As Muslims in the Midlands prepare for the Holy Month of Ramadan — starting at the end of this week — one NHS diabetes expert in the Midlands are offering important advice for people with diabetes who may be considering fasting during this time in a series of short videos

While fasting is an important aspect of many religions including Islam, it can lead to major health problems for some people. People with diabetes should carefully consider their individual, medical circumstances before fasting and consult with their GP or their healthcare team, advises Diabetes UK.

According to regionally published NHS data, over a quarter (10,610) of those starting diabetes prevention programmes (41,820) are Asian, Black or Mixed Race. For the West Midlands, 28% (8,450) of those starting diabetes prevention programmes (30,165) are Asian, Black or Mixed Race. (NHS Diabetes Prevention Programme, Midlands Referral and MS1 data by Ethnicity for Framework 3 up to 31st December 2024)

Professor Azhar Farooqi, Co Clinical Director, Midlands Diabetes Clinical Network, NHS Midlands said: “If you are diabetic and are interested in fasting this Ramadan, your GP practice or diabetes specialist may be able to advise if it is safe for you to fast, or if you need to make any adjustments to your treatment when fasting. Please talk to them first.

“For people with diabetes, it is very important to carefully choose your foods and drinks during Ramadan and monitor your blood sugar, so that you don’t trigger high or low blood sugar situations that could put your health seriously at risk. For instance, there’s a risk that your blood sugar levels during or after fasting could become too low (a hypo). If you do have a hypo during fasting, it is important to break the fast and treat the hypo with your usual hypo treatment.

“Whatever your informed choice is about fasting, have a safe and blessed Ramadan.”

Peter Shorrick, Head of Midlands and East at Diabetes UK, said: 

“Choosing whether to fast is a personal choice. However, getting information and advice ahead of Ramadan is essential and can help you decide whether it is safe for you to do so.  Speak to your healthcare team to understand the potential risks for you.

“Fasting affects your body in different ways and if you are living with diabetes there may be increased risks such as hypoglycaemia. There is also the risk of dehydration and hyperglycaemia which can lead to diabetic ketoacidosis (DKA) – a condition that can require emergency hospital treatment.”

GENERAL ADVICE FOR PEOPLE WITH DIABETES DURING RAMADAN (with video links)

1. Before fasting: seek medical advice

• It is a personal choice whether or not to fast. If you do choose to fast, then you must consult your doctor to make you’re able to look after yourself properly
• Your GP practice or diabetes specialist may be able to advise if it safe for your to fast, or if you need to make any adjustments to your treatment when fasting
• If you are putting your health at serious risk by fasting, you are usually exempt from fasting.  For example, if you treat your diabetes with insulin or have diabetes complications such as damage to your eyes, kidneys or nerves in your hands and feet, then you are exempted from fasting.

2. While fasting: monitoring your blood sugar

• There is a risk for diabetics that your blood sugar levels during or after fasting could become too low (a hypo). If you do have a hypo during fasting, it is important to break the fast and treat the hypo with your usual hypo treatment.
• If your blood sugar levels become too high, this could lead to diabetic ketoacidosis (DKA), which would require hospital treatment.
• If you are diabetic and fasting and have high blood sugars, it is important to break the fast with some water and treat as you normally would to reduce the risk of dehydration and DKA. Speak to your GP or healthcare team in advance about how to manage high blood sugars during fasting.

3. While fasting: dietary choices

• Your eating patterns during Ramadan can vary depending on the fasting, suhoor/iftar and prayer schedules. It’s important to keep to a balanced way of eating, including food from all of the food groups.
• Include more slowly absorbed foods (that have a lower glycaemic index) just before you begin the fast. Low GI foods include fruits and vegetables, unsweetened milk, nuts, pulses, some wholegrain cereals and bread.
• Choosing these types of foods will help to fill you up and keep your blood glucose levels more even during the course of the fast.  Be mindful of portion sizes of carbohydrate containing foods. Fruits, vegetables and salad should also be included.
• When you break the fast, include only small quantities of sugary and fatty foods such as Indian sweets, cakes, samosas and puris. Use less oil in cooking and try grilling, baking or dry frying food using a non-stick pan or air fryer.

4. Hydration: fluid intake/choice at suhoor/iftar

• Staying hydrated during Ramadan with plenty of water, regardless of weather, is one of the more important aspects of fasting.
• Drink sugar-free and decaffeinated drinks to avoid dehydration, such as water, diet fizzy drinks or no-added sugar squashes. If you like sweet drinks then use a sweetener instead of sugar.