Ramadan 2017 and fasting
Ramadan is based on the ninth month of the lunar calendar, so this year it is expected that the fast of Ramadan 2017 will start on Saturday, the 27th of May and will continue for 30 days until Sunday, the 25th of June. During this month it is expected that Muslims who participate will abstain from food, water, beverages, smoking, oral drugs and sexual intercourse from sunrise to sunset.
Ramadan moves forward each year by about 11 days which means the length of fasting is greater at certain times of year than others. The length of fasting has special consequences for people with diabetes, especially those taking insulin and the risk of complications increases with longer periods of fasting.
People with diabetes may be exempted from fasting but the majority of people with diabetes do fast so run increased risks of adverse health effects, such as hypoglycaemia, hyperglycaemia, diabetic ketoacidosis and dehydration. Most of these are as a result of a reduction of food and fluid intake and the timing of meals.
There are no evidence-based guidelines for safe fasting, so people have to rely on expert advice from doctors and their personal experiences. However, a study in people with Type 1 and Type 2 diabetes carried out in Pakistan, has shown that with active glucose monitoring, alteration of drug dosage and timing, dietary counselling and patient education, the majority of patients did not have any serious acute complications during Ramadan.
In addition, researchers have quoted an observational study which showed people with Type 2 who did not have education about fasting were 4 times more likely to have hypos. Therefore, they recommend that those who do not normally carry out self-monitoring of blood glucose should be provided with meters (Diab. Med. February 2016).
The findings of this and other studies suggest that people with Type 1 and Type 2 diabetes should have an assessment with their diabetes team 1 to 2 months before Ramadan about drug/insulin adjustments, exercise and awareness of the risks of hypo- and hyperglycaemia. If they are ill during the fasting, then they should seek advice from their diabetes team.