Are you living with diabetes and planning to fast for Ramadan? Follow these practical tips and advice so you can enjoy a safe and healthy Ramadan.

Consider your risk

Fasting, refraining from using medications, insulin and drinking water will affect your blood glucose levels (BGL) and can lead to potential risks including high BGL (hyperglycaemia), low BGL (hypoglycaemia or hypo), dehydration, blood clots and diabetic ketoacidosis (DKA).

According to religious tenets, fasting is not meant to create excessive hardship on an individual. It is a commendable spiritual practice but it’s one that can come with health risks for people living with diabetes. You may be advised not to fast if your diabetes management is unstable prior to Ramadan, if you have type 1 diabetes, if you are hypo unaware, pregnant, unwell, or will be performing intense physical labour.

If you have compilations associated with diabetes, such as heart disease, kidney disease or visual problems, the risk of these issues becoming worse during the fast is high, and so you should consider not fasting.

If you have type 2 diabetes and are treated with metformin, thiazolinediones or diet alone, and if your blood glucose is well managed, you are at low risk of complications with fasting.

The decision to fast is personal, and your health care team has a duty of care to respect your commitment and ensure your safety.

Be prepared

A pre-Ramadan assessment is an opportunity to review your blood pressure, BGL and lipids, learn of any potential risks of fasting, discuss monitoring and how to treat a hypo or manage high BGL, and prescribe any Ramadan-specific changes in the dose and/or timing of your medication or insulin regime.

Remember a hypo is a medical emergency and treatment means you will need to break your fast. Visiting your doctor to adjust your insulin regime before you begin fasting can help you avoid this.

Safety tip: Never stop taking your insulin or your diabetes medications. Speak with your diabetes doctor or nurse about how to change the time and dose during Ramadan.

Check BGLs regularly

Checking your BGL more frequently is encouraged during Ramadan, particularly if you take insulin or are on any sulfonylureas.

The Diabetes and Ramadan International Alliance confirm that pricking the skin for blood glucose testing does not invalidate the fast.

Safety tip: If you feel unwell at any time during Ramadan, check your BGL and be prepared to break the fast to treat a hypo (BGL less than 4mmol/L) – or manage hyperglycaemia (BGL more than 15mmol/L).

Eating during Ramadan

During the month of Ramadan your eating pattern will be affected by long gaps between meals and feasting after iftar that can lead to greater swings in blood glucose levels. Good nutrition is particularly important at this time and maintaining a healthy eating plan will help you avoid the overeating of carbohydrates and fatty foods at the sunset meal.

Suggested meal plan

• Let your predawn meal (suhoor) be the largest one.
• Include complex carbohydrates such as multigrain/wholegrain, sourdough breads, porridge, oats, bran, barley, semolina and buckwheat to give you sustainable energy throughout the day.
• Include protein rich foods such as lean meat, poultry, fish, eggs, dairy products, seeds, nuts, beans, legumes and tofu.
• Drink plenty of fluids, and choose fluid-rich foods to make sure you are well hydrated for the day.

When breaking your fast (iftar)

• Break your fast with a ‘sunset snack’ of one date, a cup of water and a bowl of soup. This will provide an instant boost of energy and hydration to help settle your hunger and prevent overeating at the start of your main meal.
• Try to eat slowly and chew well to prevent overeating.
• Use the healthy plate model as a reminder: a quarter of your plate should be complex low GI carbohydrates such as low GI rice, legumes and sweet potato, a further quarter of your plate should be lean meat, skinless chicken, egg, fish or tofu; the final half of your plate should be vegetables or salad.
• Try to avoid fried and salty foods at iftar.
• Make sure you drink plenty of fluids – try to drink two cups every hour to remain hydrated.

Snack right

Two hours after the dinner meal, it is normal to feel hungry. Have a healthy snack to avoid overeating or overindulging in traditional sweets. Avoid sugary foods as they don’t provide you with sustainable energy. Fried foods may also make you feel sluggish.

Some healthy choices include:

• One or two pieces of fresh fruit
• Canned fruit in natural juice (drained)
• Vegetable sticks with a tablespoon of hummus, tomato salsa or yoghurt dip
• 100-200g of low fat yoghurt
• A cup of low fat milk or soy milk (calcium fortified)
• 1-2 cups unbuttered and unsalted popcorn
• A handful of plain raw unsalted nuts
• A slice of grainy bread with a thin spread of avocado, low-fat ricotta, cottage cheese or hummus, with sliced vegetables.

