Islamic law exempts the sick from fasting, and medical exemption is a recognised concession, not a failure. That said, most people with well-controlled type 2 diabetes can fast safely with preparation. The decision is yours; the risk assessment should be your doctor's.
Risk categories
Guidance from the IDF and DAR alliance sorts people into risk groups. Broadly:
Very high risk — fasting is strongly advised against: severe hypoglycaemia within the last three months; hypoglycaemia unawareness; recurrent lows; a recent episode of DKA or HHS; poorly controlled type 1; acute illness; advanced kidney disease on dialysis; pregnancy on insulin.
High risk: A1c above 9%; type 1 with reasonable control; chronic kidney disease stage 3; treatment with sulfonylureas or insulin; significant heart disease; living alone on insulin; older age with frailty.
Moderate to low risk: well-controlled type 2 on diet, metformin, DPP-4 inhibitors, SGLT2 inhibitors or GLP-1 agonists.
Before Ramadan
- See your doctor six to eight weeks ahead. Medication timing and doses usually need adjusting, and that is not a same-week conversation.
- Ask specifically about medications that cause lows — sulfonylureas such as glibenclamide and glimepiride often need reducing, switching or moving to iftar.
- If you use insulin, expect basal to be reduced by around 15–30% and the two main bolus doses to be swapped so the larger one goes with iftar.
- Make sure you have enough test strips. You will be testing more, not less.
Testing does not break the fast
This is settled among the major scholarly bodies: a finger-prick blood glucose test does not invalidate the fast. Neither do injections that are not nutritive. Do not skip testing out of concern about this — it is precisely the thing that makes fasting safe.
Break the fast immediately if
- Glucose falls below 70 mg/dL (3.9 mmol/L)
- Glucose is below 90 mg/dL (5.0 mmol/L) early in the day and still falling
- Glucose rises above 300 mg/dL (16.7 mmol/L)
- You have symptoms of hypoglycaemia, dehydration or acute illness
Breaking the fast in these circumstances is required, not permitted. The day can be made up later.
Suhoor and iftar
Suhoor should be as late as possible, and built around slow carbohydrate and protein: burghul or whole-grain bread, eggs, cheese, yoghurt, beans, vegetables. Avoid a high-sugar suhoor, which produces a spike and then an early crash.
Iftar is where most of the glucose damage happens. Break the fast with one to three dates and water, then pray, then eat. That pause matters. When you do eat, keep the plate method in mind and be deliberate about the sweets — a single piece of baqlawa is fine; the tray is not. Drink water steadily between iftar and suhoor rather than all at once.
Through the day
- Test at least at suhoor, midday, mid-afternoon, before iftar and two hours after. Late afternoon is when lows most often appear.
- Keep normal physical activity light. Move taraweeh into your daily exercise budget rather than adding to it.
- In an Iraqi summer, dehydration is a genuine risk — it concentrates glucose and strains the kidneys. This raises the threshold for whether fasting is advisable at all.
- Do not exercise hard in the hours before iftar.
Log everything through the month. The pattern of a fasting day is different enough from a normal one that the first Ramadan with good records makes every subsequent one considerably easier to plan.