Many people with a health condition can fast safely with planning, and many others are not expected to fast at all. The Quran itself makes room for people who are ill or travelling, and UK health bodies list children, older people, people who are unwell, and those who are pregnant, breastfeeding or menstruating among those who can be exempt. Whether you should fast is a personal decision best made with two people: your doctor, who knows your health, and your own scholar, who can advise on the religious side. Scholars differ on many of the details, so this guide gives you the questions to take to both, not a ruling.
With Ramadan in 2027 expected to begin on or around Sunday 7 February, according to Diabetes UK, now is a good time to book those conversations.
What does the Quran say about fasting when you are ill?
The verses on fasting build ease in from the start. In Surah Al-Baqarah, in the translation by Dr Mustafa Khattab on quran.com:
But whoever of you is ill or on a journey, then ˹let them fast˺ an equal number of days ˹after Ramaḍân˺. For those who can only fast with extreme difficulty, compensation can be made by feeding a needy person ˹for every day not fasted˺.— Quran 2:184, trans. Dr Mustafa Khattab
The next verse repeats the allowance for illness and travel and adds: "Allah intends ease for you, not hardship."
That compensation is known as fidyah, which the BDA describes as charity to make for missed fasts of Muslims who cannot fast. How these verses apply to your particular condition, and whether you should make up the days later or give fidyah, are questions for a scholar, and scholars do not all answer them the same way. An article in The Pharmaceutical Journal describes how an Islamic scholar, after discussion with the healthcare professional, can confirm whether the patient's fast is valid, requires being made up later, or that the fidyah (charity in lieu of a fast) be offered. That is the right order of things: medical facts first, then your scholar.
Who is exempt from fasting in Ramadan?
Diabetes UK lists people who can be exempt from fasting as those who:
- are children (under the age of puberty)
- are elderly
- are sick or have a certain health condition
- have learning difficulties
- are travelling
- are pregnant, breastfeeding or menstruating.
The British Dietetic Association gives a similar list, noting that the pregnancy and breastfeeding exemption applies depending on personal circumstances. Diabetes UK also suggests that if you have symptoms of flu or another illness, it would be advisable not to fast.
Exemption is not exclusion. Diabetes UK points out that if you cannot fast or choose not to, you can still observe Ramadan by offering charity or providing food to the poor, and suggests speaking to your local imam about this.
Can you fast in Ramadan if you have diabetes?
Some people with diabetes can, with a plan agreed in advance; for others the risk is too high. Diabetes UK's guidance is that people with diabetes should only fast after discussing it first with their diabetes team. It says your risk depends on the type of diabetes you have, whether your HbA1c is in a healthy range for you, the medicines you take (especially those that can cause low blood sugar, such as sulphonylureas and insulin), and whether you have complications such as eye, nerve, heart or kidney problems.
Recommendations compiled by the British Islamic Medical Association and summarised by the BDA say that people with type 1 diabetes and/or uncontrolled diabetes are strongly advised against fasting because of the risk of very low and very high blood sugar.
If you do fast, Diabetes UK's guidance includes:
- Agree a plan with your healthcare team covering blood sugar checks, what to do if you become unwell, and any changes to your tablets or insulin.
- Diabetes UK notes that checking your blood sugar levels does not break the fast, but you must break the fast if your levels are too high or too low.
- If your blood sugar drops below 4 mmol/l you must break your fast and treat the hypo.
- If you cannot get hold of your GP or diabetes team, it says it would be advisable not to fast.
Should you fast while pregnant or breastfeeding?
The pregnancy charity Tommy's is clear that not fasting protects you and your baby, and that this is especially important for anyone with complications such as gestational diabetes. It says research links religious fasting in pregnancy with dehydration and tiredness, and that while it does not affect babies' birth weight, more research is needed on other effects.
Tommy's also recognises the feeling of missing out when family and friends are fasting, and says that people who are pregnant or breastfeeding are not usually expected to take part in religious fasting, but it's a personal decision. If you do fast, its advice is to talk to your midwife or doctor first, consider taking a break from fasting every couple of days, watch for signs of dehydration such as dark urine, dizziness or headaches, and keep feeling your baby move every day.
For breastfeeding, Tommy's says mothers are not expected to fast, particularly if their baby is under 6 months and exclusively breastfed. If you choose to fast, speak to a health professional first; they may suggest a trial fast to watch for any drop in milk supply.
Can you take medication while fasting?
Never stop or change a prescribed medicine on your own. The Pharmaceutical Journal's guidance for pharmacists says patients should not stop or alter any prescribed medicines without consulting their pharmacist or GP. It notes that people with stable long-term conditions taking several medicines may be able to fast, though this may require a different formulation or revised dose timings to fit around the fast. Your pharmacist can talk this through without an appointment.
Which medicines affect the fast is a religious question, and here views genuinely differ. The scholar quoted in the same article describes non-essential medicines during fasting as an area of debate with legitimate differences of opinion, noting that ear drops, creams, ointments and some eye drops and injections are thought to break a fast by some schools of thought. Ask your own scholar, with your pharmacist's information in hand.
The same article adds that if you become unwell while fasting, you have the option of breaking your fast.
Whose decision is it?
Yours, made with good advice. The British Islamic Medical Association's compendium on fasting with health conditions says that the final decision to fast or not rests with the patient/individual concerned, and that a decision to fast should not be made without consultation with their responsible healthcare professional. Diabetes UK puts it simply: it is a personal choice whether or not to fast.
Whatever you decide, the month is still yours: the prayers, the Quran, the generosity and the iftar table with the people you love. Our guide to eating well at suhoor and iftar has ideas for the table, whoever is fasting.
Edited by Jeloni, editor-in-chief. Researched and drafted with AI assistance; every fact in this article was checked against its sources.
