Diabetes Ramadan Guidelines 2010
As you know Ramadan is the ninth month of the Islamic
lunar calendar. Ramadan begins with the sighting of the new
moon and the date changes each year. During this time all
healthy physically mature Muslims are required to fast from
sunrise to sunset. People with diabetes can be exempt from
fasting during Ramadan but many still prefer to participate
during this important time. It is advisable that people with
diabetes who wish to participate in fasting should seek
medical advice regarding Ramadan for support and guidance
to help reduce risks.
It can be a challenge for people with diabetes to maintain
good diabetes control during Ramadan. In the U.K the length
of fasting this summer will be approximately 17 hours
commencing around the 11th August until 10th September.
The time between Iftar and Sehri will be 7 hours
To enable you to fast safely this leaflet includes
important advice you should follow:
Complications that may occur during fasting include:
• Hypoglycaemia “hypo’s” – blood glucose level below
4mmols/l. This applies for those treated with insulin and/or
medication that stimulates insulin secretion e.g. Gliclazide,
Glimepiride.
• Dehydration particularly in individuals with poorly
controlled diabetes
• Hyperglycaemia – blood glucose levels persistently above
13mmols/l
• Constipation due to not enough fibre and fluid intake
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• Indigestion from over indulgence of fried and spicy foods
The
following
factors
increase
the
risk
of
complications from fasting:
• Type 1 diabetes with unstable diabetes control
• Type 1 and type 2 diabetes with poor diabetes control
• People with kidney impairment as there is a risk of
dehydration and deterioration of kidney function
• People who have reduced awareness of hypoglycaemia or
frequent hypos
• People with Type 1 diabetes who have had a recent
ketoacidosis event
• Women who are pregnant or breastfeeding these women
are strongly advised not to fast.
You may be advised against fasting if any of the above
applies.
Recommendations for Fasting
Your diabetes control is still important during Ramadan and
your blood glucose levels need to be near to normal as
possible. As a general guide it is recommended that:• Breakfast (Sehri) is eaten sometime before dawn or 1-2
hours before dawn. A good choice for breakfast would be
perhaps a high fibre or oat based cereals, granary or whole
meal toast and fruit with yoghurt.
• The fast is usually broken (Iftar) with snacks such as 1-3
dates and water with the meal consumed shortly after
Sunset.
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 As the fast this year will be longer and broken later in
the evening, try to break the fast with foods that have
a lower glycaemic index (GI) such as fruit, yoghurt,
chick peas, lentils, with smaller portions of rice or
chappati with your meal
 Foods which are high in fibre such as wholemeal bread,
cereals and fruit are more filling and will help promote
good bowel health.
 Asian sweets are also high in calories and so people
with diabetes should eat small amounts of these, or
only as a special treat.
 Foods which are fried such as pakoras or samosas
should be consumed only in small amounts as a treat
 Try to drink plenty of clear fluids such as water, sugar
free squashes or diet drinks. Use sweetener in tea and
coffee if required to prevent dehydration.
Medication
ORAL HYPOGLYCAEMIC AGENTS such as Metformin or
Acarbose
These medications do not cause people to experience
Hypoglycaemia or “hypos” so no change to this medication is
required. It is recommended that these tablets should be
taken with food therefore when a person is fasting it is
advisable to miss the dose at lunchtime when not eating.
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Once Ramadan and your fast is over you should go
back to your normal doses as before.
Thiazolidinediones (Glitazones)
No changes will need to be made to glitazone
treatment as it is usually only a once or twice daily
regime.
These medications do not cause hypoglycaemia unless they
are taken with insulin or tablets called sulphonylureas (such
as Gliclazide) or prandial glucose regulators (such as
Nataglinide) and it is those treatments that will need
adjustment if hypoglycaemia is a risk or problem.
Sulphonylureas (Glimepiride Gliclazide)
Medications such as Gliclazide or Glimepiride are drugs for
diabetes which can cause hypoglycaemia. Care as to when
and how they are taken, needs to be planned for when
fasting.
Problems such as Hypoglycaemia related to these tablets
can be avoided by making changes such as
 Glimepiride taken once daily when the fast is broken
during the month of Ramadan
 Gliclazide if you normally take 2 tablets morning and
evening take only one tablet in the morning during
fasting for Ramadan.
 If you take two tablets in the evening continue as
normal.
