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Wednesday, April 10, 2013

Fasting and Diabetes: Hand of God?

Fasting during Ramadan, a holy month of Islam, is an obligatory duty for all healthy adult Muslims.

Ramadan is a lunar based month and depending on the region and season, the timings of the fast may vary from a few hours to more than 20 hrs.
Muslims who fast during Ramadan must abstain from eating, drinking, use of oral medications, and smoking from predawn to after sunset; however, there are no restrictions on food or fluid intake between sunset and dawn. Most people consume two meals per day during this month, one after sunset, referred to in Arabic as Iftar (breaking of the fast meal), and the other before dawn, referred to as Suhur (predawn).

The sick are exempt from fasting as it may pose a serious health hazard. Diabetics fall in this category because their chronic metabolic disorder may place them at high risk for various complications if the pattern and amount of their meal and fluid intake is markedly altered.


Fasting during Ramadan has been uniformly discouraged by the medical profession for patients with diabetes. Fasting works against the principles of diabetes management. The small, frequent meals advised in diabetics turn into 2 large meals during fasting. The fluid intake drastically drops. Gorging and compensatory eating is difficult to avoid during the non fasting period. The daily exercise routine has to stop since it is not humanly possible to continue it during the fast and equally difficult to pursue during the non fasting period due to lack of time. The doses of all medications need to be altered predisposing to various complications. In keeping with this, a large epidemiological study EPIDIAR conducted in 13 Islamic countries on 13,000 individuals with diabetes who fasted during Ramadan showed a high rate of acute complications.


Needless to say, decreased food intake predisposes to severe hypoglycemia during the fasting period. This is much more so in those patients whose sugars are tightly controlled.


Most likely due to excessive reduction in dosages of medications to prevent hypoglycemia. Increased sugars in turn increase the risk of micro as well as macro vascular complications.


Type I diabetics are more prone to this complication especially if their sugars are poorly controlled.


Markedly reduced fluid intake coupled with increased urine frequency in uncontrolled diabetics may result in dehydration and electrolyte imbalance. This could lead to thrombosis. A report from Saudi Arabia suggested an increased incidence of retinal vein occlusion in patients who fasted during Ramadan.

It may be re-emphasized here that fasting is a personal decision significantly based on religious sentiments.

Several studies have been published later on the effects of fasting; some of the results are controversial. Most of them conclude that Ramadan fasting leads to significant body weight reduction and improvement of glycaemic control in diabetic patients with out other significant metabolic changes in lipids, uric acid and renal functions.

Despite the potential health risks of fasting in diabetics, the majority of studies have not shown significantly high rates of complications. On the contrary, there has been an improvement in the sugar levels during periods of fast. The underestimation of the incidence of hypoglycemia is however due to the fact that very few patients have a tight control of their glucose levels during the pre Ramadan period. But how do we explain the low incidence of the other known complications? We may have to accept the involvement of a Heavenly Hand in the protection against these untoward events.

I would like to conclude on a scientific note that the bulk of literature indicates that fasting in Ramadan is safe for the majority of diabetics patients with proper education and diabetic management. The patients on their parts need to be conscious of their disease and be compliant with their diet and drug intakes.


  1. i agree with u.proper education and medical management will definetly reduce the chances of any complications like hypo or hyperglycaemia during ramadan fasting.

  2. i thnk new drug of dpp4 will reduce drug induced hypoglycemia a boon for diabtic pt who want to do fast in ramzaan