Physical activity

You can continue to do your normal physical activity. However excessive physical activity should be avoided as this can increase your risk of hypoglycaemia, particularly during the few hours before the sunset meal.

Taraweeh (multiple prayers performed after the sunset meal which involve repeated cycles of rising, kneeling, and bowing) can be a tiring activity and you could become dehydrated or be at risk of hypos. To avoid problems during Taraweeh, make sure you:

• Eat starchy foods with iftar as they are digested slowly
• Drink plenty of water following iftar
• Take a bottle of water and glucose treatment with you to taraweeh.

Insulin treatment

Basal (sometimes also called background insulin, long or intermediate-acting) insulin doses may need to be reduced by around 15-30%. It is best taken after iftar.

Bolus (mealtime, rapid or short-acting) insulin doses should not be taken at lunchtime. The suhoor dosage may need to be reduced by around 25-50%. Usually the regular bolus dosage can be continued at iftar, provided you have a similar sized meal as you would usually have at dinner.

If you take premixed insulin once daily the dosage can be taken at iftar. For those taking twice daily premixed insulin, the suhur dosage will need to be reduced by around 25-50%. If you are usually on three lots of premixed insulin at main meals, the lunchtime one should not be taken. The iftar and suhoor doses will need to be adjusted.

If you have type 1 diabetes and you are on an insulin pump, generally the basal rates will need to be reduced by 20-40% in the last three to four hours of fasting. You should increase your basal rates by up to 30% after iftar.  Normal carbohydrate counting and insulin sensitivity principles apply in regards to bolus doses at both suhoor and iftar.

Note: The above medication and insulin dose adjustment recommendations are a guideline only. You should always seek advice from your doctor prior to Ramadan in regards to any medication changes that may be needed.

Diabetes Educator and Accredited Practising Dietitian Shannon Lin
Accredited Practising Dietitian Lina Breik
Accredited Practising Dietitian Dyala Al Jabi

Updated February 2025

The festive season often brings joy, togetherness, and the sharing of delicious meals. However, the aftermath can include unwanted weight gain, which can be particularly challenging for individuals managing diabetes. Carrying extra weight can impact blood glucose levels and overall health, but the good news is that it is never too late to get back on track. Here’s a diabetes-friendly guide to shedding those extra kilos and regaining control of your health. 

Begin by assessing where you’re at presently. Step on the scales, measure your blood glucose levels, and take note of any changes in your energy levels or mood. This baseline will help you set realistic goals and track your progress. 

Tip: Avoid being too hard on yourself. Treat this as a fresh start rather than a punishment for holiday indulgences. 

Refocus on a balanced diet 

The festive season often involves consuming energy-dense, high-sugar and high-fat foods. To get back on track, shift your focus to a diabetes-friendly, healthy eating meal plan: 

• Prioritise whole foods: base your meals on low GI carbohydrate foods, non-starchy vegetables, lean protein sources, and healthy fats. 

• Control portions: Use smaller plates and practice mindful eating to avoid overeating. 

• Choose low-GI carbs: Opt for whole grains like quinoa, pasta, basmati rice, long grain brown rice, and legumes to stabilise blood glucose levels. 

• Limit processed foods: Avoid sugary snacks and added sugar foods that can spike blood glucose levels. 

Reintroduce regular exercise 

Physical activity plays a critical role in weight loss and blood glucose management. If your routine slipped during the holidays, start small and build up gradually: 

• Cardio: Walking, cycling, or swimming can help burn energy (kilojoules) and improve heart health. 

• Strength training: Incorporate resistance training exercises to build muscle, which improves insulin sensitivity. 

• Daily movement: Stay active throughout the day, take the stairs, stretch during work breaks, or go for short walks after meals. 

Hydrate wisely 

Alcohol and sugary drinks from festive celebrations may have contributed to water retention or dehydration. Rehydrate with plenty of water to aid metabolism, reduce cravings, and support blood glucose control. Aim for at least eight glasses daily. 

Tip: Herbal teas or lemon-infused water are great alternatives to plain water. 

