Managing Diabetes during Ramadan

Managing Diabetes during Ramadan
06 May 2021

People with high blood sugar level must maintain its balance, either through a healthy diet or prescribed medications. The ongoing debate over whether people with diabetes should fast during the month of Ramadan or not worries hundreds of people around the world. According to Dr. Fahim Ullah, Consultant Endocrinologist at RMI, "It is permissible for diabetic patients without any kidney or heart problems to fast. Patients with high blood sugar levels should avoid fasting, especially without a doctor's consent". 
Fasting in general may compromise the health of patients with diabetes. It is advised that people on blood glucose-lowering medications or insulin therapy should consult their General Physicians or Endocrinologists before fasting. Individuals with diabetes should be well aware of the risk to their health if they fast, and how they can manage their blood glucose levels from dropping or spiking. “Diabetic patients who are fasting should take a wholesome meal in suhoor, and the iftaar meal should be divided into 2-3 small meals. During iftaar, avoid eating everything in one sitting as it can cause a spike in the blood sugar level,” says Dr. Fahim Ullah, Consultant Endocrinologist. Thus, reasonable glycemic control can be achieved by maintaining an appropriate diet. 


Exercise Recommendations for Diabetic Patients during Ramadan

People with diabetes should incorporate light intensity exercise regularly. The exercise routine should be modified with respect to a patients’ diabetic history. Generally, a 20-30 minutes’ walk is recommended. The exercise time should be set to two hours after iftaar to avoid any hypoglycaemic episodes.


Health and Nourishment

Individuals with diabetes need to take an appropriate amount of food to stay nourished throughout the day. The predawn meal should be taken as late as possible before starting the fast and should include a higher proportion of carbohydrates along with fibres. Drinks with high sugar contents, and fried food should be avoided during iftar at all costs. After iftar, a dinner meal should be consumed, ideally with complex carbohydrates, vegetables, and protein-rich foods followed by a light snack before bedtime. Dr. Fahim Ullah suggests, “The major reason for weakness while fasting is dehydration. Diabetic patients need to stay hydrated. This can be achieved by drinking water from iftaar to suhoor.” 


Dietary Guidelines

The following options are a great way to get the energy you need whilst keeping your blood sugar levels under control.

  1. Carbohydrates with a low glycaemic index such as brown rice, whole grain bread and vegetables are a better option than white rice, flour bread or potatoes.
  2. Protein is a good source of energy as it is absorbed slower than carbohydrates. Therefore, protein-rich foods should be added to your suhoor and iftaar meals. 
  3. Nuts, oily fish, avocados, olives, and olive oil are excellent energy sources, and they help increase your HDL. 
  4. Once you break your fast in the evening, eat small, healthy and nutritious meals.
  5. Be careful about the portion size.
  6. Do not overeat.
  7. Water is the best fluid you can drink to break your fast. Other options include lemon infused water, buttermilk, unsweetened lassi and plain milk. Avoid drinking Sherbets, fruit juice, packaged drinks, and other sugar-sweetened beverages.
  8. Caffeinated beverages such as coffee, soda and fizzy drinks are strictly not recommended as these can further lead to dehydration.

General Diet Plan for Diabetic Patients in Ramadan


Suhoor/Predawn meal Iftaar/Sunset meal Snack post Iftaar
1 small whole wheat roti 1 glass of water/lemon infused water 1 bran bread sandwich
2 egg vegetable omelette 1 date 1 cup of green tea
½ cup yogurt with any seasonal fruit (apple, peach, guava etc.) Bowl of fresh salad  
  1-2 shami kabab/1 small bowl chana chaat  
  1 plate chicken curry with 1 whole wheat roti  


It is recommended for all diabetic patients to visit their General Physicians before Ramadan to avoid any mishaps and follow a balanced diet as advised by the physician. Also, keep track of blood sugar levels while fasting and after iftaar to maintain their balance.


It is advised by Dr. Fahim Ullah, Consultant Endocrinologist at RMI Peshawar, to break the fast if the blood glucose level drops below 70.


The blog post was written by MS. Hira Siddiqui, Coordinator Dietician at RMI Peshawar.