Recommendations for Ramadan Fasting in Patients with Diabetes Mellitus Based on Integrative Medicine and According to the Persian Culture- A Review Study

A lot of the adult Muslim population will fast during Ramadan while many of those suffering from diabetes mellitus (DM). Risks of fasting for people with DM include hypoglycemia, hyperglycemia, ketoacidosis, and dehydration. Physicians should assess the likelihood of these risks in each patient and recommend him/her accordingly. With the right management and correct intervention, many people with diabetes can fast safely during Ramadan, but some of them need to be closely monitored and educated for the appropriate action. By quantifying multiple risk factors, a risk score is calculated that plays an important role in the decision/permission to fast for each patient. The new risk stratifying system defines three risk groups.  People, who fast against the advice of their physician/health care provider, should carefully follow the instructions of the expert to prevent serious complications. In this article, first, we discuss the risks of fasting in patients with diabetes mellitus, based on recent international guidelines and scientific pieces of evidence. Then we present dietary and lifestyle instructions for patients with diabetes mellitus during Ramadan, based on traditional Iranian medicine and also according to the latest pieces of evidence.