Ramadan Fasting with Insulin-Treated Diabetes: A Narrative Review of Structured Pre-Ramadan Assessment and Reported Outcomes
DOI:
https://doi.org/10.5281/zenodo.22261604Keywords:
Ramadan, Insulin therapy, Hypoglycaemia, Risk stratification, Structured educationAbstract
Religious exemption from fasting exists for people with diabetes and is widely not taken: epidemiological survey found 42.8 per
cent of those with type 1 diabetes and 78.7 per cent with type 2 diabetes fasted for at least fifteen days. The clinical question is
therefore not whether to permit fasting but how to support it. Older observational data recorded a significant excess of severe
hypoglycaemia during Ramadan, particularly in those treated with insulin or sulfonylureas, with reported hypoglycaemia
incidence of 13.8 per cent in one cohort and 11.7 per cent in another. More recent work points the other way. In a study of stable,
uncomplicated type 1 diabetes managed with structured education and advanced glucose monitoring, hypoglycaemia fell during
Ramadan relative to before it, at 0.53 against 0.81 episodes per day, with no severe hypoglycaemia or ketoacidosis. Time above 10
mmol/L rose significantly over the same period, so the improvement was a trade rather than a net gain.
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