Prioritise sleep 

Lack of sleep can disrupt hunger hormones and lead to increased cravings, making weight loss harder. Return to a consistent sleep schedule and aim for seven to nine hours of quality rest each night to support your metabolism and blood glucose stability. 

Monitor blood glucose levels 

Weight gain can cause fluctuations in blood glucose levels. Keep a close eye on your readings, especially as you make dietary and exercise changes. If necessary, consult your healthcare provider about adjusting your medication or insulin dosage. 

Set realistic weight loss goals 

Weight loss doesn’t need to be rapid to be effective. In fact, research recommends, for sustainable weight loss, to aim for 1-4kgs a month. Everyone will be different as to how much they lose but the main aim is to see a trend going down. Even a modest weight reduction of 5-10% can significantly improve blood glucose management and reduce the risk of diabetes-related complications 

Plan your meals 

Meal planning helps you avoid unhealthy choices and ensures balanced nutrition. Prepare your meals in advance, focusing on portion control and diabetes-friendly recipes. Include protein-rich snacks, such as boiled eggs, a handful of raw nuts, or Greek yogurt, to keep you satisfied between meals. 

Stay accountable 

Accountability can make a big difference in staying on track. Share your weight loss goals with a friend, family member, or support group. Tracking your meals and exercise in a journal or app (calorieking.com.au) can also help you stay consistent.  

Learn from the festive season 

Reflect on what led to the weight gain during the festive season. Were there particular foods or habits that derailed you? Use this knowledge to plan better strategies for future celebrations, such as healthier recipe swaps or sticking to smaller portions. 

Celebrate non-scale victories 

Weight loss isn’t the only marker of success. Celebrate other achievements, such as improved blood glucose levels, increased energy, improved sleep, better mood or fitting into your favourite clothes again. These victories can keep you motivated on your journey. 

Weight gain during the festive season is common, but it’s entirely possible to reverse it with small, consistent changes. By focusing on balanced nutrition, regular exercise, a positive mindset and maintaining a healthy lifestyle, you can manage your diabetes and achieve sustainable weight loss. Remember, progress takes time, be patient with yourself and celebrate every step forward.

By Robbie Tyson, Accredited Practising Dietitian and Credentialled Diabetes Educator 

An Urgent Product Correction Notification has been issued for Dexcom G6 Continuous Glucose Monitoring (CGM) receivers.

Manufacturer AMSL Diabetes says some customers of the G6 receiver may experience an issue where alerts/alarms do not function as they should. In very rare instances, the alert/alarm may be missed or delayed.  

Users rely on these alerts to show glucose levels that are too high or too low. If these alerts do not operate as expected, users may not receive timely notifications.

The manufacturer lists identification information relating to the affected devices as (STK-GS-120 – All batches) ARTG 169241.

Users are urged to take immediate action to ensure their device is functioning correctly and to avoid potential health risks.

The manufacturer has outlined a series of steps for users to verify that their alerts are functioning properly. These include checking the device settings, ensuring notifications are enabled, and confirming that software updates have been installed. Additionally, users can perform regular manual glucose monitoring as a backup measure.

Individuals who experience issues with their device should seek immediate help from Dexcom’s customer support team on 1300 851 056 or email diabetes@amsl.com.au with the product serial number listed on the back.

Novo Nordisk has advised that it will discontinue the Protaphane InnoLet human insulin (rys) 100 IU/mL injection multidose cartridge on February 1, 2025. The device is used particularly among the elderly because it’s easy to use and women with gestational diabetes mellitus.

Novo Nordisk is advising people to substitute Protaphane Penfill human insulin 100 IU/mL (ARTG 169635) or Humulin NPH biosynthetic human isophane insulin 100 IU/mL injection multidose cartridge (ARTG 39662).

Between now and February 1, the Therapeutic Goods Administration is advising pharmacists to use a Serious Scarcity Substitution Instrument (SSSI) to dispense the Protaphane Penfill human insulin (rys) 100 IU/mL injection multidose cartridge without the need for a new prescription. These penfills will need a new insulin delivery device and those using it will need to know how to insert cartridges and use the new pen safely and accurately.

People living with diabetes who will be affected by the discontinuation are advised to ask their health professionals about changing over to the suggested replacements as soon as possible.

Diabetes Australia has raised concerns about the discontinuation, including access to the replacement device.

