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Ramadan 2027 and chronic illness: fasting safely

Diabetes, blood pressure, heart, kidneys, pregnancy: prepare for Ramadan with your doctor, adjust your treatment and know when to break the fast.

4 October 20264 min readDr. Selim Zenginramadan · diabete · maladie-chronique

For many families in Anderlecht and Brussels, Ramadan is an important time. If you have type 2 diabetes, high blood pressure, heart or kidney disease, or are pregnant, fasting should be prepared with your doctor.

Islam provides exemptions for people who are ill. The decision to fast is personal: you make it with your doctor and, if you wish, with a religious authority you trust.

Start preparing from mid-December 2026

Ramadan 2027 should begin around 8 February 2027 (Diyanet calendar); the exact date depends on the sighting of the moon and may differ by one day between communities. The IDF-DAR guidelines and the Belgian Diabetes Liga advise a consultation 6 to 8 weeks beforehand, that is between mid- and late December 2026, to assess your risk, adjust your medicines and plan meals, fluids and monitoring.

Diabetes: know your level of risk

The IDF-DAR score (2021, updated in 2026) adds up points for diabetes, treatment, hypoglycaemia, complications and frailty. Three categories:

  • Low risk (0 to 3 points): fasting generally possible, with a medical review, treatment adjustment and monitoring.
  • Moderate risk (3.5 to 6 points): safety uncertain; if you fast, strict monitoring and medical adjustments.
  • High risk (more than 6 points): fasting advised against on medical grounds, for example with hypoglycaemia you do not feel coming, unstable cardiovascular disease, severe kidney failure, advanced frailty or diabetes during pregnancy.

Diabetes: when to break the fast

Signs of hypoglycaemia: trembling, sweating, palpitations, hunger, confusion. Signs of hyperglycaemia: intense thirst, frequent urination, tiredness, nausea. According to IDF-DAR, break the fast immediately if:

  • your blood glucose is below 70 mg/dL (3.9 mmol/L); between 70 and 90 mg/dL (3.9 to 5.0 mmol/L), check again within the hour;
  • your blood glucose is above 300 mg/dL (about 16.7 mmol/L);
  • you have signs of hypo- or hyperglycaemia, dehydration or an acute illness (fever, vomiting, diarrhoea).

If you have a hypo, take fast-acting sugar (a small glass of juice) and check again after 15 to 20 minutes. According to IDF-DAR, a finger-prick glucose test and an insulin injection do not break the fast.

Diabetes: adjusting medicines with your doctor

Never change your doses or timings on your own. General principles:

  • Sulfonylureas (gliclazide, glimepiride…) and insulin: risk of hypoglycaemia during the day; dose and timing often need adjusting.
  • Metformin: the dose changes little; mainly the timing changes (iftar, suhoor).
  • SGLT2 inhibitors (dapagliflozin, empagliflozin…): risk of dehydration; ideally they are not started in the month before or during Ramadan. Do not stop them without medical advice, and seek advice if you have nausea, vomiting or abdominal pain.

Blood pressure, heart and kidneys

Some heart and blood pressure medicines must be taken at regular times; your doctor can adapt the schedule. Diuretics (water tablets) can contribute to dehydration and kidney injury: discuss their dose and timing with your doctor. Do not stop any treatment without medical advice. Check your blood pressure at home if you have a monitor, cut down on salt, which makes you thirsty, and drink regularly between iftar and suhoor, unless you have been prescribed a fluid restriction.

Break the fast and contact your doctor if you have breathlessness, swollen ankles, dizziness or palpitations; for chest pain, call 112. Fasting is generally advised against after a recent heart attack, stroke or heart procedure, and with severe heart failure, advanced kidney disease or dialysis.

Pregnancy and breastfeeding

Pregnant and breastfeeding women are exempted and have the right not to fast, with or without diabetes. Diabetes during pregnancy is classed as high risk. The decision is made with your doctor, gynaecologist or midwife. If you do fast, break the fast if you feel unwell, if your blood glucose drops below 70 mg/dL or if your baby moves less.

Practical tips

  • Suhoor: as late as possible before dawn, with complex carbohydrates (wholemeal bread, oats, pulses) and protein.
  • Iftar: water and one to three dates, then a balanced meal with plenty of vegetables.
  • Drinks: drink water regularly between iftar and suhoor; avoid sugary drinks, and limit coffee, tea and cola.
  • Fried food and sweet desserts: keep them limited.
  • Physical activity: keep up your usual activity (walking, Taraweeh prayers), without strenuous effort in the hours before iftar.
  • Monitoring: check your blood glucose according to your plan and as soon as you feel unwell.

After Ramadan and when to call

A consultation after Ramadan helps to readjust your treatment. In a life-threatening emergency (loss of consciousness, difficulty breathing, chest pain), call 112. For any other question, contact the practice.

At Maison Médicale Parc Astrid, this preparation is possible in French, Dutch, English, Turkish and Arabic.

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