Ramadan fasting represents a significant spiritual practice for Muslims worldwide. Although individuals with diabetes are religiously exempt when fasting poses a health risk, many choose to fast. Therefore, proper medical guidance is essential to prevent complications. University of Al-Mustaqbal – The First and Leading Private University Physiological Effects of Fasting in Diabetic Patients During fasting, the body initially utilizes stored hepatic glucose, then shifts toward fat metabolism for energy. In diabetic patients, this metabolic shift may lead to: • Hypoglycemia • Hyperglycemia • Diabetic Ketoacidosis (especially in Type 1 diabetes) • Dehydration and electrolyte imbalance Risks increase when medications are not properly adjusted. Risk Stratification for Fasting According to international guidelines (e.g., IDF-DAR): Very High Risk • Uncontrolled Type 1 diabetes • Pregnant women with diabetes • History of severe hypoglycemia ➜ Fasting is not recommended. Moderate Risk • Relatively controlled Type 2 diabetes ➜ May fast under strict medical supervision. Low Risk • Well-controlled patients with stable metabolic status ➜ May fast with regular monitoring. Safe Medical Recommendations 1️⃣ Pre-Ramadan Medical Assessment • Physician consultation 4–6 weeks before Ramadan • HbA1c evaluation • Individualized treatment planning 2️⃣ Medication Adjustment • Insulin dose modification to prevent hypoglycemia • Redistribution of oral medications between Iftar and Suhoor • Careful consideration of medications increasing dehydration risk 3️⃣ Blood Glucose Monitoring • Frequent glucose monitoring during fasting hours • Breaking the fast immediately if: • Blood glucose < 70 mg/dL • Blood glucose > 300 mg/dL (Self-monitoring does not invalidate fasting religiously.) 4️⃣ Nutritional Advice • Late Suhoor meal rich in complex carbohydrates • Avoid excessive simple sugars and sweetened beverages • Adequate hydration between Iftar and Suhoor 5️⃣ Physical Activity • Avoid strenuous exercise during fasting hours • Light activity after Iftar is recommended Potential Complications Failure to adhere to medical advice may result in: • Severe hypoglycemia • Loss of consciousness • Dehydration • Cardiovascular complications Conclusion Diabetic patients may fast safely if appropriately assessed and medically supervised. The decision should be individualized and made collaboratively between the patient and healthcare provider to minimize health risks. University of Al-Mustaqbal – The First and Leading Private University