Faith and diabetes: How patients can stay safe during fasting periods

As Christians observing Lent and Muslims marking Ramadan enter periods of fasting, prayer, and spiritual renewal, the experience is different for people living with diabetes.

For them, these sacred months can present unique health challenges. Whether abstaining from food from dawn to dusk during Ramadan or giving up certain meals and habits during Lent, individuals with diabetes must carefully balance devotion with medical guidance.

For many, this journey becomes not only a test of spiritual discipline but also a matter of monitoring blood sugar levels, adjusting medication, and making thoughtful nutritional choices to stay safe while honouring their faith.

“There are different levels of diabetes. Some people cannot fast completely. Fortunately, I can fast. I just monitor my sugar levels and take my medication very early in the morning before starting the fast,” says Sultan Mohamed.

However, there is an exemption for those who are unwell, allowing them to refrain from fasting while using the period to help the less fortunate.

According to Dr Christian Omoaghe, an endocrinologist at MP Shah Hospital, Nairobi, the risk of developing complications while fasting is generally low. However, people with type 1 diabetes are usually advised not to fast, regardless of their sugar control.

“Every person living with diabetes should meet a doctor before fasting. A pre-fasting medical assessment is necessary to evaluate the degree of sugar control,” says Dr Omoaghe.

Sultan is fortunate because his type of diabetes allows him to fast.

The case is different for 36-year-old Jason Mwakio, who has type 1 diabetes. Mwakio cannot fast for religious reasons, or for lifestyle approaches such as intermittent fasting or OMAD (One Meal A Day). Mwakio was diagnosed with diabetes in 2005, at age 15, after experiencing rapid weight loss and frequent urination. He collapsed and was rushed to the hospital, where the diagnosis was confirmed.  “At the time, the only thing I knew about diabetes was that my grandmother had it,” he recalls.

He believes his lifestyle may have contributed: “I consumed a lot of sugar, often drinking tea with half a glass of sugar. I was also overweight, around 70 kilos at the time. I feel like this may have triggered it.”

The condition greatly affected his teenage years and schooling.

“While I was in Form Four, I fainted about three to four times,” he says. 

In 2018, his condition deteriorated further due to inconsistent monitoring and missed checkups.

“My legs started swelling and I was gaining weight. I went for a biopsy, but the results took nine months. My kidneys were functioning at 48 per cent and were gradually shutting down,” he explains.

In November 2018, further tests at the Lancet Kenya revealed his kidneys were functioning at just 11 per cent. He began dialysis in January 2019.

“In January 2020, I underwent a successful kidney transplant at MP Shah Hospital. I now take expensive immunosuppressant drugs. Before Social Health Authority (SHA), I used to pay between Sh60,000 and Sh70,000 per month. Now, with SHA, I pay around Sh40,000 per month,” he says.

“It is an expensive disease. One insulin pen costs around Sh2,000 and lasts about a week, depending on usage,” Mwakio adds.

He stresses that acceptance is key to managing diabetes: “Accept it, eat healthily, and make your doctor your friend. Avoid sugary foods. Diabetes is manageable,” he says.

Diabetes types

According to Dr Omoaghe, diabetes is a chronic metabolic disorder characterised by persistent high blood sugar, which can damage cells and lead to complications. There are four main types:

Type 1 is insulin-dependent; without insulin, blood sugars cannot be controlled. Insulin is a hormone produced by the pancreas that allows cells to absorb glucose (sugar) for energy.

Type 2 is insulin-resistant; the hormone is present but does not function effectively. Risk factors include hypertension, alcohol, smoking, obesity, family history, polycystic ovarian syndrome, and previous gestational diabetes.

Type 3 is secondary, caused by conditions that destroy the pancreas, such as surgery, cancer, alcohol, or viral infections. Some medications can contribute to diabetes. Drugs used to treat hypertension, steroids, and certain anti-cancer medications may inadvertently affect pancreatic function. Unfortunately, while these drugs may combat disease, they can also impair the pancreas.

