Fasting during Ramadan when you have Type 2 Diabetes

22 April 2020

For people with type 2 diabetes, managing blood sugar levels can be a daily challenge. For Muslim people with Diabetes who choose to fast during of Ramadan, it is even more difficult.

People who observe Ramadan, which occurs this year from April 23 to May 23, do not eat or drink during daylight hours, shifting the times they normally eat their meals as well as changing their sleeping patterns. Going without food or beverages for 11-16 hours a day can cause huge changes in blood sugar levels.

During fasting hours, metabolism adapts to the lack of food and reacts to maintain the constant energy and glucose levels in the body by using energy stored in the liver and fat tissue. Eventually that can affect glucose levels in people with Diabetes.

How a person’s body adapts to fasting depends on the length of the fast, how well blood sugar is being managed before and during the fasting period, and your general health. If you have Type 2 Diabetes, your body can respond with hypo- or hyperglycemia, with blood sugar levels dropping or spiking too high.

However, there are ways to manage Diabetes during fasting.

The metabolic goal during Ramadan fasting, as in all other times of the year, is to maintain blood sugar level as stable as can be, and close to the values that you and your doctor have discussed. It is important that people with Diabetes who want to participate in fasting are in close contact with their healthcare practitioner and follow a personalized nutritional plan, which may include a dietary supplement for people with Diabetes.

A new study performed in Malaysia has confirmed that there is a way to manage blood sugar while fasting and reduce risk of hyperglycemia during Ramadan. The authors of the study looked at a group of participants with Diabetes who followed a structured nutritional program which included a Diabetes specific nutritional formula (DSF) to their pre-dawn (sahoor) and/or as pre-bedtime snack and compared them with fasting patients who did not follow any advice on meal composition during Ramadan. The results showed that the group who followed the complete nutritional plan with DSF had lower pre-dawn and pre-bedtime blood sugar levels and meaningfully better fasting blood glucose. The DSF in the study, Nestlé Health Science’s Nutren Diabetes, contributed to stabilize blood sugar level throughout the day.

The International Diabetes Federation’s (IDF) Diabetes and Ramadan Practical Guidelines (LINK) recommend to patients with Diabetes to use medical nutrition therapy during the fasting period. It is very important that all patients consume an adequate amount of calories with the right nutrients to prevent hypoglycemia. And patients are encouraged to distribute their carbohydrate intake equally among meals to minimize blood sugar spikes following meals.

Whether or not you use a Diabetes specific formula while fasting, the same principles of nutrition apply. According to the IDF, for your morning and evening meals, 40-50% of your calories should come from complex carbohydrates; 20-30% should be protein; and fats should make up less than 35% of your daily calories, with saturated fatty acids comprising less than 10% of that.

A typical meal can consist of vegetables, lean protein, beans/lentils/peas, whole grain rice, two dates, one glass of low-fat milk and one piece of fruit. It is also very important to drink a lot of water or non-sweetened beverages during the night, to avoid dehydration. The key to safe fasting is the right nutrition, consistent blood sugar level monitoring, physical exercise and listening to your body. And don’t hesitate to contact your healthcare provider if you feel unwell.

Healthy tips:

  • Speak to your doctor or nurse before you start fasting
  • Ensure you eat healthy, nutritionally balanced meals with complex carbohydrates, proteins and fats from healthy oils (such as oily fish or olive oil)
  • Drink plenty of water, and non-sweetened beverages
  • Test your blood sugar often, as recommended by your HCP

For more information on managing your Type 2 Diabetes during Ramadan, check out:

Nestlé Health Science Malaysia’s Smart Tips to Manage Diabetes During Ramadan

International Diabetes Federation’s Diabetes and Ramadan: A practical guide

“Comparison of Structured Nutrition Therapy for Ramadan with Standard Care in Type 2 Diabetes Patients” Abstract