Fasting With Diabetes in Ramadan: How to Stay Safe (and When Not to Fast)

Ramadan is a deeply important month for millions of families in Bangladesh. For people with diabetes, it also raises real health questions: Is it safe to fast? What about my tablets or insulin? What if my sugar drops in the afternoon?

NHS diabetes experts stress that whether to fast is a personal choice, but if you choose to fast with diabetes, talk to your doctor first so you can do it as safely as possible. This guide brings together NHS advice on fasting with diabetes, with practical tips for Bangladeshi sehri and iftar — and some notes for people with high blood pressure.

Islam provides exemptions for people whose health would be seriously harmed by fasting. NHS guidance notes that people who treat diabetes with insulin or have complications affecting the eyes, kidneys or nerves are usually exempt. Discuss this with your doctor and, if you wish, a religious scholar.

Step 1: Talk to Your Doctor Before Ramadan

NHS England diabetes guidance advises consulting your doctor before fasting. They can tell you:

• Whether it's safe for you to fast
• Whether your medicines need changing — dose, type or timing
• How often to check your blood sugar
• What to do if your sugar goes too low or too high

Who is at higher risk?

Talk to your doctor carefully if you:

• Use insulin
• Take medicines that can cause low blood sugar (such as some tablets — your doctor will know which)
• Have diabetes complications — eye, kidney, nerve or heart problems
• Have frequent hypos or poorly controlled sugar
• Are pregnant, elderly or frail
• Do heavy physical work in the heat

Never stop insulin on your own. NHS Scotland advice says you should never stop your insulin, but you must speak to your doctor because the dose and timing may need to change.

Step 2: Check Your Blood Sugar — It Does Not Break the Fast

NHS Scotland's diabetes guidance states that testing your blood sugar will not break your fast. Check:

• Before sehri
• Mid-morning and mid-afternoon
• Before iftar
• 2 hours after iftar
• Any time you feel unwell

Step 3: Know When You MUST Break the Fast

NHS Scotland's diabetes guidance says:

• If your blood sugar is below 4 mmol/L, end the fast immediately and treat the low sugar
• If your blood sugar is 4 mmol/L at the start of the fast and you take insulin or gliclazide, do not fast
• If your blood sugar is higher than 16 mmol/L, end the fast immediately
• If you become dehydrated, end the fast and drink water
• If you feel unwell, disoriented, confused, or you collapse or faint, stop fasting and drink water or other fluid

Signs of a hypo (low blood sugar)

NHS Scotland lists:

• Sweating
• Shaking
• Palpitations
• Double vision
• Hunger pangs
• Slurred speech
• Odd behaviour

Ask family members to watch for these — you may not notice them yourself.

How to treat a hypo while fasting

NHS Scotland advises:

1. Break the fast — otherwise the hypo may get worse and could lead to coma
2. Take fast-acting sugar — such as a sugary drink or glucose sweets
3. Then eat slow-acting carbohydrate — like a roti or chapati or a sandwich
4. Recheck your blood sugar every 10 minutes until it's safe

High blood sugar

Very high blood sugar can become dangerous and may need hospital treatment. Break the fast with water and follow your doctor's high-sugar plan.

Go to hospital or call 999 if you have vomiting, fast breathing, confusion, drowsiness, or you collapse.

Step 4: Smart Sehri and Iftar Choices

NHS England's guidance recommends slowly absorbed (low glycaemic index) foods just before the fast, watching carbohydrate portions, and only small amounts of sugary and fatty foods when you break the fast — giving examples such as Indian sweets, samosas and puris.

Sehri: keep it slow and steady

• Roti, oats or a moderate portion of rice with dal — pulses are low-GI foods
• Eggs, fish or chicken
• Vegetables
• Unsweetened milk or yoghurt
• Plenty of water
• Eat sehri as late as allowed, not at midnight

Iftar: break gently

• 1–2 dates and water
• Then a balanced plate: vegetables, salad, dal, fish or chicken, and a moderate portion of rice or roti
• Go easy on beguni, piyaju, chop, jilapi, halim and sweet sherbet — they're high in oil, sugar and refined carbs
• Use less oil in cooking — grill, bake or dry-fry where possible

Drinks

NHS England advice: drink plenty of water and choose sugar-free and decaffeinated drinks. Avoid sugary juices, sweetened Rooh Afza-style sherbets and soft drinks, and limit tea and coffee, which can add to dehydration.

Step 5: Activity and Heat

• Taraweeh prayers count as activity — check sugar if you feel unwell
• Avoid heavy exercise during fasting hours; light walking after iftar is better
• In hot weather, take extra care with dehydration, especially outdoor workers

Fasting With High Blood Pressure

Many people with diabetes also have high blood pressure. General safety points:

• Talk to your doctor before Ramadan about when to take BP medicines — some may be moved to sehri or iftar
• Don't skip doses or stop medicines on your own
• Cut down on salt — the WHO recommends adults eat less than 5 g of salt a day. Watch salty iftar items and pickles
• Drink enough water between iftar and sehri
• Check your BP at home if you can

Get emergency help (999) for chest pain, sudden weakness on one side, trouble speaking, severe headache or fainting.

After Ramadan

• Return to your usual medicine schedule as your doctor advises
• Check your HbA1c after Ramadan if your doctor recommends
• Be careful with Eid sweets and rich food

Related reading: Check your control before Ramadan with an HbA1c test. Learn the early signs of diabetes, and if you also have high BP, see high blood pressure symptoms and home monitoring.

Frequently Asked Questions

Can I fast with type 2 diabetes?

Many people with type 2 diabetes do fast, but you should talk to your doctor first about safety and medicine changes (NHS England).

Does checking blood sugar break the fast?

No. NHS Scotland diabetes guidance says testing will not break your fast.

When should I break my fast?

If your blood sugar is below 4 mmol/L or above 16 mmol/L, if you're dehydrated, or if you feel confused, faint or unwell (NHS Scotland).

Can I fast if I use insulin?

NHS guidance says people who use insulin are usually exempt. If you choose to fast, never stop insulin — speak to your doctor about changing dose and timing.

What should a diabetic eat at sehri?

Slowly absorbed foods like roti, oats, dal, eggs, vegetables and unsweetened milk, with plenty of water.

Can I take BP tablets during Ramadan?

Yes, but timings may need adjusting. Talk to your doctor before Ramadan.

Plan Your Ramadan With a ShifaMate Doctor

Before Ramadan, you can consult a verified doctor through ShifaMate to discuss whether fasting is safe for you. Share your recent HbA1c, blood sugar and BP records, and a list of all your medicines. The doctor can advise on adjustments and issue a digital prescription when clinically appropriate. You can also browse ShifaMate doctors.

For a hypo that doesn't improve, confusion, vomiting or chest pain, call 999.

References

• NHS England (Midlands). NHS expert offers fasting advice to people with diabetes for Ramadan (27 Feb 2025)
• NHS Scotland — My Diabetes My Way. Ramadan
• World Health Organization. Salt reduction (fact sheet)

This article is for general information and does not replace advice from a qualified doctor.