There are so many ways to take part in Ramadan without fasting” Nadia Malik, diabetes specialist pharmacist

Ramadan is one of the most sacred times in the Muslim calendar. During the month of Ramadan, Muslims abstain from food and drink (yes even water!) from sunrise to sunset, which can present challenges for people with type 1 diabetes.

People with type 1 are exempt from fasting

There have been times where I have had to omit fasting due to ill health during Ramadan, so I can appreciate how difficult not fasting can be when it is such an integral part of the faith. People who have an illness or medical condition where fasting could affect their health and wellbeing are exempt from fasting, therefore I would recommend people with type 1 do not fast during Ramadan.

You wouldn’t be alone

Fasting during Ramadan is one of the five pillars of Islam and is thought of as an act of worship, as well as a means of empathising with those less fortunate. Fasting is mandatory for healthy Muslims after the age of puberty, but there are several exemptions including during pregnancy, breastfeeding, ill health or where fasting would be detrimental to health or wellbeing. If you are unable to fast, you are not alone; there are plenty of people in the same situation and there are other opportunities for you to make the most of this holy time.

Fasting is just one part of Ramadan

It’s easy to get overwhelmed or feel like you are missing out if you can’t participate in fasting. But there’s so much more to Ramadan than fasting. This month is about renewing one’s personal connection with God. Those who are exempt from fasting due to health reasons can still take part in Ramadan activities such as congregational prayers and gatherings.

The holy month offers opportunities for self-reflection, charity and prayer as well as the chance to be more spiritual and spend time with loved ones. Muslims perform prayers (called salah) five times a day and these prayers help provide spiritual discipline throughout the day. It’s also about personal growth, focusing your thoughts on helping others and improving yourself. Ramadan is a prime opportunity to reflect on your life and reset your routines.

Alternatives to fasting

Ramadan is a very family orientated time. If you are not fasting, you can still wake up before the start of Fajr (the dawn prayer) to join in and prepare the pre-dawn meal (suhoor) with your family. If you are waking for suhoor, then this might affect your sleeping schedule, even a half-hour power nap will leave you feeling refreshed.

Give charity

Charity is an integral part of the spirit of Islam, especially during Ramadan. You can help other people by giving one meal per fast that you miss to someone in need or donating the cost of each meal to a relevant charity. This is a form of charity called Fidya, which people who are unable to fast make in place of the fast.

You could also be charitable by volunteering in the community or helping at the mosque by serving food to people who have been fasting or to rough sleepers. You can even give back to others simply by being patient and kind. Take this month as an opportunity to be the best sort of person that you can be.

Advice for those who choose to fast

If you have type 1 diabetes and choose to fast, I advise that you discuss the risks to your health of doing so with your diabetes team first.

My top tips:

• Discuss your plan to fast with your diabetes teams to allow for adjustments to your insulin regimen.
• Check your glucose levels more regularly using continuous glucose monitoring  
• If you encounter hypoglycaemia, it is important that you break your fast and manage the hypo with fast-acting sugar. Please try not to feel guilty – your health comes first.
• Check your ketones regularly and seek help from your diabetes team if they are high.
• Try to avoid intense physical activity whilst fasting.
• Aim to drink two litres of water between sundown and sunrise.

If at any time you feel unwell, your glucose levels are out of range or complications arise, take the appropriate action to safeguard your health, including breaking your fast and contacting your diabetes team.