People who are pregnant or breastfeeding, children and adolescents, people with a history of eating disorders or severe hypoglycemia, and older adults with frailty or sarcopenia risk should generally avoid elective intermittent fasting or have it assessed by a clinician first. People with diabetes—especially those using insulin or sulfonylureas—need an individualized plan before fasting. Do not stop, skip, or change medication on your own.
Who should avoid elective fasting?
A 2026 review advises against prescribing intermittent fasting to several groups because its safety may not be established for them or fasting may be inappropriate. Its recommendations concern elective intermittent fasting, not every fast undertaken for a medical reason.
| Group | What to do |
|---|---|
| People who are pregnant or breastfeeding | Avoid elective intermittent fasting unless a clinician who knows the person’s circumstances advises otherwise. |
| Children and adolescents | Intermittent fasting is not recommended for children; the review also advises against prescribing it to adolescents. |
| People with a history of an eating disorder | Avoid elective fasting unless a qualified clinician specifically assesses and advises it. |
| People with a history of severe hypoglycemia | Do not begin an elective fast without clinical assessment; fasting may increase the risk of another dangerous low. |
| Older adults with frailty or sarcopenia, or at risk of either | Fasting should generally not be prescribed without careful clinical consideration. |
These are reasons for caution, not a blanket rule against medically supervised fasting for every purpose. The 2026 review discusses intermittent fasting; the appropriate advice can differ for a short fast required before a procedure.
Can people with diabetes fast?
Sometimes, but having diabetes means fasting should be assessed individually rather than treated as automatically safe or automatically prohibited. The clinician needs to consider glucose control, prior hypoglycemia or diabetic ketoacidosis (DKA), complications, medication, how long the fast lasts, and whether fluids are allowed. The NIDDK overview of fasting safely with diabetes identifies hypoglycemia as the main fasting risk, while also noting the potential for high glucose and DKA if medication is reduced too much.
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Diabetes factors that raise concern
People with unstable glucose, recurrent DKA, significant diabetes-related macrovascular or microvascular complications, hypoglycemia unawareness, frequent hypoglycemia, or intensive insulin therapy need particular caution and advance medical advice. These risk factors appear in the RSSDI’s 2017 recommendations, which call for physician consultation and pre-fast counseling; the list is guidance, not a validated risk score for an individual.
The ADA’s Standards of Care in Diabetes—2026, published in 2025, say people with diabetes taking insulin and/or insulin secretagogues should be medically monitored during fasting. For religious fasting, the Standards discuss advance risk assessment and optimizing the treatment plan with the care team.
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One study result is not a universal rate
In one study cited in the ADA Standards, 16.5% of people with type 2 diabetes who fasted for Ramadan reported glucose above 300 mg/dL (16.6 mmol/L) on fasting days. That result belongs to that study and fasting context; it should not be read as the expected rate for all people with diabetes or all fasting schedules.
Can I fast while taking medication?
Medication can change fasting risk, and the consequences of changing it without a plan can also be serious. Insulin and sulfonylureas are especially important to discuss because they can increase the risk of hypoglycemia when someone is not eating. NIDDK also notes that reducing diabetes medication too much can contribute to hyperglycemia or DKA. Do not skip, reduce, delay, or otherwise alter a dose unless the prescribing clinician has given you a plan.
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Before a fast, ask the prescriber or pharmacist to review every medicine and its timing, including whether it must be taken with food. Diabetes medicines called SGLT2 inhibitors and diuretics, as well as high glucose, can contribute to fluid loss; the degree of risk depends on the person’s health, medicine, and type of fast. A clinician may recommend monitoring or changes to a treatment plan, but those decisions must be individualized. The 2019 review Clinical Management of Intermittent Fasting in Patients with Diabetes Mellitus also addresses clinical planning for fasting.
Does it matter whether water is allowed?
Yes. A fast that prohibits drinks adds dehydration risk to the risks of going without food. The relevant questions are how long the fast lasts, whether water and other fluids are permitted, and whether a person’s condition or medicines may increase fluid loss. Do not assume that guidance for a water-permitted fast applies to a no-fluid fast.
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How to discuss a planned fast with your care team
- Explain the fast. Say why you plan to fast, when it starts and ends, whether it recurs, and whether you can drink water or other fluids.
- Review your health history. Discuss glucose control, prior severe lows or DKA, awareness of low glucose, and any diabetes complications.
- Review all medicines. Bring the medication list and ask how each medicine relates to food, timing, glucose, and hydration during the proposed fast.
- Agree on monitoring and a response plan. Ask what to monitor, how often, what readings or symptoms mean you should break the fast, and when to seek urgent help. Follow thresholds set for you by your clinician rather than relying on a universal number.
For a clinician-led plan, monitoring may include a glucose meter or another method recommended by the care team. A device does not make fasting safe by itself or replace medical advice.
Elective fasting is not pre-procedure fasting
Do not apply advice about intermittent or religious fasting to a fast ordered before surgery, anesthesia, imaging, or another procedure. Follow the treating team’s specific instructions, including what to do with food, drinks, and medicines, and contact them if the instructions are unclear.
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