According to the 2021 IDF–DAR guidelines, many individuals with diabetes can safely fast if their condition is stable. However, the decision must be made after a clinical assessment that includes:
Blood glucose stability over the preceding weeks.
Absence of frequent episodes of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).
Consulting a physician before Ramadan to determine the individual’s risk category.
Furthermore, ADA/EASD (2020) guidelines recommend categorizing patients into risk levels before granting permission to fast.
Based on research published in BMJ Open Diabetes Research & Care and the IDF–DAR guidelines:
Blood sugar levels gradually decrease with food abstinence.
The body begins utilizing glycogen stores, followed by fat, as primary energy sources.
The greatest risks include acute hypoglycemia or sudden hyperglycemia due to an imbalance between medication and nutrition.
Consequently, medication dosages must be adjusted in coordination with a healthcare provider.
The IDF–DAR guidelines recommend:
Protein consumption: Eggs, yogurt, and cheese.
Slow-release carbohydrates (Low GI): Brown bread, oats, and legumes.
Avoiding sugars: Steer clear of sweets and rapidly absorbed juices.
Consume only 1–2 dates to prevent a rapid glucose spike.
A balanced meal: Vegetables + Protein + a moderate portion of complex carbohydrates.
Minimize fried foods and traditional desserts.
These recommendations are supported by IDF–DAR and ADA/EASD.
International guidelines (IDF–DAR, ADA/EASD, ISPAD) confirm that:
Checking blood sugar levels does not invalidate the fast.
Testing is mandatory upon feeling fatigued, dizzy, shaky, or experiencing headaches.
If severe hypoglycemia or hyperglycemia is detected → you must break the fast immediately to prevent serious complications.
According to IDF–DAR and BMJ recommendations, break your fast if you experience:
Excessive sweating or tremors.
Dizziness or mental confusion.
Heart palpitations or severe headaches.
Unusual exhaustion.
Blood sugar levels: Below 70 mg/dL or above 300 mg/dL (based on your doctor’s specific instructions).
Breaking the fast in these scenarios is a medical necessity to prevent acute hypoglycemia or Diabetic Ketoacidosis (DKA).
Engage in light activity after Iftar.
Avoid strenuous physical exertion while fasting.
Consult your doctor regarding suitable exercises, especially for Type 1 diabetics or those on insulin.
These recommendations align with ISPAD guidelines for youth with diabetes.
Fasting is possible for many, but only after a rigorous medical evaluation.
Structured nutrition, medication adjustment, and frequent monitoring are the pillars of safety.
Breaking the fast when danger signs appear is a medical obligation, not a choice.
International guidelines prioritize the patient's safety above all else.
Dr. Suzan Wadih Alshammas Dr. Suzan Alshammas
