Ramadan Fasting and Diabetes

The fast of Ramadan is for Muslims a sacred religious duty and one of the pillars of Islam. However, there are people with chronic diseases for whom fasting may cause serious complications and endanger their health. The largest section of the population at risk are diabetics whose numbers are increasing every year due to change in lifestyle and eating habits in Morocco

Check your blood glucose levels more often than you normally would

Around 2 million people aged over 20 have diabetes, 50% of whom are unaware of being affected by this disease.  According to the Minister of Health, El Houssaine Louardi,  awareness is urgently needed to inform diabetic people about the dangers of fasting and teach them about medical and dietary guidelines to follow.

The risks faced by diabetics who fast are higher this year because Ramadan coincides with hot weather and a fasting period of over 16 hours.

Under pressure from socio-cultural traditions and the burden of guilt associated with non-fasting, the large majority of Moroccan diabetics insist on fasting during Ramadan, despite the real risks they run of serious complications. Yet the Qur'an is clear about the conditions under which a person can be free of the observance of fasting. "(...) One of you who is ill or traveling then will fast the same number of days. Allah seeks to facilitate you the fulfilment of the rule, he does not try to make it hard for you."

According to Dr. Nadia El Ghissassi, an endocrinologist and diabetologist in Rabat, when you have diabetes risks of fasting include: hypoglycemia (low sugar levels in the blood) or hyperglycemia (increased the sugar levels in the blood) and even a diabetic coma. There is also the risk of new or worsening degenerative complications such as damage to the eyes and kidneys, as well as dehydration and increased chance of renal failure, given the number of hours of fasting during the summer.

Dr. El Ghissassi has called patients to consult their doctor and to adjust treatment if needed and know the precautions to follow in order to observe fasting in the best conditions.These precautions, she says, are to ensure to have a perfect glycemic control, drink lots of water between Iftar and Souhour, Iftar that should be a normal meal containing vegetables and pasta or bread and fruit, and at Souhour the meal should contain carbohydrates.

"We must educate patients not to overeat sweets during Iftar and eat salad containing vegetables, food containing protein, starch and fruit without forgetting the dairy product and the same for the Souhour," she says, adding that patients can be satisfied with a fruit or a dairy for dinner.

Dr. El Ghissassi also stresses the need of glycemic self-monitoring, morning, noon, before iftar and bedtime, noting that it is imperative to break the fast in case of hypoglycemia, hyperglycemia or discomfort.

Consult your doctor before fasting

If, after consulting with your doctor, you decide to fast:

If you are taking insulin, you will require less insulin before the start of the fast
The type of insulin may also need changing from your usual type
Pre-mixed insulin is not recommended during fasting
Before starting the fast, you should include more slowly absorbed food (low GI), such as basmati rice and dhal, in your meal, along with fruit and vegetables
Check your blood glucose levels more often than you normally would
When you break the fast, have only small quantities food, and avoid only eating sweet or fatty foods
Try to eat just before sunrise, when you commence the next day's fast
At the end of fasting you should drink plenty of sugar-free and decaffeinated fluids to avoid being dehydrated.

Ultimately, it is a personal choice whether or not to fast. However, if you do choose to fast, then you must consult your doctor to make sure that you are able to look after yourself properly. Failing to do so is in itself contrary to the Qur'an, which clearly states that you must not act in a way that harms your body.


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