Caring for Fasting Patients During Ramadan: A Nurse’s Guide (2027)

Every year, hundreds of millions of Muslims around the world fast from dawn to sunset during Ramadan, abstaining from food, drink, oral medicines and smoking during daylight hours. Many patients, including people with diabetes, kidney disease, heart disease and pregnant women, choose to fast even when they could be exempt. Nurses in the Gulf, the wider Middle East, Africa, Asia and Muslim communities everywhere play a central role in helping patients fast safely, recognise when fasting is unsafe, and adjust care without losing trust.

This guide explains what Ramadan fasting involves, which patients are at higher risk, how to assess and educate, how to time medicines and monitoring, when patients should break their fast, and how nurses who are fasting themselves can stay safe on shift. Ramadan 2027 is expected to begin around 8 February 2027, depending on the sighting of the moon.

This guide is educational. Decisions about fasting, medicines and doses should be made by the patient with their healthcare provider, following local protocols and current guidelines such as those from the International Diabetes Federation and the Diabetes and Ramadan International Alliance (IDF-DAR).

What Ramadan fasting involves

• Fasting lasts from dawn (fajr) to sunset (maghrib) each day for 29 or 30 days.
• Most people eat a pre-dawn meal, suhoor, and break the fast at sunset with iftar, often starting with dates and water.
• Fasting hours vary with season and latitude. In the Gulf in February and March they are roughly 12 to 13 hours; in high-latitude countries in summer they can be much longer.
• During the fast, people abstain from food, drink (including water), oral medicines and smoking.
• Sleep and meal patterns change: many people stay up late, eat larger meals at night and sleep less.

Who is exempt from fasting?

Islam exempts people for whom fasting may cause harm, including those who are ill, travellers, and in many interpretations pregnant or breastfeeding women who fear harm to themselves or their baby, as well as older adults who cannot fast. Exempt people may make up missed days later or offer compensation (fidya), depending on their circumstances and religious guidance.

Despite this, many patients choose to fast because of its deep spiritual and social importance. The nurse’s role is not to decide religious questions, but to give clear health information, respect the patient’s choice, and help them fast as safely as possible or understand when breaking the fast is medically necessary. Encourage patients to discuss religious questions with their imam or religious adviser, many of whom are well informed about medical exemptions.

Higher-risk patients

• Diabetes, especially type 1 diabetes, poorly controlled type 2 diabetes, recent severe hypoglycaemia or diabetic ketoacidosis, or treatment with insulin or sulfonylureas.
• Chronic kidney disease, particularly advanced stages and people on dialysis.
• Heart failure, recent heart attack or unstable heart disease.
• Pregnancy, especially with gestational diabetes, pre-eclampsia or other complications.
• Epilepsy requiring medicines at fixed intervals.
• Frailty and older age, with risks of dehydration, falls and confusion.
• Acute illness, such as infections, vomiting or diarrhoea.
• Time-critical medicines, such as some anticoagulants, antiretrovirals, immunosuppressants or Parkinson’s disease medicines.

The IDF-DAR Practical Guidelines classify people with diabetes into risk categories (very high, high, moderate/low) to support individualised advice. People in the highest risk categories are generally advised not to fast, while others may fast with careful planning and monitoring.

Before Ramadan: the pre-Ramadan assessment

1. Ask: “Are you planning to fast this Ramadan?” Ask early, respectfully and without judgement.
2. Assess risk: diagnosis, recent control (for example HbA1c in diabetes), complications, previous fasting experience, hypoglycaemia history, kidney function and frailty.
3. Review medicines: list every medicine, dose and timing, including over-the-counter and herbal products.
4. Refer for medicine adjustment: the prescribing healthcare provider or pharmacist may change doses, timing or medicine choice. Nurses should not change prescriptions independently.
5. Educate: monitoring, warning signs, hydration, meal planning and when to break the fast.
6. Agree a written plan and follow-up arrangements during Ramadan.

Diabetes: key points for nurses

Monitoring

Checking blood glucose does not break the fast, according to widely accepted religious guidance and diabetes guidelines. Encourage people with diabetes, especially those on insulin or sulfonylureas, to check before suhoor, mid-morning, midday, mid-afternoon, before iftar, two hours after iftar and any time they feel unwell.

