Rybelsus (semaglutide) is an oral GLP-1 receptor agonist used to treat type 2 diabetes in the UK. It must be taken on an empty stomach with plain water, followed by a 30-minute wait before eating—a requirement that poses unique challenges during Ramadan fasting. Many Muslims with diabetes choose to observe Ramadan for spiritual reasons, necessitating careful planning to balance religious observance with safe diabetes management. This article provides practical guidance on timing Rybelsus doses, monitoring blood glucose, and adjusting treatment plans during Ramadan, in line with UK clinical practice and international diabetes-fasting guidelines.

Understanding Rybelsus and Fasting Requirements

Rybelsus (semaglutide) is an oral glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus in adults. It works by enhancing insulin secretion in a glucose-dependent manner, suppressing glucagon release, slowing gastric emptying, and reducing appetite. These mechanisms help improve glycaemic control and often support weight loss. Rybelsus is typically taken once daily on an empty stomach, at least 30 minutes before the first food, drink (other than plain water), or other oral medications of the day. The tablet should be swallowed whole with no more than 120 mL of plain water and should not be split, crushed, or chewed.

During Ramadan, Muslims observe a fast from dawn (Fajr) until sunset (Maghrib), abstaining from all food, drink, and oral medications. This presents a unique challenge for individuals taking Rybelsus, as the medication's strict administration requirements—specifically the need for an empty stomach and a 30-minute wait before eating—must be reconciled with altered meal timings and the prohibition on oral intake during daylight hours.

It is important to recognise that fasting during Ramadan is not obligatory for individuals whose health may be compromised, including those with diabetes. Islamic jurisprudence provides exemptions for those who are ill or for whom fasting poses a significant health risk. However, many Muslims with diabetes choose to fast for spiritual reasons. In such cases, careful planning and consultation with healthcare professionals are essential to ensure both religious observance and patient safety.

The MHRA and NICE do not provide specific guidance on Rybelsus use during Ramadan, but general principles of diabetes management during fasting periods emphasise individualised risk assessment, medication adjustment, and close monitoring to prevent hypoglycaemia, hyperglycaemia, dehydration, and other complications. Resources from Diabetes UK and TREND-UK offer practical guidance for managing diabetes during Ramadan and can be valuable for both patients and healthcare professionals.

How to Take Rybelsus During Ramadan

Taking Rybelsus during Ramadan requires careful consideration of the medication's unique administration requirements. Rybelsus must be taken on an empty stomach with no more than 120 mL of plain water, and patients must wait at least 30 minutes before consuming any food, drink, or other medications. This timing is critical for optimal absorption, as food and beverages significantly reduce the bioavailability of semaglutide. Remember to swallow the tablet whole—do not split, crush, or chew it.

For individuals observing Ramadan, the most practical approach is typically to take Rybelsus at the time of Suhoor (the pre-dawn meal). Patients should take the tablet upon waking, ideally 30–60 minutes before Suhoor, allowing sufficient time for the medication to be absorbed before eating. This strategy aligns with the fasting schedule and helps maintain a consistent routine.

Alternatively, some patients may prefer to take Rybelsus at Iftar (the evening meal to break the fast). In this case, the tablet should be taken immediately upon breaking the fast with plain water only, followed by a 30-minute wait before consuming any food, other drinks, or oral medicines. However, this approach may be more challenging, as individuals are often eager to eat after a long day of fasting, and delaying the meal by 30 minutes may be difficult in practice.

It is advisable to establish a consistent routine for taking Rybelsus throughout Ramadan. Choose either Suhoor or Iftar timing and try to maintain this schedule. If you need to change your dosing time, discuss this with your healthcare professional first, and never take more than one dose in a 24-hour period. If a dose is missed, patients should not take a double dose but should resume their usual schedule the following day.

Be aware that Rybelsus may affect the absorption of other oral medications. If you take other medicines (such as levothyroxine), ensure they are taken at least 30 minutes after Rybelsus.

