The pious month of Ramadan and Navratri has commenced and many people would observe fasting with food, without food and water (for limited hours). Approximately 80% of diabetics can observe safe fasting. International Diabetes Federation (IDF) has made global guidelines on Ramadan fasting for People with Diabetes (PWD), which should be followed during fasting. According to these guidelines, most of PWD can do fasting with precautions. Those who have Brittle Diabetes with lot of fluctuations of blood glucose should avoid fasting. PWD on many oral drugs or multiple doses of insulin should avoid fasting to prevent hypoglycemia, hyperglycemia or ketosis. Many T1 Diabetics (T1DM) are on Insulin Pump, where insulin doses can be adjusted as per the carbs in their meal, lifestyle and blood glucose. They must consult their treating Doctor before commencing any type of fast. Similarly, T2DM those who are on single or multiple drug combinations or on diet control should also consult their doctor before fasting. Few medicines like Biguanides (Metformin), Gliptins etc. are safer during fasting and have low risk of hypoglycemia. Those who are on insulin, the dose may need to be reduced to prevent hypoglycemia. PWD with associated complications like heart disease, brain stroke, kidney failure, retinopathy, Cancer etc. and those with history of any recent major surgery should avoid fasting. It is advisable to take a fitness certificate for fasting from your Doctor and practice smart fasting.

While fasting, mild exercises like daily household work, walking, yoga & Pranayam can be incorporated, however we should avoid vigorous exercises. Women with diabetes in pregnancy should avoid fasting for a healthy fetal growth. Awareness about fasting should be created amongst the health care professionals, para medical staff and diabetes educators, so that they can counsel their PWD for safe fasting.