The Conversation About Fasting With Diabetes Should Happen Two Months Before Ramadan, Not During It

If you intend to fast, the appointment to book is the one two months out, and it is worth saying explicitly at booking that this is what the appointment is for.

Which medications cause the most trouble?

The risk is not evenly distributed, and this is worth understanding rather than memorising.

Drugs that push insulin out regardless of what you have eaten are the main hazard, because a fasting body still receives the push. Sulfonylureas fall into this group, and often need dose reduction or a switch. Insulin regimens usually need restructuring rather than simply shifting, particularly the basal and mealtime split, since two meals are now compressed into the hours of darkness.

Metformin is generally lower risk but often needs its timing redistributed. Newer agents including the GLP-1 class and SGLT2 inhibitors have their own considerations. The SGLT2 point deserves emphasis: these drugs carry a risk of ketoacidosis that can occur at lower glucose readings than usual, and prolonged fasting with reduced fluid intake is exactly the setting where that becomes relevant.

None of this is a reason to stop medication independently, which is its own hazard. It is a reason to have the plan made by someone who knows the whole regimen.

Does checking glucose break the fast?

No. This is one of the most practically useful things to know and it circulates far less than it should.

A finger-prick blood glucose test does not invalidate the fast, and this position is well established among religious authorities. Nor does wearing a continuous glucose monitor, which for many people is the ideal tool during Ramadan precisely because it gives warning of a fall without any action at all. The ADA's 2026 Standards broadened CGM eligibility considerably, and the technology is more accessible than it was.

Equally, the fast must be broken if blood glucose falls too low or rises dangerously high. Continuing a fast into a severe hypoglycaemic episode is not piety, and every framework on this subject, religious and clinical, agrees.

What does a sensible Ramadan plan look like?

Get assessed six to eight weeks ahead and find out which category you are in. Agree specific medication changes and specific thresholds at which you will break the fast, written down rather than remembered. Monitor more often than usual, not less. Prioritise fluid overnight, because dehydration compounds every other risk here and the heat in this region makes it worse.

At suhoor, favour slowly digested food, which is where glycaemic load genuinely earns its keep. At iftar, the traditional dates are less of a problem than most people assume, a point our piece on dates and glucose covers with the actual data. What follows the dates is usually the issue.

And if you are placed in the high-risk group, take it seriously. The exemption exists for a reason, and there are other ways to observe the month.