Fasting naturally brings changes to eating patterns and schedules. For some, this can serve as momentum to improve a healthy lifestyle. However, for patients with diabetes, maintaining a proper and regular meal schedule is essential. This raises the question whether people with diabetes are allowed to fast during Ramadan, given the limited eating schedule during the holy month.
Internal Medicine Specialist in Endocrinology and Metabolism at Universitas Gadjah Mada Academic Hospital (RSA UGM), Dr. Ali Baswedan, explained that people with diabetes are allowed to fast under two conditions. First, those who wish to fast must consult a doctor beforehand.
“There must be approval from a doctor because it is important. Only a doctor can determine whether a patient is fit to fast or not,” Dr. Baswedan said on Tuesday (Feb. 24).
The second condition is that patients must not skip suhoor (the pre-dawn meal) and must avoid excessive eating and drinking at iftar (breaking the fast).
However, Dr. Baswedan emphasized that not all patients with diabetes are permitted to fast. Those who are allowed must not have complications, such as untreated wounds or active lung infections. They should also not be experiencing significantly elevated blood sugar levels or be in an acute illness phase.
If a patient is experiencing symptoms such as cough, cold, fever, or has wounds on the feet, they should not force themselves to fast. Nevertheless, the decision ultimately depends on the doctor’s approval.
“The doctor determines whether fasting is allowed or not, as they have access to the patient’s medical history,” he explained.
Regular eating patterns and schedules during fasting can significantly affect the condition of people with diabetes, as the body may experience fluctuations in blood sugar levels.
To address this, Dr. Baswedan reminded patients not to skip suhoor to prevent blood sugar from dropping during the day.
“And of course, do not overeat when breaking the fast,” he advised.
Dr. Baswedan also explained the proper way to manage meal timing at iftar. Food intake after breaking the fast should be divided into three phases: immediately after the call to prayer, before tarawih prayers, and after tarawih.
“If you overeat at iftar, blood sugar levels can spike excessively,” he said.
Furthermore, Dr. Baswedan discussed medication dosage adjustments for people with diabetes. While some guidelines recommend reducing the usual dose by one-third, he prefers initially reducing it by half. In his view, starting with a smaller dose is better than abruptly reducing it by one-third.
“If you reduce it by one-third, the risk of blood sugar dropping may be higher. Reducing it by half first is safer,” Dr. Baswedan stated. He added that after implementing this pattern for 45 days, an evaluation should be conducted. If necessary, the dosage can then be adjusted accordingly.
Dr. Baswedan also described the ideal meal plan for people with diabetes during fasting. For suhoor, he recommended consuming complex carbohydrates such as brown rice, whole-wheat bread, or oatmeal. Adequate protein intake and vegetables are also essential for the pre-dawn meal. He emphasized the importance of drinking sufficient water. For iftar, he suggested starting with something sweet in moderation.
“Sweet foods are recommended when breaking the fast, but only in small portions,” he explained. Before tarawih prayers, patients may eat rice, and after tarawih, they may have a light snack.
High blood sugar in people with diabetes is usually characterized by excessive thirst, frequent urination, weakness, a slightly elevated body temperature, and headaches. Meanwhile, signs of low blood sugar include extreme weakness and sweating.
To prevent such conditions, Dr. Baswedan advised checking blood sugar levels for three to four days on a schedule: before suhoor, at noon (around 12 p.m.), and two to three hours before iftar.
In closing, Dr. Baswedan emphasized that if a patient experiences low blood sugar accompanied by heart palpitations while fasting, they must immediately break the fast.
“It must be broken because the risk of hypoglycemia (low blood sugar) is far more dangerous,” he said. Ideally, blood sugar levels should remain below 200 or 180, within a range of 110–180.
Writer: Fatihah Salwa Rasyid
Editor: Gusti Grehenson
Post-editor: Jasmine Ferdian
Photo: Freepik