Fasting is considered a requirement for all Muslims adults, regardless of your gender, occupation, ethnicity… However, there are exemptions for people with serious medical conditions, which in some cases includes type 2 diabetes.  

A vast majority of people with diabetes do not consider themselves to be part of that exemption and will fast anyway. While there are certain cases of diabetes which can tolerate, under specific instructions, safe fasting, there are other cases of diabetes where it may result in serious health complications. That’s why it’s advisable to speak with your doctor about whether or not you should fast.

The International Diabetes Federation published a report with a risk classification for people with diabetes mellitus who want to fast. Take a look at the table below and see where you fall. 

Table 1: Elements for risk calculation and suggested risk score for people with diabetes mellitus (dm) that seek to fast during Ramadan

Regardless of your risk score, as someone living with diabetes there are risks associated with fasting that you should be aware of: 

  1. Becoming hypoglycemic (with blood sugar levels less than 70 mg/dl or 3.9mmol) 
  2. Becoming hyperglycemic (with blood sugar levels greater than 300mg/dl or 16.7mmol). In people with type 1 diabetes, this may lead to diabetes ketoacidosis, a life threatening condition.  
  3. Dehydration and thrombosis due to low fluid intake.

According to standard guidelines, doctors will usually advise people with the following conditions to not even fast at all: 

  • Pregnant with diabetes
  • Have chronic complications such as kidney failure and microvascular or macrovascular complications
  • A history of recurrent hypoglycemia or hypoglycemia unawareness
  • Severe hyperglycemia with average fasting or premeal plasma glucose > 16.7mmol/L (300mg/dL) or glycated hemoglobin (HbA1c) > 86mmol/mol (10%)
  • Diabetic ketoacidosis or hyperosmolar hyperglycemic coma state within the 3 months prior to Ramadan
  • Acute illness (cold, pneumonia, heart attack, broken bone)
  • Undergoing dialysis treatment