While information for pharmacists and healthcare professionals has now been released about the replacement, not all prescribers and pharmacists will see this information in a timely manner. Concerns have also been raised about the cost of the extra time or appointments that people living with diabetes may need with their GPs, educators or endocrinologists to obtain new scripts or device instructions.

Diabetes Australia is seeking assurances that there will be enough replacement devices available when required; that there will be no cost to people living with diabetes; and that the substitute devices will be available across Australia including in regional, rural, and Aboriginal and Torres Strait Islander communities.

Diabetes Australia will continue its advocacy on behalf of the estimated 30,000 people using Innolet and update the community as information becomes available.

Further information is available from the Therapeutic Goods Administration website.

For many of us, the festive season involves spending quality time with loved ones and enjoying good food. However, if you are concerned about overindulging, there are simple ways to enjoy this special time without weight gain and elevated blood glucose levels (BGLs).

Weight gain or high HbA1c levels don’t result from one or two small indulgences, and a balanced lifestyle includes enjoying treats in moderation. Consistently high HbA1c levels or weight gain typically arise from multiple factors over time. An all-or-nothing mindset can lead you to believe that one treat has ruined your efforts, prompting you to give up entirely – especially during the holiday season. While celebrating non-stop from 1 December to 31 January could impact your health, it is possible to navigate the festivities guilt-free with these practical tips.

Be careful of ‘carbohydrate amnesia’

The more you linger around a party table the more you are likely to eat. This often leads to carbohydrate amnesia, because you are so engrossed in socialising that you lose track of what and how much you’ve consumed.

To avoid this trap, grab a small plate of food to slowly enjoy – and leave the table. Fill your plate with a combination of party favourites and lower carb options, such as vegetable sticks, berries, and a selection of protein. If you have been asked to bring a plate to the party, choose something that you know you can eat freely and enjoy.

Choose wisely

If you’re attending multiple parties during the festive season, focus on quality over quantity. Skip the chips and crackers that are easy to overindulge in, and opt for some quality cheese paired with a small portion of seasonal fruit. If there’s a dessert you love, take a small serving and savour it. Instead of thinking, “I shouldn’t have this,” try asking yourself, “do I really need this?” Framing it as a question rather than imposing a rule helps you stay on track without triggering a rebellion.

Attention with alcohol

If you have decided to enjoy alcohol at a party but find it hard to control the amount, then have a game plan before you arrive. For example:

• Plan which parties you choose to have drinks at and be the designated driver for other events.
• Include alcohol free days between parties.
• Portion caution with wine pouring – using a smaller wine glass can help.
• Hydrate with water between alcoholic drinks.
• Alcohol can increase your appetite so be careful with grazing. Keep to the ‘one plate rule’ and stand away from the table.

Avoid going to parties hungry

Overindulging at a party will be inevitable if you arrive hungry. If you are attending a party between meals, have a high protein snack 60 to 90 minutes before leaving. Good options include a boiled egg, Greek yoghurt and berries, tinned fish and wholegrain crackers, half a wholegrain sandwich with a protein filling, or a small smoothie.

Keep active

Get in a bit of extra exercise if you have been to a lot of parties and eaten more than usual. Also look for opportunities to be active during the holiday season, for example, a swim at the beach, bush walking, or a walk after dinner in the early evening when temperatures have dropped.

Enjoy

Life is meant to be enjoyed, so eat, drink and be merry this season! However, having a game plan in place will help you manage BGLs and weight so you can enter 2025 feeling healthy and ready to start a new year.

By Rebecca McPhee, Accredited Practising Dietitian and Health Coach

Diabetes Australia and the Royal Australian College of General Practitioners (RACGP) have released a new edition of the “Diabetes Handbook” to equip general practitioners (GPs) with updated, evidence-based guidelines.

Diabetes Australia has supported the RACGP in updating the handbook in order to further upskill GPs to provide the best possible diabetes care.

The updated handbook provides GPs and other healthcare professionals with robust tools and insights to improve care for people living with diabetes across Australia.

The updates come at a critical time when type 2 diabetes impacts over 1.3 million Australians. Diabetes now factors in nearly 12% of GP consultations, underscoring the need for updated clinical resources to manage this complex condition effectively.