Managing Blood Sugar Levels While Fasting

Maintaining stable blood glucose levels during Ramadan is a key concern for individuals with type 2 diabetes, particularly those taking glucose-lowering medications. Rybelsus carries a low intrinsic risk of hypoglycaemia when used as monotherapy, as its glucose-dependent mechanism means insulin secretion is only enhanced when blood glucose levels are elevated. However, the risk increases if Rybelsus is used in combination with other antidiabetic agents, particularly sulphonylureas or insulin.

Patients should be advised to monitor their blood glucose levels regularly during Ramadan, particularly in the hours before Iftar when blood sugar may be at its lowest. Self-monitoring of blood glucose (SMBG) is not considered to break the fast according to most Islamic scholars, and patients should be encouraged to check their levels if they experience symptoms of hypoglycaemia, such as dizziness, sweating, confusion, or palpitations. According to IDF-DAR guidelines, if blood glucose falls below 3.9 mmol/L or rises above 16.7 mmol/L, patients should break their fast immediately and seek medical advice.

Dehydration is another significant risk during Ramadan, particularly in warmer months or for individuals taking medications that affect fluid balance. While Rybelsus itself does not directly cause dehydration, its gastrointestinal side effects—including nausea, vomiting, and diarrhoea—can increase fluid loss. Patients should be advised to drink adequate fluids between Iftar and Suhoor and to seek medical attention if they experience persistent vomiting or diarrhoea.

Dietary choices during non-fasting hours also play a crucial role in glycaemic control. Patients should aim for balanced meals with complex carbohydrates, lean proteins, and healthy fats, avoiding excessive consumption of sugary or fried foods. Portion control and spacing meals appropriately can help prevent large fluctuations in blood glucose.

If you experience severe hypoglycaemia, persistent vomiting, inability to maintain hydration, chest pain, or confusion, call NHS 111 or 999 as appropriate. Those taking SGLT2 inhibitors alongside Rybelsus should be particularly vigilant and consider ketone testing if unwell or if blood glucose is elevated.

Adjusting Your Diabetes Treatment Plan for Fasting

Pre-Ramadan consultation with a healthcare professional is strongly recommended for all individuals with diabetes who intend to fast. This allows for a comprehensive risk assessment and the development of an individualised management plan. The International Diabetes Federation (IDF) and Diabetes and Ramadan (DAR) International Alliance provide risk stratification tools that classify patients into very high, high, moderate, or low risk categories based on factors such as glycaemic control, hypoglycaemia history, comorbidities, and medication regimen.

For patients taking Rybelsus alone or in combination with metformin, the risk of hypoglycaemia during fasting is generally low, and dose adjustment may not be necessary. However, if Rybelsus is used alongside sulphonylureas or insulin, dose reduction of these agents is often required to minimise hypoglycaemia risk. According to IDF-DAR guidelines, sulphonylurea doses may need to be reduced by 25-50% or switched to a shorter-acting agent, and basal insulin doses may need adjustment based on pre-Ramadan glucose patterns. These adjustments should always be individualised based on your specific circumstances and medical history.

Patients should be educated on when to break the fast for safety reasons. Clear thresholds should be established, such as blood glucose below 3.9 mmol/L, above 16.7 mmol/L, or the presence of acute illness, dehydration, or severe hypoglycaemia symptoms. Breaking the fast for medical reasons is not only permissible but encouraged in Islamic teachings to preserve health.

If you experience gastrointestinal side effects from Rybelsus during Ramadan, consult your healthcare provider. It may be advisable to delay any planned dose increases until after Ramadan to minimise these effects during the fasting period.

Regular follow-up during Ramadan is advisable, either in person or via telephone or digital consultations. This allows for ongoing assessment of glycaemic control, medication tolerability, and any emerging complications. Patients should be provided with written information, including contact details for their diabetes team and guidance on when to seek urgent medical attention. Structured education programmes, such as those offered by Diabetes UK and TREND-UK, can provide additional support for individuals planning to fast during Ramadan, ensuring both spiritual fulfilment and optimal diabetes management.

If you experience any suspected side effects from Rybelsus, report them to the MHRA Yellow Card scheme, which helps monitor the safety of medicines in the UK.

Frequently Asked Questions