Effect of Whey Protein Consumption on Hypoglycemia Risk in Patients with Type 1 Diabetes Fasting during Ramadan: A Randomized, Crossover Trial

Abstract

Background

Fasting during Ramadan presents challenges for people with type 1 diabetes (T1D), particularly regarding hypoglycemia risk. Nutritional strategies such as whey protein (WP) supplementation may support safer fasting.

Objective

This article assesses the effect of WP supplementation at the predawn meal (Suhoor) on hypoglycemia risk and fasting continuity among patients with T1D during Ramadan fasting.

Methods

In this randomized, controlled, crossover trial, individuals with T1D planning to fast during Ramadan were recruited and assigned to two study phases: one with WP supplementation at Suhoor and one without. Outcomes were assessed using continuous glucose monitoring (CGM), dietary logs, and pre- and post-Ramadan questionnaires. The primary outcomes were the number of hypoglycemic events and the days fasting was interrupted.

Results

Forty-one patients with T1D were randomized; 33 were on multiple daily injections and 8 on continuous subcutaneous insulin infusion. The mean age was 24 ± 4.2 years, with a mean diabetes duration of 14.1 ± 7.3 years; 22 participants (53.7%) were female. Pre-Ramadan glycated hemoglobin was 7.6 ± 1.07%. At baseline, 5 patients (12.2%) were categorized as moderate risk by the DaR (Diabetes and Ramadan Alliance) risk score, and 36 (87.8%) as high risk. WP supplementation was associated with a significant reduction in the number of days on which the fast was broken (0.94 ± 1.25 vs. 1.15 ± 1.33 days; p = 0.008). The timing of reported interruptions of the fast due to hypoglycemia was similar across both weeks, with most occurring during the morning hours. CGM-detected mean hypoglycemia events per patient per week by time of day were 0.7 versus 1.1 post-Suhoor (3–6 a.m.) and 0.3 versus 0.6 pre-Iftar (4–6 p.m.), with p = 0.07 and p = 0.05, respectively. However, overall CGM-detected low events and ambulatory glucose profile metrics (time in range, time below range, glucose management indicator, and glucose variability) did not differ significantly between the two regimens. No severe hypoglycemia, diabetic ketoacidosis, or hospital admissions were reported in either week. In the poststudy survey, 51.2% of participants reported that WP at Suhoor was beneficial, and 68.3% indicated that they would use it again during Ramadan fasting.

Conclusion

WP supplementation at Suhoor may reduce hypoglycemia-related fast-breaking in adults with T1D during Ramadan without compromising glycemic safety. These findings support WP as a feasible adjunct to structured fasting plans in T1D. Further, larger multicenter studies are needed.

Keywords

Ramadan fasting - type 1 diabetes - hypoglycemia - whey protein - continuous glucose monitoring

Study Registration at Clinicaltrials.gov

NCT06595550.

Authors' Contributions

All the named authors contributed to the conceptualization, planning, and conduct of the study. They all contributed to the drafting and revising of the manuscript and approved its final version.

Compliance with Ethical Principles

The study was approved by the institutional review board and conducted in accordance with the principles outlined in the Declaration of Helsinki (Ref IRB/0605/23).

Publication History

Article published online:
21 November 2025

• References

• 1 Beshyah SA, Sherif IH, Benbarka M. Ramadan fasting and type 1 diabetes: a narrative evidence-based review. Diabetes Res Clin Pract 2021; 172: 108538
• 2 Al-Arouj M, Assaad-Khalil S, Buse J. et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care 2010; 33 (08) 1895-1902
• 3 Hassanein M, Al-Arouj M, Hamdy O, Bebakar WM, Jabbar A, Al-Madani A. Diabetes and Ramadan: Practical guidelines 2021. Brussels: International Diabetes Federation and the Diabetes and Ramadan International Alliance; 2021
• 4 Salti I, Bénard E, Detournay B. et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the EPIDIAR study. Diabetes Care 2004; 27 (10) 2306-2311
• 5 Hassanein M, Alamoudi RM, Kallash MA. et al. Ramadan fasting in people with type 1 diabetes during COVID-19 pandemic: the DaR Global survey. Diabetes Res Clin Pract 2021; 172: 108626
• 6 Jakubowicz D, Froy O, Wainstein J, Boaz M. High whey protein meals reduce postprandial glycemia. Diabetologia 2014; 57 (08) 1579-1587
• 7 Nilsson M, Stenberg M, Frid AH, Holst JJ, Björck IM. Glycemia and insulinemia in healthy subjects after lactose-equivalent meals of milk and other dairy products. Am J Clin Nutr 2004; 80 (05) 1246-1253
• 8 Pal S, Ellis V. The acute effects of four protein meals on insulin, glucose, appetite and energy intake in lean men. Br J Nutr 2010; 104 (08) 1241-1248
• 9 Bassuk SS, Kumar V, Dawson-Hughes B, Hill JO, Garber CE, Weaver CM. Whey protein intake and metabolic outcomes: a systematic review and meta-analysis. Nutr Rev 2022; 80 (05) 1067-1083
• 10 Arefhosseini SR, Asghari-Jafarabadi M, Vahabzadeh D, Nikniaz L, Moazami-Goudarzi R, Nikniaz Z. Effects of whey protein concentrate on glycemic status and lipid profile in women with T2DM: a randomized trial. Endocrinol Res Pract 2023; 27 (03) 223-229
• 11 Conn J, Gilbertson H, King B, Cameron F. Postprandial glycemic control with whey protein in adolescents with T1D on insulin pump therapy: a crossover trial. Pediatr Diabetes 2023; 24 (02) 175-183
• 12 Rath M, King BR, Jones TW. et al. Whey protein ingestion reduces the risk of overnight hypoglycemia following evening exercise in adolescents with type 1 diabetes: a randomized crossover trial. Nutrients 2023; 15 (03) 543
• 13 Alamoudi R, Hassanein M, Al Awadi F. et al. Regional differences in Ramadan fasting practices in people with type 1 diabetes: the DaR Global Survey. Diabetes Res Clin Pract 2022; 186: 109812
• 14 Alamoudi R, Alsubaiee M, Alqarni A. et al. Comparison of insulin pump therapy and multiple daily injections insulin regimen in patients with type 1 diabetes during Ramadan fasting. Diabetes Technol Ther 2017; 19 (06) 349-354