When to break the fast

The IDF-DAR guidelines advise breaking the fast immediately if blood glucose falls below 70 mg/dL (3.9 mmol/L) or rises above 300 mg/dL (16.6 mmol/L), or if there are symptoms of hypoglycaemia, hyperglycaemia, dehydration or acute illness. Teach patients the signs of hypoglycaemia (sweating, shaking, palpitations, hunger, confusion, blurred vision) and how to treat it promptly according to their plan.

Medicines

Medicines with a higher risk of hypoglycaemia, such as insulin and sulfonylureas, often need dose or timing adjustments. Others, such as metformin, may be redistributed between iftar and suhoor. These decisions belong to the prescribing healthcare provider; nurses explain changes clearly, check understanding and monitor for problems.

Food and fluids

• Start iftar with water and a small amount of dates, then a moderate meal rather than a very large one.
• Eat suhoor as late as possible before dawn, with slowly absorbed carbohydrates, protein and fibre.
• Drink plenty of water between iftar and suhoor; limit sugary drinks, fried foods and caffeine.

Other conditions

Kidney disease

Dehydration can worsen kidney function. People with advanced chronic kidney disease or on dialysis are usually advised not to fast, or to do so only with specialist approval and close monitoring.

Heart disease and hypertension

People with stable hypertension may be able to fast with adjusted medicine timing. Those with recent cardiac events or unstable heart failure are usually advised not to fast. Watch for dizziness, falls and dehydration, especially with diuretics.

Pregnancy and breastfeeding

Many pregnant and breastfeeding women choose to fast. Assess risk, check for dehydration and gestational diabetes, and advise women to break the fast if they feel unwell, notice reduced fetal movements, or show signs of dehydration or hypoglycaemia.

Older adults

Older people are at higher risk of dehydration, confusion, falls and medicine-related harm. Involve family carers in planning, and consider carefully whether fasting is safe.

Caring for fasting inpatients

• Ask every Muslim patient on admission during Ramadan whether they are fasting or would like to fast.
• Coordinate meals with catering for suhoor and iftar.
• Time medicines and observations with the healthcare team and pharmacy, scheduling oral medicines at suhoor and iftar where safe.
• Discuss non-oral treatments: views differ on whether some injections or treatments affect the fast. Ask the patient and involve chaplaincy or religious advisers if needed.
• Monitor closely: fluid balance, blood glucose, blood pressure and signs of dehydration.
• Support prayer and spirituality: help with positioning, ablution and quiet time.
• Document the fasting plan, medicine timing and advice given.

Patient education: key messages

1. Talk to your healthcare provider about fasting at least a month before Ramadan.
2. Do not change your medicines yourself.
3. Checking your blood sugar does not break your fast.
4. Break your fast immediately if your sugar is too low or too high or you feel unwell.
5. Eat suhoor late and iftar in moderation; drink plenty of water at night.
6. Avoid heavy exercise during fasting hours; light activity after iftar is better.
7. Your health is a priority; Islam provides exemptions for illness.

Nurses who are fasting

• Plan suhoor with slow-release foods and plenty of fluids, and rehydrate well between iftar and suhoor.
• Talk to your manager about shift patterns and breaks for iftar and prayer.
• Be alert to fatigue, especially on night shifts and when driving home.
• Double-check high-risk tasks, such as drug calculations, when you are very tired.
• If you have a medical condition, discuss fasting with your own healthcare provider.

Colleagues who are not fasting can help by covering iftar breaks and showing understanding.

Eid and after Ramadan

Ramadan ends with Eid al-Fitr, often with large family meals and sweets. Remind patients with diabetes to return gradually to usual routines and medicines as advised by their healthcare provider, and arrange follow-up.

Recognising dehydration in fasting patients

Dehydration is one of the most common problems during Ramadan, especially in hot climates, in older adults and in people taking diuretics. Watch for:

• Thirst, dry mouth and dry skin.
• Dark, reduced urine.
• Dizziness, especially on standing, and falls.
• Headache, fatigue and confusion.
• Rapid pulse and low blood pressure.
• Rising creatinine in people with kidney disease.

