varies from patient to patient but we will often consider options such as eating healthy foods in smaller, regular meals during dark hours, and limiting consumption of food and drink with a high sugar content. We will also discuss what to do if they feel unwell.”
Diabetes UK provides helpful tips and resources on its ‘Diabetes and Ramadan’ page. You can also seek advice from dieticians, diabetes specialist nurses, or other health professionals via your GP practice.
This article is a representation of a general approach and shouldn’t be taken as clinical guidance for individuals. Specific needs should be discussed and agreed with your GP.