Fasting Safely for Ramadan With Type 1 Diabetes

Every year, nearly two billion Muslims around the world observe Ramadan. If you’re reading this mid-Ramadan, you already know: fasting with diabetes takes more than willpower. It takes planning, monitoring and sometimes tough calls about when to break your fast.

Fasting during Ramadan—known as Sawm—is one of the five pillars of Islam. For 29 to 30 days, Muslims abstain from food, drink and oral medications from dawn to sunset. It’s a time of discipline, gratitude and deep connection to faith. For the roughly 150 million Muslims living with diabetes worldwide, it also means managing real shifts in blood sugar (BG), medication timing and energy levels.

Research suggests about 79% of people with type 2 diabetes and 43% of people with type 1 diabetes fast during Ramadan—many without support from their care team. Let’s talk about how you can do it as safely as possible.

Islam exempts people who are sick or have a medical condition from the fast. Whether or not to fast is a personal and spiritual decision—one best made with both your health care team and your Imam. This guide is not medical or spiritual advice, but a starting point.

How does fasting affect blood sugar?

Going without food, water and oral medications for 10 to 21 hours a day—depending on where you live—changes how your body manages glucose.

If you take insulin or medications like sulfonylureas, the risk of low blood sugar (hypoglycemia) is higher during fasting hours. After iftar (the meal at sunset), larger or carb-heavy meals can push blood sugar up quickly.

The IDF-DAR guidelines group fasting risk into three categories—very high, high and moderate/low—based on your type of diabetes, how stable your blood sugar has been, your medications and any existing complications. If you haven’t already, talk to your health care team about which category you fall into.

One thing worth knowing: checking your blood sugar and taking insulin do not break the fast. A continuous glucose monitor (CGM) can be especially useful right now. The IDF recommends checking blood sugar at suhoor, mid-morning, midday, mid-afternoon, at iftar, two hours after iftar and any time you feel off.

When should you consider breaking your fast?

Islam makes exceptions for people with medical conditions during Ramadan—not observing does not mean disobeying your faith. Should you choose to fast, here are some important signs to watch for. Any of these means it’s time to break your fast right away:

• Your blood sugar drops below 70 mg/dL (3.9 mmol/L)
• Your blood sugar rises above 300 mg/dL (16.6 mmol/L)
• You feel symptoms of a low—sweating, shaking, dizziness or confusion
• You notice signs of diabetic ketoacidosis (DKA)—nausea, vomiting, stomach pain or fruity-smelling breath.
• You feel dehydrated or unwell

Breaking the fast to protect your health is consistent with the Qur’an, which is clear that you should not act in a way that harms your body (Al Baqarah 2:195).

What to do at suhoor and iftar

Suhoor (predawn meal): Don’t skip it. This meal is your fuel for the day. Go for high-fiber, slow-digesting foods like oats, eggs, lentils or whole grains. Drink plenty of water and sugar-free fluids before the fast begins.

Iftar (breaking the fast): Start small. Water and a date or two is a traditional way to break—then wait before a fuller meal. This can help prevent a sharp blood sugar spike. Watch portion sizes on starchy and sugary foods and go easy on fried or heavily sweetened dishes. If you’re heading to Taraweeh prayers after iftar, eating some starchy foods like rice or beans and hydrating well beforehand can help you feel steady.

What about medications and insulin?

Your medication plan during Ramadan may need to look different than the rest of the year. Ideally, this conversation with your health care team happens one to two months before Ramadan begins. But if you’re already fasting and haven’t had that talk, it’s not too late. Reach out now.

Adjustments might include changes to insulin doses and timing, switching to medications with a lower risk of hypoglycemia or shifting when you take oral medications to line up with suhoor and iftar. Don’t make changes to your medication on your own.

Key takeaways for safe fasting during Ramadan

• Talk to your health care team and spiritual advisor before, during and after Ramadan
• Check your blood sugar frequently—it does not break the fast. Neither does injecting insulin
• Know the warning signs for highs and lows and when to break the fast
• Loop your community into your care. Educating family and friends on signs of dangerously low blood sugar or DKA makes your health plan stronger
• Don’t skip suhoor. Go for slow-digesting, high-fiber foods and hydrate well
• Ease into iftar. Water, a date, then a balanced meal
• Schedule a follow-up with your care team after Ramadan ends

Ramadan Mubarak. For more tools and support for life with diabetes, check out the Beyond Type 1 Community Guide.