08/02/2026
Quick guide on Management of Diabetes During Ramadan Fasting for HCP
🔍 1️⃣ Pre-Ramadan Assessment & Risk Stratification
All patients with diabetes should undergo pre-Ramadan evaluation, ideally 6–8 weeks before fasting.
Key components include:
📌Glycaemic control (HbA1c, glucose variability)
📌History of hypoglycaemia or hyperglycaemia
📌Type of diabetes therapy (oral agents, insulin)
📌Presence of complications (CKD, CVD, pregnancy, elderly)
📌Patient education and self-monitoring ability
✍️Patients should be stratified into low, moderate, or high risk, guiding fasting recommendations and management plans
💊 2️⃣ Medication & Insulin Adjustment
Changes in meal timing during Ramadan necessitate individualised dose and timing adjustments:
🔽Reduce or reschedule hypoglycaemia-prone agents
🔁Modify insulin regimens (basal, premix, bolus)
🔁Avoid unsupervised medication changes
📌 Adjustments should be planned and supervised to minimise fasting-related complications
📊 3️⃣ Glucose Monitoring During Fasting
Self-monitoring of blood glucose (SMBG):
Does NOT invalidate fasting
Is strongly recommended for patient safety
Suggested monitoring times:
🩸Pre-suhoor
🩸Mid-day
🩸Pre-iftar
🩸Whenever symptoms occur
SMBG is essential for early detection and prevention of complications
⚠️ 4️⃣ Complications of Fasting in High-Risk Patients
High-risk patients who fast may develop:
🆘Severe hypoglycaemia
🆘Marked hyperglycaemia, DKA or HHS
🆘Dehydration and acute kidney injury
🆘Cardiovascular events, syncope, falls
⚠️ Fasting in high-risk individuals may cause significant harm and hospitalisation
🛑 5️⃣ When to Break the Fast
Patients must be clearly counselled to break the fast immediately if:
❌Blood glucose < 3.9 mmol/L
❌Blood glucose > 16.7 mmol/L
❌Symptoms of hypoglycaemia, dizziness, confusion, or weakness occur
Patient safety takes precedence over continuation of fasting
✅ Key Takeaway
Fasting during Ramadan for patients with diabetes should be:
✔ Planned
✔ Individualised
✔ Monitored
✔ Safety-driven
Safe fasting is achieved through shared decision-making between clinicians and patients, supported by education and structured follow-up.
