Q&A: Diabetes and fasting during Ramadan

DEAR MAYO CLINIC: Our family celebrates Ramadan, but my father was recently diagnosed with diabetes. He is very spiritual and would like to continue to fast during the holiday, but I don't think it's wise. Can you share whether he can safely fast or if he should avoid this practice due to his condition?

ANSWER: When you have diabetes, your diet is a vital part of your treatment plan. Patients with diabetes need to be more mindful about the foods they eat, and the details, such as calories, total carbohydrates, fiber, fat, salt and sugar. All of these could have the potential to affect their blood sugar levels.

Having a diabetes diagnosis does not take away from the desire to celebrate holidays, though. And while some people choose to not eat for a period of time, or fast, for religious reasons, such as from dawn to sunset during the Islamic holy month of Ramadan, fasting is something that your father should not do without advance planning. I would recommend that you and your father talk with his health care provider about the specifics of his health and the details surrounding his desired fast.

There are potential risks of complications from fasting, such as low or high blood sugar and dehydration. Typically, a person with Type 2 diabetes that is well-controlled, who manages their diabetes with medications and lifestyles, may be OK fasting during Ramadan, so long as they can adjust their medications under the guidance of their care team.

However, there are individuals who may be at high risk of complications if they fast during Ramadan. These individuals would be those who have one or more of the following:

• Type 1 diabetes
• Type 2 diabetes with poor blood sugar control or taking certain types of insulin
• Recent history of severe low blood sugar or diabetic ketoacidosis
• History of recurring low blood sugar or unawareness of low blood sugar
• Conditions such as severe kidney disease or blood vessel complications
• Diabetes and are pregnant

Your father's health care provider may suggest that he avoid fasting all together if he is at high risk of complications. If the decision is made to fast, your father's health care provider and diabetes care team likely will provide you with education about managing his diabetes and adjusting medications or insulin doses while fasting.

The most important thing to remember if your father plans to fast during Ramadan is that he will need to monitor his blood sugar closely, and family members will need to be mindful of signs of low blood sugar, including:

• An irregular or fast heartbeat
• Fatigue
• Pale skin
• Shakiness
• Anxiety
• Sweating
• Hunger
• Irritability
• Tingling or numbness of the lips, tongue or cheek

• Confusion, abnormal behavior or both, such as the inability to complete routine tasks
• Visual disturbances, such as blurred vision
• Seizures
• Loss of consciousness

Low blood sugar, also called hypoglycemia, needs immediate treatment. For many people, a fasting blood sugar of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L), or below should serve as an alert for hypoglycemia. But your father's numbers might be different, so it will be important to have a conversation with him and his health care provider to know what number is too low for him.

Likewise, high blood sugar is something that needs to be watched. Additionally, your father will need to follow his health care provider's advice and suggestions regarding specific food, drink and exercise during the holiday. He should be prepared to adjust his medication doses as appropriate, and, most importantly, be ready to stop fasting if there is an issue.

Fasting during Ramadan can be done safely as long as you and your father take time to understand the risks, identify the best way to help him manage his care and carefully follow the care team's recommendations.