07/03/2026
๐ฅ๐๐ ๐๐๐๐๐ก + ๐๐ก๐ฆ๐จ๐๐๐ก: ๐๐ฎ๐น๐ฎ๐ป๐ฐ๐ถ๐ป๐ด ๐๐ฎ๐๐๐ถ๐ป๐ด ๐ฎ๐ป๐ฑ ๐๐ฒ๐ฎ๐น๐๐ต
๐ก๐ผ๐ ๐ฒ๐ฎ๐๐ถ๐ป๐ด ๐ฑ๐ผ๐ฒ๐ ๐ก๐ข๐ง ๐บ๐ฒ๐ฎ๐ป ๐๐ผ๐ ๐ฑ๐ผ๐ปโ๐ ๐ป๐ฒ๐ฒ๐ฑ ๐ถ๐ป๐๐๐น๐ถ๐ป.
Wrong timing can send your sugar crashingโฆ or silently rising all day.
Every Ramadhan, this happens.
We plan our meals carefully.
We plan our prayer times carefully.
But insulin?
โMaybe I just reduce on my own or skip it altogether. Iโm fasting, so my sugar will be low anyway.โ
๐๐๐ ๐๐ต๐ฎ๐โ๐ ๐๐ต๐ฒ๐ฟ๐ฒ ๐๐ต๐ฒ ๐ฟ๐ถ๐๐ธ ๐ฏ๐ฒ๐ด๐ถ๐ป๐.
Even when you are not eating, your liver still releases glucose.
Without enough insulin, blood sugar can climb quietly for hours.
๐๐ฒ๐ฟ๐ฒโ๐ ๐ฎ ๐ฟ๐ฒ๐ฎ๐น-๐น๐ถ๐ณ๐ฒ ๐ต๐ถ๐ด๐ต-๐ฟ๐ถ๐๐ธ ๐๐ฐ๐ฒ๐ป๐ฎ๐ฟ๐ถ๐ผ.
A patient stopped daytime insulin during fasting.
By late afternoon he felt exhausted and nauseated, assuming it was just normal fasting fatigue.
His glucose was dangerously high.
Fasting did not cause it. Unadjusted or skipped insulin did.
๐๐ฒ๐ฟ๐ฒโ๐ ๐ฎ๐ป๐ผ๐๐ต๐ฒ๐ฟ ๐ฐ๐ผ๐บ๐บ๐ผ๐ป ๐๐ถ๐๐๐ฎ๐๐ถ๐ผ๐ป.
Normal insulin dose at iftar.
Large meal. Sweet drinks. Several kuih.
Sugar spikes overnight.
Next day, long-acting insulin was never adjusted, blood sugar drops too low before iftar.
๐ง๐ต๐ถ๐ ๐ฟ๐ผ๐น๐น๐ฒ๐ฟ ๐ฐ๐ผ๐ฎ๐๐๐ฒ๐ฟ ๐ถ๐ ๐ฝ๐ฟ๐ฒ๐๐ฒ๐ป๐๐ฎ๐ฏ๐น๐ฒ.
๐ช๐ต๐ ๐ฝ๐ฒ๐ผ๐ฝ๐น๐ฒ ๐ณ๐ฎ๐น๐น ๐ถ๐ป๐๐ผ ๐๐ต๐ถ๐?
โข Fear of low blood sugar
โข Fear of โtoo much insulinโ
โข Belief that fasting naturally corrects diabetes
โข Worry that injecting during the day invalidates the fast (it does not)
โข Desire to be fully independent without medical review
๐ช๐ต๐ฎ๐ ๐ฎ๐ฟ๐ฒ ๐๐ต๐ฒ ๐ฐ๐ผ๐ป๐๐ฒ๐พ๐๐ฒ๐ป๐ฐ๐ฒ๐?
Severe hypoglycaemia can cause confusion, seizures, collapse and coma.
Severe hyperglycaemia can cause dehydration, hospitalisation, even life-threatening emergencies.
๐๐ฒ๐ฎ๐น๐๐ต ๐ถ๐ ๐ป๐ผ๐ ๐บ๐ฒ๐ฎ๐ป๐ ๐๐ผ ๐ฏ๐ฒ ๐ฐ๐ผ๐บ๐ฝ๐ฟ๐ผ๐บ๐ถ๐๐ฒ๐ฑ.
๐ฃ๐น๐ฒ๐ฎ๐๐ฒ ๐ณ๐ผ๐น๐น๐ผ๐ ๐๐ต๐ถ๐ ๐๐ถ๐บ๐ฝ๐น๐ฒ, ๐๐ฎ๐ณ๐ฒ ๐ณ๐ฟ๐ฎ๐บ๐ฒ๐๐ผ๐ฟ๐ธ ๐ณ๐ผ๐ฟ ๐ถ๐ป๐๐๐น๐ถ๐ป ๐ฑ๐๐ฟ๐ถ๐ป๐ด ๐ฅ๐ฎ๐บ๐ฎ๐ฑ๐ต๐ฎ๐ป:
1. Pre-Ramadan medical review: changes in diet and insulin regimen may need to be made.
2. Do not stop insulin without medical advice.
3. Self monitor blood glucose more frequently: pre-sahur, 2 hours post-sahur, midday, pre-iftar, and 2 hours post iftar.
4. Break the fast immediately if:
โข Blood glucose < 3.3 mmol/L at ANY time during fasting.
โข Blood glucose < 3.9 mmol/L in the early hours of fasting (especially within the first few hours after sahur, as levels may continue dropping).
โข Blood glucose > 16.7 mmol/L at any time.
โข You have symptoms of hypoglycaemia, hyperglycaemia, dehydration, or feel unwell.
5. Appropriate meal planning.
Breaking the fast for medical safety is permitted. Preserving life takes priority.
Ramadhan is about discipline. Proper insulin adjustment is part of that discipline.
๐๐ถ๐ป๐ฎ๐น ๐๐ต๐ผ๐๐ด๐ต๐:
Fasting is an act of faith. Managing your insulin is an act of responsibility.
Please share this with that friend who plans their kuih carefullyโฆ but adjusts insulin based on guesswork.
โ
Written by:
John Tiong, MPharm, PhD
Tan Li Ling, MBBS
This educational post is a collaboration between Dosing Health and Alpro Pharmacy to support informed, evidence-based health decisions.
