Intermittent Fasting And Diabetes 2024: Is It Good For Diabetics?

According to the Centers for Disease Control (CDC)^[1], 37 million people in the USA have diabetes, and 96 million have prediabetes. Diabetes is a metabolic disease characterized by elevated blood glucose levels and can lead to complications like loss of vision, nerve damage, heart disease, and a high risk of amputations. Health practitioners may recommend alternative therapies to help with the side effects of diabetes, such as insomnia and neuropathic pain, but prevention and treatment are essential.

Intermittent fasting has gathered a good following to aid weight loss and management of increased blood sugar levels. There is evidence that a fasting regimen may help improve metabolic risk factors and overall health. Although it seems it could be good for diabetes, we need to ask ourselves, is this the best for all people with diabetes? Can intermittent fasting help people with diabetes lose weight? Is intermittent fasting a diabetes treatment? 

Is Intermittent Fasting Good For Diabetics?

Diabetes is characterized by high blood glucose (sugar) levels. It is important to note that type 1 diabetes mellitus mainly occurs when your body attacks its pancreas and damages the cells inside, affecting insulin production. And this is why Type 1’s must depend on an outside source of insulin to manage their blood sugar levels. Meanwhile, type 2 diabetes mellitus is usually associated with lifestyle-related blood sugar problems, where the pancreas does not produce enough insulin or the insulin produced does not work. 

People with type 2 diabetes may be able to practice fasting safely^[2]. If you have type 1 diabetes, it may just be slightly trickier, and you may need closer monitoring from your diabetes care team. One study showed that people with type 1 diabetes could fast safely for 36 hours^[3]. Blood glucose levels can be safely lowered^[4] through intermittent fasting, while insulin sensitivity can be increased.

Religious or spiritual practices are the main reason many people practice fasting. Others may need to fast for medical or any other personal reasons. It is important to communicate with your medical providers the details of your fasting goal. This way, medications can be adjusted or suspended until fasting is completed to accommodate the lower blood sugar levels. 

This does not mean there are no risks with intermittent fasting with diabetes. Hypoglycemia or low blood glucose (sugar) levels is the biggest risk for people with diabetes while fasting. Dehydration may also occur if fasting includes avoiding drinking fluids. That’s why it’s important to discuss any changes to your diet with your medical doctor, to keep you safe.

What Is Intermittent Fasting?

According to Webster’s dictionary, fasting is abstinence from food or drink. It could be for a short or prolonged period. Fasting is not a new concept by any means since it has been part of religious practices for centuries. Thanks to some publications, intermittent fasting (IF) has come to the forefront as the new option for weight loss with research pointing to the benefits of intermittent fasting for people with diabetes. 

We usually eat three meals a day and some snacks. While eating like this, our bodies use glucose as the main energy source, which is driven by insulin to help get the glucose into our cells to create energy. After we have used up all the glucose, glucagon takes over and starts using glycogen (glucose stored in the liver) as an energy source.

A metabolic switch occurs when the fasting state is initiated after 12 hours of the last food intake. At this point, it starts using fatty acids as a source of energy while preserving the muscle. It’s this mechanism that may be beneficial for the management of body weight. During this process, your body creates ketones, which serve as fuel for your brain. It is important to note that too many ketones in your body cause an acidic state and is not healthy.

Types Of Intermittent Fasting Diets For Diabetics

As seen above, there are various fasting regimens that you may follow. 

1. A modified fasting regimen, also the basis for the 5:2 fasting regimen, requires restricting calories (0-500 calories) for 24 hours twice a week and eating as desired the other five days. The two fasting days are not back to back.
2. Time-restricted feeding, you have an eating window of around six hours, then a fasting period of 14-18 hours during the day or night. 
3. Alternate day fasting regimen; in this one, you fast one alternating day with another day to eat as desired and fast the next one. 

These three, in particular, are the main ones found in studies, but there are more options. 

So, which one is the best one? Very little research is being conducted to determine which intermittent fasting regimen would be best for improving metabolic risk factors or one leading to long-term weight maintenance. There are many variations in types of fasting, and we are not close to a consensus. It would be highly recommended to choose one that would be easy for you to follow and one that feels comfortable for you. 

Does Intermittent Fasting Help Diabetes?

Intermittent fasting may have health benefits for people with type 2 diabetes and prediabetes. 

In a literature review^[5] from 2021, intermittent fasting was superior to a continuous energy restriction approach in decreasing abdominal fat, which is associated with decreasing risk for diabetes and cardiovascular disease development.

