Category: Administration
Keywords: Ramadan, Muslim, diabetes (PubMed Search)
Posted: 3/21/2026 by Hanna Hussein, MD
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Educational Pearls for the ED:
Many Muslim patients with diabetes will fast despite medical advice. Studies show a significant number continue fasting even when they are considered high risk.
Key medical risks during Ramadan fasting include:
- Hypoglycemia
- Hyperglycemia and diabetic ketoacidosis
- Dehydration
- Medication nonadherence or altered dosing schedules
This article discusses the ethical and clinical challenges that arise when Muslim patients with diabetes choose to fast during Ramadan. During this month, fasting from dawn to sunset involves abstaining from food, drink, and oral medications, which can complicate chronic disease management and increase risks such as hypoglycemia, hyperglycemia, dehydration, and medication nonadherence. Despite these risks, many patients still opt to fast due to strong religious and cultural motivations. The authors highlight gaps in physician–patient communication, including limited counseling on medication adjustments and risk stratification before Ramadan, as well as physicians’ lack of familiarity with the religious significance of fasting. Ethically, this situation reflects the balance between patient autonomy and physician beneficence. Rather than simply telling patients not to fast, the authors recommend culturally sensitive counseling, shared decision-making, and proactive pre-Ramadan planning to promote safer fasting practices while respecting patients’ beliefs.
Islam provides exemptions from fasting for illness, including diabetes in many cases. However, patients may still choose to fast for personal or cultural reasons. Avoid framing the discussion as “you cannot fast.” A shared decision-making approach that recognizes the religious importance of fasting is generally more effective. Pre-Ramadan counseling is essential. Ideally, patients should be seen before Ramadan to discuss risk stratification, medication adjustments, hydration strategies, and when to break the fast. In the ED, consider fasting status when evaluating diabetic patients presenting with hypoglycemia, hyperglycemia, or dehydration during Ramadan. Cultural competence is important. Even a brief acknowledgment of Ramadan’s significance can help build trust and improve adherence to medical recommendations.
Ethical conflicts in the treatment of fasting Muslim patients with diabetes during Ramadan
Ilhan Ilkilic · Hakan Ertin
Med Health Care and Philos (2017) 20:561–570
DOI 10.1007/s11019-017-9777-y
