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Can you fast on Ozempic or Mounjaro in Navratri or Ramadan?

What Indian and international diabetes guidelines say about Navratri, Karva Chauth and Ramadan fasts on Ozempic, Mounjaro or Rybelsus: low blood sugar, water, large meals and dose timing.

GLP Guidebook teamPublished 5 Oct 202612 min read23 sourcesWritten from published sources

Written for India. Reading from the US? US versionComing soon

The short answer

Diabetes guidelines say a GLP-1 medicine on its own carries a low risk of severe low blood sugar during a fast. In Ramadan guidelines, it needs no dose change if dose increases finished weeks before. The main risks are insulin or sulfonylureas taken alongside, going without water, and large meals that make vomiting more likely.

Key takeaways

  • The 2021 IDF-DAR Ramadan guidelines say severe low blood sugar is unlikely on a GLP-1 medicine alone, but may be more likely alongside a sulfonylurea or insulin.1
  • India's RSSDI-ESI 2020 diabetes guideline says a GLP-1 dose needs no change during Ramadan if dose increases were finished 6 weeks before Ramadan.2
  • Navratri runs from 11 to 19 October 2026 and Karva Chauth falls on 29 October 2026, while India's 2027 holiday list puts Id-ul-Fitr on 10 March 2027.18,19,20
  • The US Ozempic and Mounjaro labels report kidney injury, sometimes needing dialysis, mostly in people dehydrated by vomiting, diarrhoea or nausea.10,11
  • India's RSSDI-ESI 2020 guideline says Hindu fasts have no universal rules and their data are "scanty". Indian reviews give GLP-1 medicines only a line each for Hindu fasts, and we found no guidance written for people taking them for weight.2,3,5
On this page
  1. Can you fast on a GLP-1?
  2. The 2026–27 fast dates
  3. Low blood sugar
  4. Doses and injection day
  5. Water and kidneys
  6. Breaking the fast
  7. Intermittent fasting
  8. Questions people ask
  9. How we researched this

Can you fast on Ozempic or Mounjaro?

Ramadan guidelines say people with diabetes on a GLP-1 can usually fast, but the studies are small and mostly of older GLP-1 medicines.

Before you go further
  • GLP‑1 medicines are prescription-only in India and cannot be bought over the counter.21
  • A government statement on 1 Apr 2026 said only endocrinologists, internal-medicine specialists and cardiologists can prescribe them.21 CDSCO expert-committee minutes attach a similar condition to some approvals (endocrinologist or internal-medicine specialist), but we found no rule covering every brand.22
  • All the risks of these medicines are in Guide 5: Side effects and risks.
  • This post describes guidelines. It is not a fasting plan or a dose plan for anyone.

GLP‑1 medicines raise insulin only when blood sugar is high.1 The guideline term is "glucose-dependent".1 The 2021 IDF-DAR guidelines come from the International Diabetes Federation and the Diabetes and Ramadan International Alliance.1 They say severe low blood sugar is unlikely on a GLP‑1 alone.1 They add that the risk "may be higher" with a sulfonylurea or insulin.1

The UK's South Asian Health Foundation (2020) rates GLP‑1 medicines as low risk for lows.6 It says they need no dose change in Ramadan.6 Its chart still puts moderately controlled type 2 diabetes on a GLP‑1 in the "moderate" fasting-risk group.6 Type 1 diabetes, an HbA1c (3-month average blood sugar) above 8.5% and pregnancy are in its "high" group.6

The evidence is thin for today's weekly medicines. The Ramadan trials IDF-DAR reviewed were of daily or older GLP‑1s: liraglutide, lixisenatide and exenatide.1 For other GLP‑1s, its advice rests on expert agreement, its lowest grade of evidence (Grade D).1 Two newer studies add a little:

