Diabetes and Nutrition: Strengthening Safety During Religious Fasting

March is one of my favorite months. Along with several family birthdays, it is also National Nutrition Month. Established by the Academy of Nutrition and Dietetics, this annual campaign encourages individuals and communities to make informed food choices and build sustainable eating habits. This year’s theme, “Discover the Power of Nutrition,” aligns closely with the direction of the American Diabetes Association 2026 Standards of Care.

To celebrate, each week this month I will take a closer look at updates to nutrition guidance in Section 5 of the 2026 Standards. This week, we will explore important updates related to safety and nutrition during religious, spiritual, or health-related fasting.

Just joining now? You can start with some of my earlier articles below:

Supporting Safe Fasting in Diabetes Care

The 2026 Standards of Care introduce important updates related to safety and nutrition during religious, spiritual, and health-related fasting. As fasting remains a meaningful practice for many individuals living with diabetes, the updated guidance emphasizes structured risk assessment, proactive planning, and targeted education.

Formalized Prefasting Risk Assessment

The 2026 Standards state that clinicians should use the updated International Diabetes Federation and Diabetes and Ramadan International Alliance comprehensive prefasting risk assessment to generate a risk score for the safety of fasting.

Rather than broadly advising caution, the updated recommendation calls for a standardized, evidence-informed risk scoring process. The goal is to more clearly stratify individuals based on their likelihood of complications such as:

- Hypoglycemia
- Hyperglycemia
- Dehydration
- Ketoacidosis

The risk score provides a framework for shared decision-making. Some individuals may be advised not to fast due to high medical risk, while others may be able to fast safely with close monitoring and medication adjustments.

Fasting-Focused Education

The 2026 Standards also explicitly call for fasting-focused education to minimize risks. This includes guidance on:

- Blood glucose monitoring frequency
- Recognizing early signs of hypoglycemia and hyperglycemia
- Hydration strategies during non-fasting hours
- Meal composition at pre-dawn and sunset meals

Balanced meals that include adequate protein, fiber, and healthy fats can help moderate postprandial glucose excursions and support satiety. Individuals should be counseled to avoid large, refined carbohydrate loads at the end of the fast, which can contribute to significant glycemic variability.

Treatment Plan Optimization

Finally, the 2026 Standards highlight the need to assess and optimize treatment plans well in advance of fasting. Medication dose, timing, and regimen adjustments should be individualized to reduce risks. This is especially important for individuals using insulin or medications that increase hypoglycemia risk.

Adjustments could include:

- Modifying basal insulin doses
- Changing bolus timing
- Adjusting sulfonylurea dosing
- Reviewing the safety profile of other glucose-lowering therapies

The emphasis on advance planning highlights that fasting should not be managed reactively.

Key Clinical Takeaways

Religious fasting can be approached safely in many cases, but it requires thoughtful preparation, close monitoring, and individualized nutrition planning.

The 2026 Standards recognize both the medical risks and the cultural importance of fasting. By combining structured assessment with nutrition-focused support, the Standards reinforce a patient-centered approach to care.

Ready to Strengthen Nutrition Services in Your Practice?

Are you looking to build, refine, or expand nutrition services within your practice? I offer flexible, consultative support designed to meet the needs of busy clinics and healthcare organizations.

Nutrition is central to my work across prevention and chronic disease management. My approach focuses on translating evidence into clear, practical strategies that help patients understand not only what to do, but why it matters for their health.

Let me help you develop patient-centered nutrition services that integrate seamlessly into clinical care. Book a discovery call to explore how we might work together.