I'm diabetic. How should I manage my condition during Ramadan?

February 20, 2025

If you are diabetic, review the below general guidelines for fasting during Ramadan, you should always consult your physician before starting to fast or implementing a change in treatment.

Disclaimer: This information is designed to provide practical advice for diabetics during the holy month of Ramadan. Any lifestyle or medication changes must be discussed with and approved by a healthcare professional.

Diabetes and fasting

If you are diabetic, you should meet with your physician before starting to fast to determine whether you need to modify your therapeutic plan. Some diabetics may be advised not to fast for fear of complications. This includes people with Type 1 diabetes, and those with Type 2 diabetes who have significant hyperglycemia and hypoglycemia or other significant diabetes complications or comorbidities. 

General advice for diabetics during Ramadan

• It is essential to monitor your blood sugar level closely during Ramadan and consult your healthcare professional immediately if you have problems managing your condition.
• Maintain the quality and quantity of your daily food intake as specified by a nutritionist. Long gaps between food intake and certain diabetes medications (such as insulin or oral diabetic medications) are well-known risk factors for hypoglycemia (low blood sugar). Some diabetic patients might require adjustments to their insulin or oral diabetic medications doses.
• Divide your daily food intake into two main moderate meals for Iftar and Suhoor, plus a light meal in between.
• It is advised to delay Suhoor until just before dawn (Imsak).
• Do not consume large quantities of food or drink that contain lots of simple sugars (such as table sugar) or saturated fat.
• You should aim to exercise three hours after Iftar and not while you are fasting.
• You may want to schedule a follow-up consultation with your physician after Ramadan to discuss any necessary readjustments of your medication(s).

Breaking your fast

You are advised to break your fast and seek medical assistance if you experience any of the following:

1. Documented hypoglycemia or symptoms of hypoglycemia.
2. If you have Type 1 diabetes, and your blood sugar is more than 250 mg/dl with the appearance of ketones in the urine or blood analysis.
3. If you have Type 2 diabetes and your blood sugar level is more than 300 mg/dl with symptoms of excessive urination.
4. If you develop dehydration or other conditions such as fever or diarrhea, then you should break your fast, drink a lot of water, and seek medical assistance.

General recommendations for managing diabetes medications and therapies

Diet and exercise therapy

Note: It is important to discuss changes with your clinician first.

If before the holy month of Ramadan you control your diabetes with diet and exercise, then during the holy month of Ramadan you should:

• Avoid exercise if your blood glucose is low
• Avoid exercise before sunset meal (Iftar)

Oral diabetes medications

Metformin

Your pre-Ramadan dosing schedule may require modification:

• Once-daily before Ramadan | No change required during Ramadan.
• Twice-daily before Ramadan | Take first dose with sunset meal (Iftar) and second dose at predawn meal (Suhoor) during Ramadan.
• Thrice-daily before Ramadan | Combine morning and afternoon dose with sunset meal (Iftar) and take evening dose with predawn meal (Suhoor) during Ramadan.

Sulfonylureas e.g. Gliblenclamide, Glimepiride, Glipizide

Your pre-Ramadan dosing schedule may require modification:

• Once-daily before Ramadan | Take before sunset meal (Iftar). If blood glucose is well controlled, dose may be reduced during Ramadan.
• Twice-daily before Ramadan | One full dose to be taken before sunset meal (Iftar) and half of the dose before predawn meal (Suhoor) during Ramadan.

Pioglitazone, Linagliptin, Empagliflozin, Dapagliflozin

Dose should be taken with sunset meal (Iftar).

Dulaglutide, Liraglutide, Semaglutide injections

For patients already active on the once-daily or once-weekly formulations, no change is needed during Ramadan.

Insulin

Note: Diabetic patients using insulin should ensure adequate fluid intake.

Basal-Bolus insulin

Basal insulin | Dose should be reduced by 20% and taken before the sunset meal (Iftar).

Rapid acting insulin with meals

• Usual pre-lunch dose should be skipped
• Same morning dose with sunset meal (Iftar)
• Half of the dinner dose with predawn meal (Suhoor)

Mixtard insulin

Twice daily | Use usual morning dose at sunset meal (Iftar) and half usual evening dose at predawn meal (Suhoor).

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