Ramadan fasting is obligatory for healthy adult Muslims, however exceptions are given to the sick, elderly, frail, and those with certain conditions like pregnancy and chronic diseases. Diabetes falls into the category of chronic disease, and some people with diabetes are indeed exempted from Ramadan fasting.
Observational studies have shown that people with type 1 and type 2 diabetes are at risk of hypoglycaemia and hyperglycaemia during Ramadan. Ramadan-focused structured diabetes educations have also been shown to reduce these risks, and ensure safer fasting during Ramadan.
EPIDIAR Study: Risks of hypo- and hyperglycaemia during Ramadan
The components of Ramadan-focused structured diabetes education includes risk stratification, glucose monitoring, medication adjustment, dietary advise, physical activity, recognition of hypo- and hyperglycaemia, and when to terminate fasting. This structured educational session is provided by a team consisting of a nurse, dietitian, and the treating physician.
Risk stratification for people with diabetes who wishes to fast during Ramadan is performed using the IDF-DAR risk stratification, and it assigns them into 3 risk categories: low risk, moderate risk, and high risk.
Risk stratification for Ramadan fasting. Image from IDF-DAR (click on image to zoom)
People who are at high risk are advised not to fast, but the decision of fasting is often a personal choice by the person with diabetes. It is important that if the person plan on fasting regardless of their risk level, they should always discuss with their diabetes care providers on ways to minimize risks during Ramadan fasting.
For people with diabetes who opt not to fast, they can pay fidyah as an alternative to Ramadan fasting.