In addition to traditional medical guidance, the handbook features new sections focused on supporting diabetes remission and managing complications.

The latest research reveals that some people with type 2 diabetes can achieve remission, (a state where blood glucose levels remain within a healthy range without glucose-lowering medication), especially when diagnosed early and with active management. This groundbreaking addition offers both hope and structured pathways for people who want to attempt remission.

The updated handbook also addresses the expanding landscape of therapeutics, including newer pharmacological agents like SGLT2 inhibitors and GLP-1 receptor agonists.

Amid recent shortages of semaglutide—a weight-loss medication now also prescribed for diabetes management—the handbook clarifies the use and availability of such medications, providing clarity to GPs.

Further, the revised guidelines expand on caring for people living with diabetes with additional health concerns, such as cognitive decline, hearing impairment, and mental health challenges, ensuring holistic patient care. The inclusion of technology-focused recommendations empowers GPs with insights into emerging tools that can streamline diabetes management for patients.

By strengthening the knowledge and resources available to primary care providers, Diabetes Australia and the RACGP underscore their commitment to improving the lives of Australians with diabetes.

The updated “Diabetes Handbook” equips GPs with the latest research and practical guidance, ultimately enabling them to deliver patient-centered care and potentially transformative outcomes in diabetes management.

This initiative, launched on World Diabetes Day, represents a milestone in the ongoing 25-year collaboration between Diabetes Australia and the RACGP.

By Hayley Nicholson, Exercise Physiologist, Credentialled Diabetes Educator 

Keeping physically active is a great way to manage your blood glucose levels daily as well as long term. But does that mean you need to play vigorous team sports or take up jogging? Absolutely not! In fact, any movement is better than nothing, particularly if it’s done regularly. On average, Australian adults spend more than half of their day sitting and that doesn’t include time spent sleeping. Prolonged periods of sitting increases the risk of chronic health conditions, including but not limited to type 2 diabetes, heart disease, depression and cancer. Not to mention that increased sitting also contributes to poor posture, muscular imbalances and weakened core muscles.  

What is incidental activity?

Incidental activity is any activity built up in small amounts over the day. For example, this may include grocery shopping, climbing the stairs, mowing, gardening, housework and playing with the grandchildren. These activities all require you to move your body and help increase your steps across the day. Incidental activities are important to increase circulation, burn energy and allows you to regularly change position. 

Easy ways to add incidental activity to your day

You can increase your incidental activity by pairing physical activities with things that you already do. That is, multi-tasking and maximizing opportunities to move more and sit less. For example, when you turn the kettle on each morning, you could do some wall push-ups or calf raises. When you take a phone call, take a gentle stroll while you chat, instead of being seated. In addition, look for opportunities to use the stairs where possible, park a little further from the shops, or do some stretches during the commercial breaks of your favourite TV shows. 

How much exercise should you do a day?

The research tells us that in addition to increasing incidental activity, people living with diabetes should also aim to accumulate 30 minutes of moderate intensity aerobic exercise on most days of the week as well as two strength training sessions per week. These are structured exercises where there is a clear purpose to improve cardiovascular fitness, strength, balance, mobility, endurance and flexibility. When working at a moderate intensity, you should be “lightly puffing”, so able to talk and walk but not able to whistle a tune. 

What’s best for blood glucose levels?

It has been shown that people living with diabetes get the best bang for their buck when managing blood glucose levels with a combination of both aerobic and muscle strengthening exercises, and a focus on breaking up long periods of sitting. That is, even if you walk or bike ride 30 minutes per day and then sit for the rest of the day, you can reverse the positive effects. Therefore, structured exercise and incidental activities are just as important as each other and should be combined for maximal health benefit. 

Find out more

If you are looking to become more physically active, you can reach out to your doctor for a referral to an Accredited Exercise Physiologist (AEP), under a diabetes care plan. The AEP can help you increase your incidental activity across the day as well as help you work towards your individual health and fitness goals. 

Research into time-restricted eating for people living with type 2 diabetes, funded by the Diabetes Australia Research Program, has just been published.

The Diabetes Research and Clinical Practice journal reported results from the study by Dr Evelyn Parr (pictured) and her team, which found time-restricted eating (TRE) may help people manage type 2 diabetes. TRE means people eat all their food within a certain time window each day.

