Fasting with Diabetes

Insulin Shock

If you have diabetes, it’s important to consider questions about the safety of fasting around Ramadan, Yom Kippur, and other times of the year. What are we talking about? Well, Muslims are instructed to abstain from food and drink from predawn to after sunset for the entire month of Ramadan. There are no restrictions between sundown and dawn. Most Muslims will eat one meal before dawn and another after sunset. During Yom Kippur, Jews fast from sundown to the following sundown. Fasting with diabetes can cause a host of problems, but, if you choose to fast anyway, consider the following...According to a 2005 commentary in Diabetes Care, the risks associated with fasting for people with diabetes are the following:

• Hypoglycemia. Hypoglycemia is another word for low blood sugar and happens when your glucose levels drop dangerously. When fasting, hypoglycemia can come from lack of food intake and improper medication adjustments.

• Hyperglycemia. Hyperglycemia is also known as high blood sugar. It happens when there’s too much glucose in your bloodstream. You can get hyperglycemia when you fast if you excessively reduce your medication in an attempt to prevent hypoglycemia.

• Diabetic ketoacidosis. When you fast, you can get diabetic ketoacidosis, which is when your body doesn’t have the insulin it needs to process glucose. This is more common in patients with type 1 diabetes, especially if they are in poor glycemic control before the fast.

• Dehydration: You can get dehydrated from lack of fluid intake or as a side effect of hyperglycemia.

• Thrombosis. A thrombosis is a blood clot, and you can get one while you fast, thanks to increased blood viscosity, secondary to dehydration.

These risks can be minimized when you make sure that you are in good glycemic control prior to the fast. This means no blood sugar highs and crashes. These risks can also be reduced if you adjust your medication thoughtfully. If you wish to fast for spiritual reasons, visit with your physicians weeks before the religious event in order to discuss appropriate treatment changes during, and possibly prior to, the fast.

Want More Information? Try...

• Al-Aourj M, Bougerra R, et al. Recommendations for Management of Diabetes During Ramadan. Diabetes Care. 28:9 (2005).

• Grajower M. Management of Diabetes Mellitus on Yom Kippur and Other Jewish Fast Days. Endocrine Practice. 14:3 (2008).

By Jill Weisenberger, MS, RD, CDE