DEAR MAYO CLINIC: My family observes Ramadan, the Muslim holy month which involves fasting. However, I recently was diagnosed with diabetes. Another relative with diabetes told me that it would not be possible for me to fast. Do you have advice for how I can safely participate in ritual fasts during this holy time? Is there anything I should shift to accommodate my condition?

ANSWER: When you are living with diabetes, your diet is a vital part of your treatment plan. Patients living with diabetes need to be more mindful about the foods they eat and the details, such as calories, total carbohydrates, fiber, fat, salt and sugar. All of these could have the potential to affect their blood sugar levels.

While some people choose to not eat for a period of time, or fast, for religious reasons, such as from dawn to sunset during the Islamic holy month of Ramadan, fasting is something that you should not do without advance planning. I would recommend that you talk with your health care team about the specifics of your health and the details surrounding the holiday and your desired fast.

There are potential risks of complications from fasting, such as low or high blood sugar, and dehydration. Typically, people with Type 2 diabetes that is well-controlled, who manage their diabetes with medications and lifestyles, may be OK fasting during Ramadan, so long as they can adjust their medications under the guidance of their care team.

However, there are people who may be at high risk of complications if they fast during Ramadan. This would be someone who has one or more of the following:

• Type 1 diabetes
• Type 2 diabetes with poor blood sugar control or taking certain types of insulin
• Recent history of severe low blood sugar or diabetic ketoacidosis
• History of recurring low blood sugar or unawareness of low blood sugar
• Conditions such as severe kidney disease or blood vessel complications
• Diabetes and is pregnant

Your health care team may suggest that you avoid fasting if you are at high risk of complications. If the decision is made to fast, your health care professional and diabetes care team likely will provide you with education about managing your diabetes and adjusting medications or insulin doses while fasting.

The most important thing to remember if you plan to fast during Ramadan is that you will need to monitor your blood sugar closely, and you should educate family members to be mindful of signs of low blood sugar, including:

• An irregular or fast heartbeat
• Fatigue
• Pale skin
• Shakiness
• Anxiety
• Sweating
• Hunger
• Irritability
• Tingling or numbness of the lips, tongue or cheek

As low blood sugar worsens, signs and symptoms can include:

• Confusion, abnormal behavior or both, such as the inability to complete routine tasks
• Visual disturbances, such as blurred vision
• Seizures
• Loss of consciousness

Low blood sugar, also called hypoglycemia, needs immediate treatment. For many people, a fasting blood sugar of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L), or below should serve as an alert for hypoglycemia. But your numbers might be different, so it will be important to have a conversation with your health care professional to know what number is too low for you.

Likewise, high blood sugar is something that needs to be watched. Talk with your health care team about suggestions regarding specific food, drink and exercise during the month, and monitor your body's response. You should be prepared to adjust medication doses as appropriate, and, most importantly, be ready to stop fasting if there is an issue.

Fasting during Ramadan can be done safely if you and your family take time to understand the risks and identify the best way to manage your routine so you can follow your care team's recommendations. — Dr. M. Regina Castro, Endocrinology, Mayo Clinic, Rochester, Minnesota

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