People with diabetes are being advised to consider the risks is they are fasting during the Muslim holy month of Ramadan.

Ramadan sees Muslims fast from sunrise to sunset for 29 or 30 days.

Although exempt, some Muslims with medical conditions such as diabetes may sometimes still choose to fast, and with careful support and advice, along with shared decision-making regarding treatment plans, successful health outcomes and safe fasting can be achieved.

Dr Waqas Tahir, a diabetes specialist has shared advice for families and friends to take into consideration when supporting someone living with diabetes who is fasting during the holy month.

Diabetes is a condition that causes a person's blood sugar level to become too high. Type 2 diabetes is far more common than type 1 – particularly among people of Asian descent. In the UK, over 90% of all adults with diabetes live with type 2.

When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it's broken down to produce energy.

However, if you have diabetes, your body is unable to break down glucose into energy. This is because there's either not enough insulin to move the glucose, or the insulin produced does not work properly.

Dr Tahir said “During the holy month of Ramadan, there have been many of my Muslim patients living with diabetes who have chosen to fast. The first thing I ask them is whether fasting is appropriate for them, why they’re choosing the fast over other options and whether it’s the right decision for them. 

"Together, we then look at their present health risks and how their bodies may have responded to fasting in the past.

“Breaking the fast is a time to come together, but many families and friends may be worrying about how best to support someone living with diabetes through Ramadan this year. So, here are my top tips.”

“Diabetes is a complex condition, and regardless of your type, food and exercise can make a big difference to how you feel.

“A healthy Ramadan plate should be 45/50% carbohydrates, 20/30% protein and less than 35% fat. 

“A lot of our food can be processed and high in fat, so when cooking for someone living with diabetes after the fasting hours, consider healthier food swaps, like substituting desserts with a healthy alternative like fruit, and choosing foods with low glycaemic index (GI), such as basmati rice or wholemeal roti. Consider using an air fryer to cook things you’d normally fry in oil, like samosas.”

Dr Tahir said:  “Usually, moving more often is important for people living with diabetes to balance glucose levels. But during Ramadan, too much exercise and physical activity is not recommended. 

"So make sure there isn’t too much unnecessary overexertion and reconsider the timing of activities in your day.

“Prayers like the Taraweeh prayer – mandated during Ramadan – is quite physical, as it involves repeated cycles of rising, kneeling, bowing down, and so should be considered as part of their daily exercise.”

Why regular monitoring is essential

Dr Tahir advised being close to your glucose levels during a fast is paramount.  

He said: "A continuous glucose monitor (CGM) is the easiest way to do this. Where a finger prick test measures glucose in the blood at one moment in time, CGMs provide updates every minute so you can see how your body is responding to changes. 

“Until recently, this technology was only accessible to people with type 1 diabetes, but now it’s become more available to people with type 2.

“Studies have shown that CGMs can improve a patients’ safety during fasting, and some CGMs like Abbott’s FreeStyle Libre 2 system also allow close family, friends and caregivers the opportunity to see how glucose levels are responding through their caregiver app LibreLinkUp. This allows you to be more aware of how the fast is impacting them and can even provide alarms and alerts if people are reaching dangerous levels, so action can be taken."

Don't be afraid to break the fast

Dr Tahir said people should approach fasting sensibly.

"When putting the body under stress, it’s vital that you listen to what it’s telling you.

“We should all drink plenty of water when possible, but people with diabetes may be at more risk of dehydration during Ramadan, so encourage them to drink more fluids during sundown and sunrise and minimise the consumption of caffeinated and fizzy drinks.

"If someone has tried fasting before, think about what was learnt and consider strategies based on how their bodies have responded previously to stay safe.

“A person living with diabetes will be at a higher risk of experiencing dangerously low blood sugar levels two hours prior to opening the fast, during the twilight period.

"This is because whatever they’ve previously eaten will have already been absorbed and the body is looking for reserves. If they need to break the fast to eat something, again, it’s so important that they are supported to do so.

“Ramadan is part of a core pillar of Islam to exercise self-control and feel closer to God. But remember, it’s not the only pillar, and the word ‘control’ must be taken seriously. If you are fasting this year, plan well, take learnings from previous fasts, and remember to put health needs first.”

If it is not safe then I don't fast

Muhammad Ali, 31, from Rochdale is a professional boxer who lives with Type 1 diabetes and has trained during Ramadan in the past.

He said: “A person’s faith is individual to them, and Islam teaches us to take a ‘common sense’ approach - there are so many ways to show devotion and to support others during the holy month.

"I’ve learnt that it’s just not safe for me to observe the fasting period completely, particularly during the spring and summer fasting hours of recent years. For someone who has to carefully manage glucose and energy on a daily basis anyway, the full duration of the day can be too long to go without food, drink and medication. 

“I know this because I’ve seen how I have responded to fasting in the past. Being able to keep a close eye on my sugar levels and manage my food intake has been so important when I’m trying to fast.

"I’ll tailor the timings of my training and nutrition programme to fit around the sun and use my Abbott FreeStyle Libre 2 system throughout the day to closely monitor how I’m responding and make sure I’m staying safe. 

“As Ramadan moves closer to winter, I might try to observe the fast again, working closely with a doctor or nurse. If you live with diabetes, it’s important to consider them as a partner in your fast. Listen to their advice and it’s OK to break the fast if it’s not safe.”