Ramadan Fasting and Health Risks: Emergency Guide for Chronic Patients

Ramadan is a deeply meaningful month for millions of people in Turkey and across the world. However, for individuals living with diabetes, hypertension, heart disease, or kidney disease, extended fasting can introduce serious health risks that require careful medical planning.

The International Diabetes Federation estimates that a significant proportion of the world's 150 million Muslim diabetic patients choose to fast during Ramadan [1]Source: Diabetes and Fasting — International Diabetes Federation — International Diabetes Federation. The World Health Organization (WHO) reports that "the number of people living with diabetes rose from 200 million in 1990 to 830 million in 2022" [4]Source: Diabetes — WHO Fact Sheet (14 November 2024) — World Health Organization, so the at-risk population is now both larger and younger. A 2024 metabolomics study from Imperial College London's London Ramadan Study (LORANS), published in the American Journal of Clinical Nutrition (PMID 38301826), showed that Ramadan fasting measurably alters the metabolic profile — changes that may be favourable or unfavourable depending on the individual's underlying health [5]Source: Metabolomics of Ramadan fasting and associated risk of chronic diseases (Am J Clin Nutr, 2024) — American Journal of Clinical Nutrition. In 2026, Ramadan falls during the winter-spring transition, which means shorter fasting hours — but the absence of food and water for 14–17 hours still creates physiological challenges that chronic patients must not underestimate.

This guide explains what physiological changes fasting triggers, which symptoms require emergency attention, and when to call 112 or Nova Ambulans (0216 339 00 39) without delay.

Disclaimer: This content is for educational purposes only and does not replace professional medical advice. If you have a chronic condition, consult your doctor before fasting.

How Ramadan Fasting Affects the Body

During the fasting hours, the body undergoes several interrelated changes:

• Blood sugar fluctuations: In patients using insulin or medications that stimulate insulin secretion, prolonged fasting can dangerously lower blood glucose (hypoglycaemia) or allow it to rise out of control (hyperglycaemia).
• Dehydration and electrolyte imbalance: Cutting off water intake can rapidly create problems for anyone with reduced kidney function or those taking diuretic medications.
• Disrupted medication metabolism: Medications designed to be taken twice daily cannot simply be condensed into one dose without clinical supervision.
• Increased cardiovascular load: In at-risk patients, dehydration from prolonged fasting and fluid restriction can raise blood viscosity and place extra strain on the heart and circulatory system [3]Source: Ramadan fasting: recommendations for patients with cardiovascular disease (Beshyah et al.) — Beshyah SA, et al. — Ibnosina J Med Biomed Sci. According to WHO 2022 data, cardiovascular diseases account for roughly 19.8 million deaths a year — about 32% of all global deaths [6]Source: Cardiovascular diseases (CVDs) — WHO Fact Sheet — World Health Organization.

Diabetes Patients and Ramadan Fasting

The most common question among diabetic patients is: "Can I fast safely?" The answer depends heavily on the type of diabetes and current treatment. The IDF-DAR Practical Guidelines categorise patients into high, moderate, and low risk groups to guide this decision [2]Source: IDF-DAR Practical Guidelines — Diabetes and Ramadan — International Diabetes Federation.

Type 1 Diabetes

Due to complete insulin dependence and the volatility of blood glucose levels, Type 1 diabetic patients face very high risk when fasting. These patients should not fast without explicit approval from their endocrinologist [1]Source: Diabetes and Fasting — International Diabetes Federation — International Diabetes Federation[2]Source: IDF-DAR Practical Guidelines — Diabetes and Ramadan — International Diabetes Federation.

Type 2 Diabetes

Patients managing Type 2 diabetes with lifestyle changes alone, or with low-hypoglycaemia-risk medications such as metformin, may fast with lower risk. However, patients on insulin or sulphonylureas (e.g. glibenclamide, gliclazide) must work with their doctor to restructure medication doses and timing before Ramadan begins [2]Source: IDF-DAR Practical Guidelines — Diabetes and Ramadan — International Diabetes Federation.

Monitoring Blood Sugar While Fasting

Testing blood glucose with a fingerprick device during fasting does not break the fast, according to both medical authorities and most religious scholars [1]Source: Diabetes and Fasting — International Diabetes Federation — International Diabetes Federation. Recommended monitoring and action thresholds:

• Check blood glucose at least 2–4 times per day during the fasting period.
• If glucose falls below 70 mg/dL — break your fast and seek medical attention.
• If glucose exceeds 300 mg/dL, especially with nausea or vomiting — seek emergency care immediately.
• For severe hypoglycaemia symptoms (confusion, shaking, loss of consciousness) — break your fast at once; this is also a religious obligation.

