Managing people with diabetes during Ramadan

Diabetes is one of the most important public health challenges in the 21st century. Globally, the number of people with diabetes has doubled over the past 20 years rising to more than 400 million in 2015. Fasting during Ramadan is one of the five pillars of Islam, and all healthy adult Muslims are obliged to refrain from eating and drinking from sunrise to sunset during this lunar month. Although exemptions from fasting exist for people with serious medical conditions, including diabetes, many still choose to fast. Fasting in people with diabetes can cause disruption of normal glucose homeostasis and lead to hypoglycaemia, hyperglycaemia, diabetic ketoacidosis, dehydration and thrombosis. This article discusses the most common acute presentations of people with diabetes who fast during Ramadan with two clinical case scenarios.