Type 4 Diabetes is pregnancy-related. This is known as gestational diabetes. The condition usually resolves after childbirth. However, studies show that women who develop gestational diabetes are at higher risk of developing type 2 diabetes in the future, especially if they gain weight, consume alcohol, smoke, develop hypertension, or have a family history of the disease.

Dr Omoaghe explains that reversal differs from a cure. Diabetes cannot be cured, but the need for medication can sometimes be eliminated. “What we define as reversal is when medication is no longer needed and blood sugar remains normal,” says Dr Omoaghe.

Type 1 diabetes can sometimes be reversed if addressed at stage 2. Type 1 diabetes progresses in four stages.

Type 2 diabetes can also be reversed, particularly when caused by poor dietary habits. With disciplined lifestyle changes, medication may no longer be required.

Type 3 diabetes, however, is difficult to reverse. “Some individuals are born with genetic conditions, such as Down syndrome or Turner syndrome. Chromosomal problems can make diabetes irreversible. Similarly, if a viral infection destroyed the pancreas, reversal is unlikely,” explains Dr Omoaghe.

Dietary planning

Philip Lundu, Clinical Nutritionist at MP Shah Hospital, says dietary planning for diabetics considers multiple factors.

“Factors include age, nutritional status, body weight—whether underweight, overweight, or ideal BMI—and level of physical activity,” he says.

Once a patient is cleared by an endocrinologist, Lundu prepares them for safe fasting, including guidance before and after meals.

“When breaking a fast, we encourage adequate hydration—one glass of water or herbal tea, such as chamomile. Wait 15–20 minutes before the main meal. Blood sugar levels should also be monitored,” he explains. 

Post-fasting blood sugar dictates portion sizes. For example, someone with hypoglycaemia (minimum blood sugar of 4 mmol/L) requires different carbohydrate intake than someone with a higher reading (e.g., 15 mmol/L).

Sugary foods and drinks must be avoided. Simple carbohydrates, including soda, fruit juices, and pastries, should be restricted, as they rapidly spike blood sugar levels.

“Meal composition matters. Animal proteins like beef, mutton, and pork break down into amino acids, which do not directly raise blood sugar,” he adds.

However, patients with diabetes and gout are advised to avoid red meat. Leafy vegetables, such as spinach and kale, are recommended instead of starchy vegetables like pumpkin or Irish potatoes.

Complex carbohydrates may include yellow ugali, wimbi ugali, or posho. “Larger portions of rice or ugali increase blood sugar. Overeating is unsafe, whether fasting, practising intermittent fasting, OMAD, or religious fasting,” says Lundu.

Regarding fruit, Lundu emphasises that carbohydrates—not vitamins—are the dominant nutrient. “Eating fruit immediately after a meal is not recommended. For example, a banana is high in sugar, and one apple contains around 14 grams of sugar, equivalent to one to two teaspoons. Multiple fruits should be avoided,” he advises.

Clinical pharmacist Dr Peter Njenga explains that different classes of medication manage diabetes.

“Some medications can cause hypoglycaemia—dangerously low blood sugar—while others, called anti-hyperglycaemics, prevent sugar levels from rising but do not lower them,” he says.

Dr Njenga adds that fasting patients should avoid oral hypoglycaemic drugs to prevent hypoglycaemia. Blood sugar must be closely monitored.

Fasting itself may cause complications, such as fasting ketoacidosis.

“If fasting continues long enough, blood glucose may be depleted. The body then breaks down fats, producing acidic compounds called ketoacids. The most common complication in type 1 diabetes is diabetic ketoacidosis,” he explains.

Patients with type 1 diabetes may experience hypoglycaemia or ketoacidosis if they fast.

Sheikh Abubakar Bini, Chair of the Council of Imams and Preachers in Uasin Gishu County, says the Qur’an exempts the ill from fasting.

Those unable to fast may make up missed days after Ramadan. However, for chronic or lifelong illnesses, the ruling differs. “For example, a diabetic unable to fast is not required to make up missed fasts. Instead, they should provide charity—approximately 2.5 kilograms of food to a needy person for each missed day,” Sheikh Bini explains.