Hypoglycaemia Symptoms and Emergency Response

Hypoglycaemia can become life-threatening within minutes, particularly in patients on insulin or sulphonylureas. Key warning signs include [1]Source: Diabetes and Fasting — International Diabetes Federation — International Diabetes Federation:

• Sudden profuse sweating and trembling
• Racing or pounding heartbeat
• Severe dizziness or headache
• Difficulty concentrating, drowsiness
• Blurred vision, tingling around the mouth
• Confusion or loss of consciousness

Critical: If the patient loses consciousness, cannot swallow, or fails to improve within 15 minutes of receiving sugar, call 112 or Nova Ambulans (0216 339 00 39) immediately. The ambulance team can administer intravenous glucose on the spot.

For step-by-step guidance on what to do while waiting for help, see our guide for relatives waiting for the ambulance.

Hypertension (High Blood Pressure) Patients and Ramadan

Hypertension is one of the most prevalent chronic conditions in Turkey. Extended dehydration combined with disrupted medication timing can cause blood pressure to spike or drop unpredictably [3]Source: Ramadan fasting: recommendations for patients with cardiovascular disease (Beshyah et al.) — Beshyah SA, et al. — Ibnosina J Med Biomed Sci.

Rescheduling Medication — Only With Your Doctor

Once-daily medications can often be safely moved to suhoor or iftar timing, but this decision must not be made without your doctor's guidance. Compressing twice-daily medications into a single dose without supervision risks overdose or inadequate blood pressure control.

Stay Ahead of Dehydration

• The fluid loss between suhoor and iftar raises the risk of hypertensive episodes.
• Drink plenty of water after iftar and again at suhoor.
• Avoid high-sodium foods (pickles, processed soups, cured meats) that exacerbate fluid retention.

Emergency Warning Signs

The following may indicate a hypertensive emergency — call 112 or Nova Ambulans immediately:

• According to the American Heart Association, blood pressure rising above 180/120 mmHg AND accompanied by a symptom such as chest pain, shortness of breath, back pain, numbness/weakness, vision changes, or difficulty speaking [7]Source: When to Call 911 for High Blood Pressure — American Heart Association — American Heart Association
• Severe headache + blurred vision + facial flushing
• Chest pain or shortness of breath alongside elevated blood pressure → see our chest pain and shortness of breath guide and call 112 without delay

Note: High blood pressure without any symptoms (≥180 systolic or ≥110 diastolic) does not usually require a hospital visit. In that case, rather than panicking, rest for a few minutes, re-take the reading, and consult your doctor [7]Source: When to Call 911 for High Blood Pressure — American Heart Association — American Heart Association.

Heart Patients and Ramadan: A High-Risk Combination

Cardiac patients require careful individualised evaluation before Ramadan fasting. According to the review of recommendations for cardiovascular patients by Beshyah et al., prolonged fasting and fluid restriction may [3]Source: Ramadan fasting: recommendations for patients with cardiovascular disease (Beshyah et al.) — Beshyah SA, et al. — Ibnosina J Med Biomed Sci:

• Increase blood viscosity, raising the risk of clot formation.
• Trigger electrolyte imbalances (including potassium disturbances) that can destabilise heart rhythm.

Patients with unstable angina, an acute coronary syndrome or heart attack in the past 6 weeks, or advanced heart failure are generally considered high-risk and advised not to fast [3]Source: Ramadan fasting: recommendations for patients with cardiovascular disease (Beshyah et al.) — Beshyah SA, et al. — Ibnosina J Med Biomed Sci. Be familiar with the early warning signs in our heart attack symptoms guide.

Cardiac Emergencies — Call 112 or Nova Ambulans Now

• Chest pressure, tightening, or burning lasting more than 5 minutes
• Pain radiating to the left arm, jaw, back, or upper abdomen
• Sudden shortness of breath + cold sweating + nausea
• Palpitations + dizziness + feeling of impending blackout

Important: Do not wait through these symptoms because you are fasting. Religious teaching also permits breaking the fast under conditions of genuine medical necessity.