The recent study, conducted between 2021 and 2022 at the Australian Catholic University, included 51 people with type 2 diabetes, aged 35 to 65, who were split into two groups. One group practiced TRE, eating only within a set 9-hour period each day, while the other group were guided by dietitians on how to improve their diet by focusing on healthier foods and cutting down on fats and carbohydrates. Both groups were monitored for six months.

The results showed that both TRE and dietitian guidance helped people improve their blood glucose management, and improvements were similar between the two groups. Participants in both groups lowered their HbA1c levels within the first two months, and these improvements lasted for the full six months.

The results also showed that TRE helped people naturally reduce their carbohydrate intake, while dietitian guidance helped people cut down on fats.

The researchers have concluded that TRE could be especially useful for people who don’t have easy access to dietitians, such as those living in rural and remote areas. Since TRE doesn’t need a detailed meal plan, it can be guided by general healthcare workers, making it a practical and easy option for many.

As with all lifestyle changes, people living with diabetes are encouraged to discuss any new eating plan with their health professional before making a change.

While there is no one-size-fits-all, and individual choice is an important part of managing diabetes, this research suggests that TRE could be a valuable first step for some.

Diabetes Australia congratulates Dr Parr and her team on the publication of their research in Diabetes Research and Clinical Practice.

As Australia prepares for the nationwide shutdown of the 3G network by major telecommunications providers from October 28, Diabetes Australia is reminding people with diabetes and their carers to check whether their medical devices, such as continuous glucose monitors (CGMs), rely on 3G connectivity.

The shutdown may disrupt the ability of some devices to send or receive data. However, it’s believed that most Australians’ glucose data transmitters are now connected by Bluetooth.

CGMs can use mobile networks to transmit blood glucose data or alerts to smartphones, healthcare providers, or caregivers. If these devices are only compatible with 3G technology, the loss of service could lead to delays in receiving critical health information or warnings of high or low blood glucose levels.

For a small number of people whose devices are not connected to Bluetooth and who will be affected by the shutdown, this could present a risk.

Those who are unsure about their equipment’s connectivity are encouraged to check the compatibility of their device and contact their healthcare providers or device manufacturer for guidance on upgrading if necessary.

Australia’s Therapeutic Goods Administration (TGA) advises that devices which may be impacted by the decommissioning of the 3G network include:  

• Glucose data transmitters  
• Pacemakers and implantable cardioverter defibrillators (ICD) 
• CPAP therapy machines  
• Cardiac resynchronisation therapy monitoring devices 
• Telehealth devices  
• Wearable health monitors  

Others not regulated by the TGA but also potentially impacted by the shutdown include: 

• Personal safety pendants 
• Fall detection systems  
• Home security alarms  
• GPS tracking devices  
• Automated medication dispensers  

The transition to newer 4G and 5G networks will improve connectivity and offer faster data transfer. However, people with older devices that are not compatible with these networks may need to upgrade to avoid disruptions.

To avoid potential issues, Diabetes Australia recommends that people review their device specifications, reach out to their device manufacturers, and ensure they have access to alternative methods for managing their diabetes, such as manual glucose checks or backup devices.

For more information and guidance on the 3G shutdown and its impact on diabetes management, visit the TGA website or contact your healthcare provider.

Diabetes Australia RN/CDE Carolien Koreneff does a finger prick test on Cook MP Simon Kennedy during the Health Checks and Tech event in Parliament House.

Diabetes Australia held an important Health Check and Tech event at Parliament House in Canberra this week. Group CEO Justine Cain joined people living with diabetes, CDEs and Health Professionals to speak with Senators and MPs about the essential health checks and technologies that support people living with diabetes to live well.

Co-Chairs of the Parliamentary Friends of Diabetes group, Graham Perrett MP and Rowan Ramsey MP, were among the first to participate, along with Dr Mike Freelander MP, Chair of the Health, Aged Care and Sport Committee.

Our nation’s decisionmakers underwent a health check, including HbA1c, cholesterol, blood pressure and heart health, and heard about the importance of these vital health checks. Diabetes Australia’s campaign to Unite for Tech also continued, as we highlighted the need for more equitable access to insulin pumps and continuous glucose monitoring devices.

The health check event was a great opportunity for MPs to learn more about diabetes technology and the importance of early detection and prevention of the condition.