Many religious faiths recommend spiritual strengthening through periods of prayer and fasting — a sacred time to commune with God while abstaining from all food, drink, or both. Today actually marks the first day of the month of Ramadan, where Muslims worldwide begin fasting during daylight hours.

While fasting is a commendable spiritual practice, it’s one that could come with major health risk when you have diabetes.

Fasting can last from one day to a month or longer. People of the Jewish faith fast for 25 hours from sundown to sundown during Yom Kippur. Muslims fast during daylight hours for the entire holy month of Ramadan. And many Christian religions call for it when there’s a need to reinforce spiritual discipline, put a situation under concentrated prayer, or experience divine intervention. During the Lenten season Christians fast and pray for 40 days.

Fasting during Ramadan

Ramadan represents more of a challenge than other spiritual fasts — particularly when you have diabetes.  During the month of Ramadan, Muslims abstain from all food, drink, use of oral medications and smoking from sunup to sundown. Christians experience a less restrictive fast during the 40-day Lenten season. You may give up eating certain foods or meals throughout the season, but not all food is forbidden. You can usually continue taking your daily medications.

But, for a Muslim with diabetes, going without food and drink for several hours a day, and many days at a time, can lead to serious complications. And for that reason, many healthcare providers discourage people with diabetes from fasting during Ramadan.

Know the Risks

Understanding the risks can help you avoid serious health problems while fasting.

Hypoglycemia: a drop in blood sugar due to decreased food intake. Signs include nervousness, dizziness, feeling shaky, sweating, sleepiness, and confusion. If left untreated, hypoglycemia may lead to unconsciousness.

Hyperglycemia: a blood-sugar spike that can happen when you aren’t taking as much medicine, or when you begin to eat again after the fast.

Diabetic ketoacidosis (DKA) – a reaction to less insulin or poorly-controlled diabetes prior to the fast or both. This is an emergency condition and you should call your healthcare provider immediately. Signs of DKA are nausea and vomiting, stomach pain, a fruity breath odor, and rapid breathing. Untreated DKA can lead to coma and death.

Dehydration: occurs due to decreased fluid intake during fast. Dehydration can be mild, moderate, or severe based on how much of the body’s fluid is lost and not replenished. Severe dehydration is a life-threatening emergency.

Tips for a Successful Fast

• Avoid binge eating during your pre-dawn meal and when you begin eating again after sunset. Large meals with excessive amounts of carbohydrate can lead to high blood sugar.

• Go easy on the physical activity while fasting. Too much can lead to low blood sugar and dehydration.

• Monitor your blood glucose more frequently. This is especially important if you have type 1 diabetes or type 2 diabetes treated with insulin or oral diabetes medicines.

• Talk to your healthcare provider about your medication. You should know how your medication works, how much to take and when to take it. The times and the amount of medicine you should take is likely to change while you are fasting.

• Discuss the fast with your spiritual leader. Because you have a health condition, you may be able to modify your fast in a way that meets your health objectives as well as your spiritual ones.

• You and your family should be aware of the signs and symptoms of hyperglycemia and what to do in case you have a medical crisis.

• Wear a medical alert bracelet and keep emergency contact numbers in an obvious place—your wallet, in your car, under I.C.E. (in case of emergency) on your cell phone contact list.

Constance Brown-Riggs, MSEd, RD, CDE, CDN, is the national spokesperson for the Academy of Nutrition and Dietetics, specializing in African American nutrition, and author of The African American Guide to Living Well With Diabetes. Visit her website at www.eatingsoulfully.com and follow her on twitter @eatingsoulfully.