How should a Muslim patient with type 2 diabetes or obesity taking semaglutide manage their medication regimen during Ramadan?

How to Use Semaglutide During Ramadan

Continue semaglutide at the same dose and timing throughout Ramadan without any adjustment—GLP-1 receptor agonists like semaglutide are safe during fasting with minimal hypoglycemia risk and require no modification. 1

Pre-Ramadan Preparation (6-8 Weeks Before)

Begin counseling and risk assessment 6-8 weeks before Ramadan starts to optimize safety 2, 1:

• Evaluate glycemic control, renal function, hepatic status, and complete biochemical profile 1
• Patients on semaglutide alone are classified as low-risk for fasting complications, making them excellent candidates for safe fasting 1
• Conduct structured education on recognizing hypoglycemia/hyperglycemia symptoms and when breaking the fast is mandatory 1

Semaglutide Dosing Strategy

The dose and timing remain completely unchanged during Ramadan 1:

• Continue weekly semaglutide injections on the exact same schedule as before Ramadan 1
• No dose reduction or timing adjustment is needed 1
• This applies to both diabetes and obesity indications 1

Managing Combination Therapy

When semaglutide is combined with other medications, adjust the companion drugs but never the semaglutide 1:

With Metformin:

• Give two-thirds of total daily metformin dose immediately before the sunset meal (Iftar) 1
• Give one-third before the predawn meal (Suhur) 1
• Semaglutide timing remains unchanged 1

With Sulfonylureas:

• Reduce sulfonylurea dose by at least 50% or discontinue entirely when combined with semaglutide to prevent hypoglycemia 1
• The high hypoglycemia risk of sulfonylureas is amplified during fasting 2

Glucose Monitoring Requirements

Self-monitor blood glucose closely during the first 3-4 weeks of Ramadan, particularly at high-risk times 1:

• Check in the first few hours after starting the fast 1
• Check in late afternoon before breaking the fast 1
• Break the fast immediately if blood glucose drops below 70 mg/dL 1
• Also break the fast if glucose exceeds 300 mg/dL 2

Nutritional Strategy During Non-Fasting Hours

Distribute calories over two to three smaller meals during the non-fasting interval rather than one large meal at sunset 1:

• Break the fast with a small, balanced meal containing fiber, protein, and complex carbohydrates 1
• Avoid ingesting large amounts of foods rich in simple carbohydrates and fat at the sunset meal 2
• Take the predawn meal as late as possible before starting the daily fast 2

Hydration Management

Maintain adequate hydration by drinking at least 1.5-2 liters of water during non-fasting hours 1:

• Volume depletion remains a concern even with semaglutide's low hypoglycemia risk 1
• Increase fluid intake during all non-fasting hours 2

Physical Activity Considerations

• Normal levels of physical activity may be maintained 2
• Avoid excessive physical activity, particularly during the few hours before the sunset meal, as this increases hypoglycemia risk 2
• If performing Tarawaih prayers (multiple prayers after sunset), consider this part of the daily exercise program 2

Critical Safety Pitfalls to Avoid

Common mistakes that compromise safety 2, 1:

• Never delay breaking the fast if glucose drops below 70 mg/dL—there is no guarantee glucose won't drop further 2
• Don't assume semaglutide's low hypoglycemia risk eliminates all monitoring needs during the adaptation period 1
• Avoid fasting on sick days 2
• Don't continue fasting if glucose exceeds 300 mg/dL 2