Advise patients to break their fast if they develop signs of significant dehydration, and to seek care urgently if they become confused, faint or stop passing urine.

A sample pre-Ramadan checklist for nurses

1. Is the patient planning to fast? For how many days?
2. What conditions do they have, and how well controlled are they?
3. Have they had problems during previous Ramadans, such as hypoglycaemia, dehydration or hospital admission?
4. Which medicines do they take, and at what times?
5. Has a healthcare provider reviewed their medicines for Ramadan?
6. Do they have a glucose meter or blood pressure monitor at home, and know how to use it?
7. Do they know when to break the fast and how to treat a hypo?
8. Who can they call for advice during Ramadan?
9. Is a follow-up appointment booked during or after Ramadan?

Cultural sensitivity on the ward

Ramadan is a time of prayer, reflection, charity and family gatherings. Small gestures make a big difference to patients and families: greeting them with “Ramadan Kareem” (generous Ramadan) or “Ramadan Mubarak” (blessed Ramadan), avoiding unnecessary disturbances at iftar time, allowing family to bring food after sunset where hospital policy permits, and respecting patients’ wishes about prayer and Qur’an recitation. Even nurses who do not share the faith can make patients feel understood and cared for. Learning a few words of Arabic helps; see our guide to Arabic phrases for nurses.

Worked example: planning with a patient

Mrs A is 52, has type 2 diabetes treated with metformin and a once-daily sulfonylurea, and wants to fast all of Ramadan. Her HbA1c three months ago was reasonably controlled, and she had one mild hypo last year while fasting.

1. The nurse asks about her fasting plans six weeks before Ramadan and books a medicine review with her healthcare provider.
2. The healthcare provider reviews her treatment and adjusts her medicines and timing for Ramadan, considering her hypo risk.
3. The nurse teaches her to check glucose before suhoor, at midday, before iftar and whenever she feels unwell, and gives her the break-the-fast thresholds in writing.
4. They plan meals: a late suhoor with wholegrain bread, eggs and yoghurt, and an iftar starting with water and two dates followed by a balanced plate.
5. The nurse arranges a phone check in the first week of Ramadan and a review after Eid.

Mrs A completes Ramadan without a hypo and feels respected. That is the goal of good Ramadan care: safety and dignity together.

Ramadan in countries with long fasting hours

Muslim patients in northern Europe, Canada and other high-latitude countries may fast for 16 to 20 hours in summer, which greatly increases the risk of dehydration and hypoglycaemia. In 2027 Ramadan falls in February and March, so fasting days will be shorter in most of the world, but nurses working with diaspora communities should remember that risk changes as Ramadan moves about 11 days earlier each year, gradually moving into longer summer days later in the decade.

Frequently asked questions

Does checking blood sugar break the fast?

Widely accepted religious and medical guidance says that finger-prick glucose testing does not break the fast.

When should a person with diabetes break their fast?

If blood glucose is below 70 mg/dL (3.9 mmol/L) or above 300 mg/dL (16.6 mmol/L), or if they feel unwell, according to IDF-DAR guidance.

Can pregnant women fast during Ramadan?

Many do, but they may be exempt. Assess risks individually and advise breaking the fast if there are warning signs.

When does Ramadan 2027 begin?

Ramadan 2027 is expected to begin around 8 February 2027, depending on the sighting of the moon.

But what if a patient insists on fasting against advice?

Respect their autonomy while ensuring they understand the risks. Agree clear safety limits, such as glucose thresholds and symptoms that mean breaking the fast, increase monitoring, involve family, and offer to connect them with a religious adviser. Document the discussion. A patient who feels respected is far more likely to accept advice when it matters most.

Related: Arabic phrases for nurses · Nursing in the Middle East · Heat stroke and heat exhaustion · Medication safety

Sources: International Diabetes Federation and Diabetes and Ramadan International Alliance (IDF-DAR) Diabetes and Ramadan Practical Guidelines; World Health Organization; national diabetes and kidney guidelines. Educational information only; individual decisions should be made with a healthcare provider.