Kidney Disease Patients and Prolonged Dehydration

Individuals with chronic kidney disease or a history of kidney stones face elevated risk during extended fasting periods:

• Dehydration concentrates urine, significantly raising the risk of kidney stone formation [1]Source: Diabetes and Fasting — International Diabetes Federation — International Diabetes Federation.
• In patients with already compromised kidney function, electrolyte disturbances can escalate quickly.
• Dialysis patients should generally not fast. For regular medical transport needs, explore our dialysis patient transport service.

Emergency indicators:

• Severe flank or back pain (kidney stone crisis)
• Markedly reduced urine output and dark-coloured urine
• High fever accompanied by back pain (possible kidney infection)

Suhoor and Iftar Nutrition: Key Principles for Chronic Patients

For patients managing chronic illness, what and how you eat at suhoor and iftar directly affects medication efficacy — not just energy balance.

At suhoor:

• Choose slow-digesting carbohydrates: wholegrain bread, oats, legumes.
• Drink plenty of water; aim to cover a large proportion of your daily fluid needs at suhoor.
• Diabetic patients should plan carbohydrate intake in advance with their doctor or dietitian.

At iftar:

• Start with a few dates and water, then a light soup — this gradually wakes the digestive system and blunts the post-fast glucose spike.
• Limit high-glycaemic-index foods (white bread, sugary desserts).
• Heart and blood pressure patients should avoid heavily salted foods.

When to Call an Ambulance During Ramadan

If any of the following situations arise, call 112 or Nova Ambulans (0216 339 00 39) without delay:

Our 5 tips to stay calm in emergencies guide can help you and your family act clearly and quickly under pressure.

Important: While waiting for the ambulance, keep the patient calm, seated or semi-reclined. Do not give any medication that has not been prescribed by their doctor.

Nova Ambulans: 24/7 Support Throughout Ramadan

Nova Ambulans continues its 24/7 emergency ambulance and planned patient transport service throughout the month of Ramadan without interruption. Whether you need a urgent emergency response or regular medical transport — for dialysis, chemotherapy, or specialist appointments — call us at 0216 339 00 39.

Frequently Asked Questions (FAQ)

Q: I have diabetes. Can I fast safely during Ramadan? A: It depends on your diabetes type, medications, and overall health status. A consultation with your endocrinologist or internist before Ramadan is essential. Patients at high hypoglycaemia risk — including most Type 1 diabetics and insulin-dependent Type 2 patients — are generally advised not to fast [1]Source: Diabetes and Fasting — International Diabetes Federation — International Diabetes Federation[2]Source: IDF-DAR Practical Guidelines — Diabetes and Ramadan — International Diabetes Federation.

Q: Does using insulin or testing blood sugar break the fast? A: Testing blood glucose with a fingerprick does not break the fast according to the majority of religious and medical authorities. Insulin is a medical necessity and most scholarly opinions permit its use without invalidating the fast. Always discuss timing and dose adjustments with your doctor [2]Source: IDF-DAR Practical Guidelines — Diabetes and Ramadan — International Diabetes Federation.

Q: How far in advance should I see my doctor before Ramadan? A: Book your appointment at least 2–4 weeks before Ramadan begins. This gives your doctor enough time to restructure medications, conduct a risk assessment, and provide you with clear fasting guidelines.

Q: What should I do if someone with diabetes collapses during fasting? A: Break their fast immediately — offer fruit juice or a few sugar cubes if they are conscious and can swallow safely. If there is no improvement within 15 minutes, or if the person is unconscious, call 112 or Nova Ambulans (0216 339 00 39) at once. The medical team can administer intravenous glucose [1]Source: Diabetes and Fasting — International Diabetes Federation — International Diabetes Federation.

Q: Should I change the timing of my blood pressure medication myself? A: No. Changing the timing of antihypertensive medications without medical guidance can cause either overdose or inadequate blood pressure control. Always make this change in consultation with your prescribing doctor.

Q: My relative has heart failure and wants to fast. What are the risks? A: Advanced heart failure, an acute coronary syndrome or heart attack in the past 6 weeks, or unstable angina are generally considered high-risk for fasting, and these patients are advised not to fast without cardiologist approval [3]Source: Ramadan fasting: recommendations for patients with cardiovascular disease (Beshyah et al.) — Beshyah SA, et al. — Ibnosina J Med Biomed Sci. Please ensure your relative has a pre-Ramadan cardiac review.

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