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Researchers study how fasting during Ramadan affects type 1 diabetes

We caught up with researchers in Saudi Arabia to find out more about their important research into fasting with type 1 diabetes.

Dr Ebtihal Alyusuf and Professor Abdullah Alguwaihes, type 1 diabetes researchers

Muslims with type 1 aren’t required to fast during Ramadan because of their diabetes, but some people still choose to. With Ramadan coming up, we caught up with researchers in Saudi Arabia to find out more about their important research into fasting with type 1 diabetes.

What is fasting Ramadan?

The holy month of Ramadan takes place from the evening of Sunday 10 March 2024 through to the evening of Tuesday 9 April. Throughout the holy month, Muslims refrain from eating and drinking from dawn until sunset as well as abstaining from impure thoughts and activities.

How long do Muslims fast for during Ramadan?

Each day before dawn, Muslims eat a meal called Suhoor. Fasting Muslims then don’t eat or drink anything until the sun sets, when they have a meal called Iftar. Because the length of days is dictated by the time of year and where in the world you are, the length of time fasting changes depending on when Ramadan falls.

Muslims with type 1 diabetes are exempt from fasting

Not eating or drinking all day can make managing type 1 diabetes even more challenging than usual and can even be dangerous for some people. Muslims with type 1 are exempt from fasting as a result of their diabetes, but many still choose to take part.

Research about fasting with type 1 diabetes

Dr Ebtihal Alyusuf and Professor Abdullah Alguwaihes from King Saud University in Saudi Arabia led a research study observing the glucose levels of a small group of people with type 1 before, during and after fasting Ramadan. They analysed the participants’ blood glucose readings from their glucose monitors and recorded how often they checked their levels.

Short-term effects of fasting on type 1 diabetes

The researchers found that Ramadan fasting was linked to worsening glycaemic control, with participants spending a long time in hyperglycaemia after Iftar and Suhoor. However, there was no change in how long the participants spent in hypoglycaemia.

Interestingly, people who had had diabetes for longer had higher average glucose levels before Ramadan, which increased further during Ramadan. The participants who scanned their glucose sensors more often spent more time in their target range, less time in hyperglycaemia and experienced less variability in their glucose levels.

No apparent long-term change to blood glucose levels

Although the participants’ blood glucose levels were less stable during the holy month of Ramadan, they returned to their normal levels once the month ended. The researchers saw no change in the participants’ blood glucose levels or HbA1c between the month before and the month after fasting Ramadan.

A message from the researchers

Dr Ebtihal Alyusuf said: “People with type 1 diabetes may be able to fast Ramadan safely by consulting their physicians in advance prior to the commencement of fasting and by carefully following their recommendations. While hypoglycemia is a common concern during fasting, hyperglycemia can be encountered after the meals of Ramadan and may be avoided by nutritional counseling for healthy eating tips. Making the most of diabetes technology in glucose monitoring by increasing the frequency of sensor scanning may help in keeping the glucose level within the target range during most of the hours of Ramadan.”

Professor Abdullah Alguwaihes said: “This is one of a few studies that gave us insight into what is happening to the glucose levels of people with type 1 diabetes during Ramadan.

Although fear of hypoglycemia and taking measures to avoid it are both legitimate, it seems that we are under-estimating the risk of hyperglycemia post Iftar meal and to lesser extent post Suhoor meal. I would encourage (and now feel more confident to do so) my patients to proactively adjust their insulin doses before Iftar if they noticed this degree of hyperglycemia. Diabetes technology is great and continues to facilitate the participation of people with type 1 diabetes in Fasting Ramadan.”

What should I do if I have questions about fasting?

You should always speak to your diabetes team if you are unsure whether to fast, or if you encounter any difficulties relating to your type 1 diabetes while you are fasting.