Obesity is also associated with insulin resistance and increased risk for diabetes development by affecting glucose metabolism and causing high blood sugar (glucose) levels. So, losing weight will help by improving your metabolic risk factors such as high blood pressure, elevated cholesterol levels, high blood sugar, and insulin resistance and decreasing your risk for type 2 diabetes. 

Some studies^[6] have suggested that people who practice intermittent fasting experience decreased blood insulin levels and improved insulin resistance. If this is possible, this form of intervention can also help decrease fat storage formation along with body weight loss. 

Another study^[7] showed a promising result that intermittent fasting, even with no weight loss, may increase adiponectin, a hormone that helps with insulin sensitivity and decreases inflammation; both could improve type 2 diabetes and prevent diabetes or alleviate its symptoms altogether.  

One of the biggest possible benefits is that for some people, this may translate into behavior change regarding food. Limiting food intake during your eating window may translate to less binging and improved diet quality.  It might also get you in tune with your hunger cues.  

Keep in mind that an intermittent fasting regimen may not benefit pregnant or breastfeeding individuals, people with Type I Diabetes not on a continuous glucose monitoring system, people with eating disorders, the elderly, children, or those who need to eat frequently. If you experience low blood sugar or frequent hypoglycemia, fasting may not be an ideal option for you. 

Tips For Intermittent Fasting And Diabetes

Talk To Your Doctor First

If you have diabetes or any other medical conditions, you may need adjustments in your diabetes medication, especially if you are on insulin therapy. Long periods without food may cause lower-than-normal blood sugar levels or loss of glycemic control. Increased blood glucose monitoring can be a guide if needed to modify your medications to match the type of fasting you would like to practice. Involve your blood sugar management team in your decision to adopt IF.

You May Start Slow

If fasting for 24 hours sounds like a daunting task, maybe start with a shorter 12-hour fasting period, including your sleeping time. Then start increasing as you start feeling comfortable with longer fasting windows. You do not need to throw yourself out on an intense regimen.  

Choose Healthy Foods

During feeding times; it would be advisable to follow a healthy diet that includes fruits, vegetables, lean proteins, healthy fats, and high-fiber starches. You may choose to follow a caloric restriction on nonfasting days to continue promoting weight loss. That does not mean you cannot indulge during your feeding time. But, by keeping your diet relatively healthy, you will start getting into the habit of eating for nourishment and also to protect your body.

Due to days of poor intake or daily fasting periods, you may benefit from vitamin or mineral supplements to achieve your daily requirements. 

Follow A Fasting Type That Fits Your Lifestyle

A good thing about having options is that you can choose one that will be beneficial. If you have an active job and feel you need to eat 5x a week, maybe the approach 5:2 will be good for you. If you tend to go to the gym in the morning and work out while fasting, maybe a daily short 6-hour eating window while fasting overnight and in the morning will be best for you. 

Stay Hydrated

Even if you are fasting for religious reasons, you should drink water during the day. You may also use low or no-calorie fluids like sugar-free drinks, broth, tea, or coffee. This may be a good time to kick your sugary drink habit. Water will help keep your system clean and your bowels moving. 

Exercise

Ask your doctor if you can exercise. If able, it is advised^[8] to complete 150 minutes of moderate to vigorous exercise per week. But if this is daunting, go for short walks, dance, do some chores around the home, do some gardening, or enjoy the local pool. Just move! Our bodies thrive on movement. It also uses up any extra glucose in your blood for energy. Being active is an integral part of a healthy lifestyle. 

Know When To Stop

Evaluate how your body behaves during fasting. You should expect to feel a bit crummy and maybe hungry at first. If you cannot function, feel extremely bad, are experiencing changes in your heartbeat, or develop acid reflux, it might be a good idea to stop fasting. 

Summary

Intermittent fasting is proving itself to be a diet pattern that is here to stay. Is it good for diabetes? We don’t know yet, but it may have some metabolic benefits that could prevent diabetes development or act in the capacity of nonpharmaceutical type 2 diabetes management.

Studies^[9] are showing some promising results that suggest that intermittent fasting or periodic fasting may be of aid in the management of obesity and insulin resistance. And although we do not currently have evidence that intermittent fasting will be a treatment for type 2 diabetes or help with reversal, it is another tool to have on our belts with which we may take some control over our health. 

For those who decide to give intermittent fasting a try, make sure to keep it safe and keep communication open with your diabetes care team or your primary care providers. 

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