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Yom Kippur and Diabetes

With Yom Kippur – one of the holiest days of the Jewish year – quickly approaching, many people are preparing for their fast, which is observed from sundown one day to sundown the next day. For people with diabetes, fasting can sometimes be challenging, but with the right precautions, fasting can be done in a safe and healthy environment.

Is fasting required?

Although fasting is an important aspect of Yom Kippur, the Torah states that fasting is not required, especially if it puts your health at risk. This includes children, pregnant or breastfeeding women, the elderly and anyone who might make themselves ill by fasting.  This also includes people with poorly controlled diabetes, and specifically, people with type 1 diabetes who take insulin or type 2 on a mixed insulin regimen or those who often have very high or very low blood glucose levels.

I know many people with diabetes who fast and don’t have a problem.  Is it okay for me?

It is true, many people with diabetes can fast safely, but each person is different. Part of the decision you will make with your doctor has to do with the kind of diabetes medicine you take. It is important to schedule an appointment 2-3 months before Yom Kippur to discuss how fasting might affect your diabetes. Your doctor or healthcare provider may suggest a change in your medication plan.

What risks should I be aware of?

These are the key risks:
• Low blood glucose (or hypoglycemia) – The risk of blood glucose levels going too low is highest in people taking insulin or certain diabetes pills. Limit physical activity during fasting hours and be more active after sunset.  Talk with your healthcare provider to find out if your medicine puts you at risk for low blood glucose and discuss how to prevent it. 
• High blood glucose (or hyperglycemia) – While low blood glucose levels may happen during the day, after the fast is broken, there is a greater risk to overeat.  Watch out for eating too many carbohydrates and keep the portion sizes moderate during the break fast.  
• Dehydration – This is especially a problem during the longer and hotter summer days.  Aim to drink sugar free and caffeine free drinks on Kol Nidre, the night before Yom Kippur.
I was told to not check my blood glucose during the day as it will break the fast. Is that true?

Checking blood glucose will not break a fast! It is important to monitor blood glucose levels especially to identify a low glucose level.  A fast will have to be ended if glucose levels fall too low (below 70 mg/dl)

How is low blood glucose treated?

If glucose levels do fall below 70, take 15 grams of carbohydrate in the form of one of these:  4 glucose tablets, 6 oz regular soda, 4 oz fruit juice or 1 tube glucose gel.  Wait 15 minutes and recheck again.  Follow with a snack if the evening meal is not for more than an hour. 

Do I stop taking medicine during Yom Kippur?

No, you continue taking your diabetes medicine, but your dosage may also change. This is one reason why it is very important to talk with your healthcare provider several months before Yom Kippur so you can plan ahead for how your diabetes medicines may need to change.

What foods should I consume and avoid when breaking my fast?

When breaking your fast you should be cautious about consuming too many carbohydrates in one sitting, especially since break fast is usually a larger meal. You should do your best to keep the carbohydrate amounts as close to your meal goals as possible, and try to consume more protein and vegetables to fill yourself up, which will not aggravate your glycemic control.

Page last updated: November 07, 2019