For people who live with diabetes, fasting for long periods is actually risky. Especially when talking about people with type 1 diabetes or uncontrolled type 2 diabetes, fasting can be the origin of serious health issues, like:

• Dangerously low blood glucose: During the fast the sugar in the blood might go too low (less than 70mg/dl – 3.9mmol/l) when the food intake during eating hours is minimal and/or if the insulin dose is excessive. If not taken care of, hypoglycemia can cause blackout.

• Excessively high blood sugar: When meals are high in simple carbohydrates and/or when insulin doses are omitted or lower than they should be, the blood sugar may rise to unhealthy levels (above 200 mg/dl – 11.1 mmol/l) exacerbating diabetes complications.

• Diabetic ketoacidosis: Due to excessive reduction of insulin, body cells can’t receive glucose so they start to burn fat for energy creating waste products called ketones. Ketones can make the blood dangerously acidic. Generally, it is a byproduct of hyperglycemia in patients with type 1 diabetes.

• Dehydration and blood clots: Lack of fluid intake especially in a hot and humid weather can result in dehydration. In this case, blood viscosity might be higher which increases the risk of forming blood clots.

Now in the case, you decided to take the risk and fast, you need to carefully do the following steps that will help keep you safe:

Test your blood glucose levels at least 4 times a day:

1. When you wake up  
2. Mid-day  
3. 2 hours after Iftar 
4. Directly before Suhoor
5. Anytime you feel unwell
6. You can test your blood sugar anytime; it doesn’t break your fasting. However, you should end the fast immediately if your blood glucose is less than 70 mg/dL (3.9 mmol/L) or higher than 300 mg/dL (16.7 mmol/L) or if it’s around 90 mg/dL (3.9 mmol/L) and you still have 2 or more hours before Iftar, to avoid the low blood sugar.
7. Always carry glucose treatment with you
8. Reduce fasting hours by having a rich meal at Suhoor, just before the break of dawn
9. Always speak to your doctor because you may need to change the dose, type and times of your medication or insulin. Never do the change on your own!
10. Discuss with your dietitian or diabetes educator your dietary plan for the month
11. Always have a diabetes identification accessory, such as a medical bracelet
12. If you notice dehydration symptoms like feeling disoriented, confused, collapsing, headache…break your fast with a glass of water
13. Abstain from increasing the level of physical activity during fasting hours; it may lead to hypoglycemia
14. Avoid sleeping during the later hours of the fasting day in order to remain alert to the signs of hypoglycemia

It is crucial to acknowledge that fasting is not recommended for all people with diabetes and it is seriously advised that you reconsider not fasting if you have any of the following:

• Type 1 diabetes

• Chronic complication such as heart condition or kidney disease

• Poor glycemic control , such as frequent high and low blood sugars

• Lack of awareness to the signs of hyperglycemia and hypoglycemia

Remember, maintaining healthy blood sugar levels is your responsibility and it is serious. Follow the guidelines and let this Ramadan be your best!