From the Guidelines
Individuals with diabetes should consult their healthcare provider before starting intermittent fasting, as it requires careful monitoring and potential medication adjustments, and a gradual approach is recommended, beginning with a 12:12 schedule and slowly extending the fasting window to 16:8 over several weeks, as suggested by the most recent guidelines 1. When considering intermittent fasting for individuals with diabetes, it is crucial to prioritize their safety and health outcomes. The most recent guidelines from 2024 1 emphasize the importance of healthcare professionals inquiring about any religious fasting for people with diabetes and providing education and support to accommodate their choice.
Key Recommendations
- Consult healthcare provider before starting intermittent fasting to discuss potential risks and benefits, and to determine the best approach for individualized care 1.
- Gradual approach to intermittent fasting, starting with a 12:12 schedule and gradually increasing the fasting window to 16:8 over several weeks, to allow the body to adapt and reduce the risk of hypoglycemia and other complications.
- Monitor blood glucose levels closely during the initial adaptation phase, checking levels before, during, and after fasting periods, to ensure safe and effective management of diabetes.
- Stay hydrated with water, black coffee, or unsweetened tea during fasting windows, and focus on balanced meals with protein, healthy fats, and complex carbohydrates when eating, to maintain stable blood sugar levels and overall health.
- Break fasts gently with small, balanced meals rather than large carbohydrate-heavy options, to prevent rebound hypoglycemia and support overall health and well-being.
Considerations for Diabetes Management
- Medication adjustments may be necessary to prevent hypoglycemia during fasting periods, especially for individuals taking insulin or sulfonylureas like glipizide or glyburide 1.
- Individualized care is essential, taking into account the type of diabetes, type of therapy, and presence and severity of diabetes-related complications, to ensure safe and effective management of diabetes during intermittent fasting.
- Education and support from healthcare professionals, including registered dietitians and certified diabetes care and education specialists, can help individuals with diabetes make informed decisions about intermittent fasting and develop a personalized plan for safe and effective management of their condition 1.
From the Research
Recommendations for Starting an Intermittent Fasting Regimen
- Before starting an intermittent fasting regimen, especially for individuals with diabetes, it is crucial to consult with a healthcare provider to discuss the potential benefits and risks and to determine the most suitable approach [(2,3,4,5)].
- Intermittent fasting diets can be defined as periods of fasting alternating with periods of eating, and the most studied forms include alternate day fasting, the 5:2 diet, and time-restricted eating 2.
- Time-restricted eating (TRE) is a form of intermittent fasting that involves eating within a certain window of time (usually 4 to 10 hours) and water-fasting for the remaining hours of the day [(3,4)].
Benefits of Intermittent Fasting for Diabetes
- Intermittent fasting has been shown to produce mild weight loss, improve glycaemic control, and reduce fasting insulin and improve insulin sensitivity in individuals with prediabetes and those with obesity 3.
- TRE has been found to improve glucose tolerance and decrease serum glucose excursions, and the possible mechanisms underlying these benefits include increased autophagic flux, mild elevations in ketone bodies, a reduction in oxidative stress, and the stimulation of β-cell responsiveness 3.
- Current evidence suggests that intermittent fasting is an effective non-medicinal treatment option for type 2 diabetes, and some studies have found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician 5.
Safety and Precautions
- It is essential to assess the safety of intermittent fasting regimens, particularly for individuals with diabetes, and to offer practical advice for incorporating these diets into everyday life [(2,4,5)].
- Individuals with diabetes should consult their physician prior to beginning an intermittent fasting regimen to allow for appropriate oversight and titration of their medication regimen during periods of fasting 5.