As the sun sets over Alexandria, the scent of simmering Molokhia fills the air, mingling with the voices of street vendors calling out their final sales before Ramadan fasting ends for the day.
By Naqaa Alomari
Long tables offer festive dishes of lamb with grilled meats, dates, lentil soup and rice, beloved traditions passed down through generations. Yet this plenty poses a chronic health risk – because many Egyptian adults live with diabetes.
In Irbid, Jordan, a similar scene unfolds. Families sit down to enjoy Mansaf, Jordan’s rich national dish of lamb, alongside plates of fresh vegetables, pickles, yoghurt, and warm Shrak bread.
Again, the celebrations pose dietary changes as well as possible medication issues, with many disadvantaged Muslims choosing holiday food purchases over insulin. In many other nations, providing insulin without holiday interruptions or unfair pricing is a challenge.
Ramadan is not just about fasting – it is about community, generosity, and celebration. But amid the joy and indulgence, people with diabetes face a difficult puzzle: how to balance their health with the deep-rooted traditions.
Fasting and blood sugar
Without proper guidance, fasting can lead to dangerous fluctuations in blood sugar levels, dehydration, and cardiovascular complications. These lead to serious illness and death, but also disability with job loss and further demands on health budgets.
Pre-Ramadan nutrition education is a public health necessity. Scaling up structured, culturally relevant diabetes education programs can empower Muslims worldwide to observe Ramadan safely while maintaining their health.
While the global rise in diabetes prevalence is well known, fasting during Ramadan presents unique challenges from Zamboanga to Tangier. Across diverse Muslim communities – whether in majority-Muslim nations or as minorities worldwide – growing diabetic populations need knowledge to fast safely.
In Egypt and Jordan, pre-Ramadan nutrition education has emerged as a policy-driven intervention that empowers individuals with diabetes to make informed dietary and lifestyle choices while fasting. By integrating structured education into national healthcare systems, policymakers can ensure that diabetes patients receive the guidance they need to observe Ramadan safely.
The new interface between social media and telehealth is showing promise in providing culturally sensitive education about diabetes. Starting before the holiday and continuing to measure results months later, researchers have found ways to help patients complete Ramadan with greater knowledge and more stable blood sugar levels.
Ramadan also poses challenges in terms of medication access and distribution, raising a major public health concern in a nation where nearly 15% of adults live with type 2 diabetes. Across all regions, individuals with diabetes face significant risks, including hypoglycemia, hyperglycemia, dehydration, and cardiovascular complications if not properly managed.
Bridging the gap between faith and health
Fasting from dawn to sunset disrupts the typical dietary and medication routines of individuals with diabetes. Without proper guidance, some consume high-sugar, high-fat meals at iftar, leading to post-fasting hyperglycemia, while others experience dangerously low blood sugar throughout the day. Irregular medication use further complicates diabetes management, making fasting particularly risky for those on insulin or glucose-lowering therapies.
Despite medical concerns, fasting is a strong religious and cultural obligation for Muslims – but most lack accessible fasting and dietary guidance, increasing their vulnerability to complications.
The International Diabetes Federation (IDF) and the Diabetes and Ramadan (DAR) International Alliance have long recommended personalized strategies including meal planning, medication adjustments, and frequent glucose monitoring to mitigate risks. Yet these strategies remain rare, inconsistent and underdeveloped across healthcare systems.
Nutrition education in diabetes management
Nutrition is central to diabetes management, and education programs tailored to Ramadan fasting have shown significant benefits.
Patients who receive structured guidance before Ramadan learn how different foods affect blood sugar and adjust meal choices accordingly. This enables them to reduce their risk of complications such as hypoglycemia and cardiovascular issues.
Improved medication adherence and modified dosages can be undertaken safely under medical supervision.
These interventions enable people with diabetes to sustain healthier habits beyond Ramadan, promoting long-term diabetes control.
Studies from Egypt, Jordan, and Pakistan show that individuals who participate in pre-Ramadan nutrition education programs experience improved glycemic control and lower rates of diabetes-related complications.
By equipping patients with practical, culturally relevant guidance, these programs have the potential to transform diabetes management during fasting periods.
Scaling pre-Ramadan education through policy
Despite its benefits, pre-Ramadan diabetes education is not widely institutionalized. To bridge this gap, policymakers must integrate structured education programs into primary healthcare systems.
If pre-Ramadan education is mandated in healthcare settings, primary care providers could offer structured guidance for diabetes patients who intend to fast.
Public health campaigns need to provide accessible, culturally relevant materials that address common misconceptions and promote balanced eating. Mobile health (mHealth) applications and telemedicine services can extend the reach of diabetes education, providing real-time support to fasting individuals.
Physicians, dietitians, and community health workers should be equipped with specialized training on Ramadan-focused diabetes management.
National media campaigns should highlight the importance of pre-Ramadan preparation and safe fasting practices.
The UK and Canada have begun integrating Ramadan-focused diabetes education into their broader public health initiatives, providing models that can be adapted in other regions with large fasting populations.
Holiday Training Pays Health Dividends
Pre-Ramadan nutrition education is more than a clinical intervention – it is a public health necessity. By embedding structured, culturally sensitive diabetes education into care systems, governments protect both fasting individuals and health budgets without undermining religious practices.
Tight health budgets and rising diabetes rates require policy-driven education strategies to reduce illness and deaths. These simple preventive programs can improve the quality of life worldwide for nearly two billion Muslims. The time to act is now—because no one should have to choose between their faith and their health.
Alomari is a Jordanian health educator and nutritionist working in Egypt on diabetes. Work experience at the Diabetes and Diabetic Foot Center and as a Saudi government health specialist deepened her focus on health policy needs. Her research merging new media with Ramadan education is forthcoming. She compared US and Taiwan school lunch programs for a global health and development thesis at Taipei Medical University.