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 If you take one tablet morning and one tablet evening
no change required
 Longer acting tablets such as Glibenclamide must be
changed see your GP or Nurse to switch to a more
suitable tablet prior to Ramadan. This will be a
permanent change.
 If you find you are still experiencing hypo events
during Ramadan you may need to talk to your diabetes
team.
 Further dose reductions may be needed.
Gliptins tablets such as Sitagliptin, Vildagliptin or
Saxagliptin
No change required
These tablets are once daily preparations and taken more
commonly with other oral medications for diabetes and are
less commonly associated with Hypoglycaemia.
Insulin Therapy
Individual advice is important if you plan on fasting for
Ramadan and are taking insulin therapy with or without
tablets for your diabetes. Contact your health care
professional for specific advice, but the following general
guidelines may help to prevent problems.
One injection per day
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 If taking a once daily injection of long acting insulin
such as Lantus or Levimir no need to change the dose
unless you find after - fasting for a few days you are
experiencing hypos, if this is the case it would be
advisable to reduce your dose by 2-4 units during
fasting period. It would then need to be increased after
Ramadan finishes.
Two injections per day
 If taking twice daily injections of a mix 30, mix 25 or
mix 50 insulin the change depends on the amount of
insulin injections you take - for example, if you take 40
units before breakfast and 32 units before evening
meal it would help to reverse the injections during
fasting, i.e.: take 32 units before breakfast and 40
units before evening meal. If you are taking the same
amounts with both meals the Sehri (morning) dose
will need to be reduced by about 30% e.g. 50
units would be reduced to 35 units. However the
Sehri dose may require further reduction if you
experience low blood glucose levels during the day.
Remembering to go back to your normal doses
after Ramadan finishes.
Three injections per day
 If you are on a three times daily mix you would need to
miss out the lunchtime dose and follow the above
instructions remembering to go back to your
normal doses after Ramadan finishes.
Four injections per day
 If you are on a basal bolus or 4 injections per day you
would need to take your long acting insulin as normal
or at the same time as when breaking the fast. Take
your rapid acting insulin only when you eat, if your
meal is higher in carbohydrates than normal you may
need to increase this dose. One way to check if you
have given the correct amount is to test 2 hours after
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eating. If your result is under 10mmol/l you have
estimated correctly.
Exenatide (Byetta)
This treatment by injection for your diabetes is unlikely to
cause Hypoglycaemia unless taken with Sulphonylurea such
as Glimepiride which may cause hypos. There is no need to
change the injection as it is a fixed dose but it is important
that it is given before food and there is 6 hours
between the 2 injections.
Checking your blood glucose levels
It is important to check your blood glucose levels during
fasting especially if you feel unwell or think you may be
hypo, it is not breaking your fast as you are not putting
anything into your body to break the fast.
If you have hypo symptoms or your blood glucose level is
below 4mmol/l you must break your fast it is important
to treat a hypo should it occur during your fast with
the correct amount of glucose.
Patient information leaflets are available from your practice
nurse or diabetes team to help with your diet or
hypoglycaemic events.
Liraglutide (Victoza)
This treatment by injection for your diabetes is unlikely to
cause Hypoglycaemia unless taken with Sulphonylurea such
as Glimepiride which may cause hypos. There is no need to
change the injection as it is a fixed dose. However this
injection may normally be given during the time you are
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fasting. Taking your injection as normal will not be
breaking the fast. But if you are not happy to take the
injection whilst fasting it should be taken when you break
the fast.
Hypoglycaemia
Symptoms
 Tingling hands, feet, lips
tongue
 Sweating
 Dizziness
 Trembling Hunger
 Blurred vision
 Difficulty in concentration
 Palpitations
 Occasional headaches
Any blood glucose (sugar)
or level under 4mmol/l should
be treated with Glucose
such as Lucozade or a
small glass of any sugary
pop or 3-4 glucose tablets
or jelly babies. This will
work to bring your blood
glucose levels back up to
normal but you may also
need a small snack such as
fruit, cereal or toast if it is
not your meal time.
After Ramadan
Go back to taking your medication as it was taken
before Ramadan started. Check that you are taking
the correct dosages of all of your medications.
Eid Mubarack
Diabetes Team
Horton Park
Bradford
Tel: 0845 111 4002
Review date June 2010
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