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Categories of Risk in People with Diabetes Who Fast During Ramadhan

Are you supposed to abstain from fasting? Those who fall in the ‘very high’ and ‘high risk’ groups are advised to abstain from fasting.This classification is based largely on expert opinion and not on scientific data derived from clinical studies. Please consult your doctor or diabetes nurse for further advice.


Very High Risk
  • History of severe diabetes complications within 3 months prior to Ramadan
    • Severe hypoglycemia 
    • Diabetic ketoacidosis
    • Hyperglycemic hyperosmolar state
    • Recurrent hypoglycemia
  • Hypoglycemia unawareness
  • Type 1 diabetes
  • Acute severe illness
  • Sustained poor glycemic control (HbA1c > 9%)
  • Performing intense physical labour
  • Pregnancy
  • Advanced renal failure/ chronic hemodialysis
High Risk
  • Moderate hyperglycemia (HbA1c 7.5-9%)
  • Moderate renal failure
  • Advanced macrovascular complications
  • Living alone and treated with insulin or sulphonylureas
  • Patients with comorbid conditions that present additional risk factors
  • Old age with ill health
  • Treatment with drugs that may affect mentation
Moderate Risk
  • Well controlled diabetes treated with short-acting insulin
Low Risk
  • Well controlled diabetes treated with lifestyle therapy, oral anti-diabetic drugs in otherwise healthy patients





Clinical Practice Guidelines, Management of Type 2 Diabetes Mellitus, 5th Edition, 2015, Ministry of Health Malaysia.



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