Ramzan fasting with diabetes — what we plan with our patients

Ramzan begins on **February 28, 2026** (subject to moon sighting). For patients with diabetes, the safety of fasting depends on disease type, current control, and current medication. We see fasting-planning appointments three weeks before Ramzan and have a clear framework.

The IDF-DAR risk categories

The International Diabetes Federation and Diabetes & Ramzan alliance puts patients into four risk levels.

Very high risk — do NOT fast

• Type 1 diabetes
• HbA1c above 9.0%
• Frequent hypoglycaemia (more than 2 episodes per week)
• Severe hypoglycaemia in the last 3 months
• Diabetic ketoacidosis in the last 3 months
• Pregnancy with pre-existing diabetes
• Active acute illness

We have a frank conversation with these patients. Most Islamic scholars accept medical exemption from fasting; missed fasts can be made up later or substituted with fidya. We will not give "permission to fast" against this profile.

High risk — fast with caution

• HbA1c 7.5–9.0%
• On insulin (any type)
• On sulphonylureas (gliclazide, glimepiride)
• Stable chronic complications (mild kidney disease, mild retinopathy)
• Over 75 years

These patients can usually fast 15–20 days of Ramzan with careful planning — modified medication, SMBG (self-monitoring of blood glucose) before sehri, midday, before iftar, and 2 hours post-iftar.

Moderate / low risk — can fast with adjustments

• HbA1c below 7.5%
• Well-controlled type 2 diabetes on oral metformin or DPP-4 inhibitors alone
• No significant complications
• Under 65 years

These patients usually fast safely. Medication timing shifts from morning-evening to sehri-iftar, doses are adjusted by ~25% on the smaller meal, and we set thresholds for breaking the fast (glucose < 70 mg/dL or > 300 mg/dL on SMBG).

The fast-breaking thresholds

Every fasting diabetic patient leaves our clinic with these written numbers:

• Break the fast if SMBG < 70 mg/dL at any check.
• Break the fast if SMBG > 300 mg/dL at any check (this is hyperglycaemia + dehydration risk).
• Break the fast if symptomatic hypoglycaemia — sweating, shakiness, confusion — regardless of number.
• Drink water first, then 1–2 dates, then check sugar in 15 minutes.

What we adjust in the medication

• Metformin: timing shift only — full dose with iftar, half dose with sehri.
• DPP-4 inhibitors: no change.
• SGLT-2 inhibitors (empagliflozin, dapagliflozin): we usually pause these during Ramzan — dehydration risk. Restart after Eid.
• Sulphonylureas: reduce by 25–50%, shift to iftar only.
• Insulin (basal-bolus): long-acting reduced 15–20%, mealtime insulin restructured around iftar + sehri only.
• Pre-mixed insulin: typically not recommended for fasting; we switch to basal-bolus 4 weeks before Ramzan.

Three weeks before Ramzan — book an appointment

If you have diabetes and intend to fast, book a Ramzan-planning consultation **at least three weeks before Ramzan starts**. We need time to: review your control, run an HbA1c if it's been more than 3 months, adjust your medications gradually, and train you on SMBG if you're not already monitoring.

This is not an emergency visit. It's a planning visit. Do not wait until day 3 of Ramzan with a hypo episode to think about this.

WhatsApp us to book — usual fees apply, insurance panels covered.