  • Tirzepatide (Mounjaro's medicine), Bangladesh, Ramadan 2025: 109 adults with type 2 diabetes on the 2.5 mg starting dose.8 About 12% had mild stomach effects and none reported low blood sugar.8 Weight fell by 5.3 kg on average.8 There was no comparison group, and Beximco Pharmaceuticals sponsored it.8
  • Semaglutide tablets (Rybelsus), Gulf countries, Ramadan 2023: 257 adults with type 2 diabetes.9 No severe lows were reported, but 31% of 216 reported a low at some point.9 Stomach problems were the most common side effect.9 Novo Nordisk, Rybelsus's maker, funded it.9

For weight loss without diabetes, there is almost nothing. A 2023 review found "a dearth of studies" on GLP‑1 users without diabetes fasting in Ramadan.7 We found no study of GLP‑1 users during Navratri or Karva Chauth.

RisksThe risks, in brief
  • Stomach effects are common. In US Ozempic diabetes trials, 16% to 20% had nausea, against 6% on a dummy injection.10
  • Pancreatitis. The label's warning sign is persistent or severe stomach pain, sometimes spreading to the back.11
  • Gallbladder problems. Gallstones were reported in 1.5% on Ozempic 0.5 mg, against none on placebo.10
  • Dehydration from vomiting or diarrhoea can injure the kidneys.10,11
  • Thyroid warning. Ruled out by the US label for anyone with a personal or family history of medullary thyroid cancer (MTC) or MEN 2; tell your doctor if this applies.10
  • Not in pregnancy. The US Ozempic label says to stop at least 2 months before a planned pregnancy.10
Full detail in Guide 5: Side effects and risks →

When are Navratri, Karva Chauth and Ramadan in 2026 and 2027?

Sharad Navratri runs 11 to 19 October 2026, Karva Chauth is on 29 October, and Ramadan 2027 should end around 10 March.

Navratri dates follow the Hindu lunar calendar, and Ramadan follows the Islamic one, so they move every year.4,2 We took the 2026 Navratri dates from a dated news report.20 The other dates come from the central government's holiday lists.18,19

The three fasts differ in the way that matters most here: whether you drink water, and for how long.1,2,3

FastNext datesUsual patternWater and food
Sharad Navratri11–19 Oct 2026; Dussehra 20 Oct20,188–9 days, usually dawn to moonrise or star-rise. Some fast on every day, some on chosen days or one meal a day3,2,20Varies by family; vrat foods such as sabudana, kuttu and singhara are allowed4,20
Karva Chauth29 Oct 202618One day, from dawn until the moon is sighted: roughly 12–15 hours3May or may not allow "a glass of water or juice in the afternoon"3
RamadanId-ul-Fitr 10 Mar 2027, subject to the moon; Ramadan begins about 29–30 days earlier19,129–30 days, dawn to dusk; each day 10–20 hours, by season and place1No food or drink between dawn and dusk1,2

Sources: Navratri 2026 from Brut (21 Sep 2026); Karva Chauth and Dussehra 2026 from the DoPT holiday order of 3 Jul 2025; Id-ul-Fitr 2027 from the DoPT order of 16 Jul 2026. Checked 5 Oct 2026.

By our arithmetic, a 10 March Id-ul-Fitr puts the first day of Ramadan 2027 around 8 or 9 February. The exact day depends on the moon.19 IDF-DAR advises a pre-Ramadan check-up with a doctor 6 to 8 weeks before Ramadan starts.1 For a February start, that falls around December 2026.

Who is at risk of low blood sugar during a fast?

People who take insulin or a sulfonylurea, such as glimepiride or gliclazide, alongside a GLP-1 carry most of the risk.

The US Ozempic and Mounjaro labels both warn of low blood sugar (hypoglycaemia), "including severe hypoglycemia", with a sulfonylurea or insulin.10,11 They say lowering the dose of those other medicines may cut that risk.10,11 A 2015 review by Indian diabetes doctors explains why. Drugs that act only when sugar is high may need no change during fasts.3 Sulfonylureas and insulin "may need down-titration of dose".3

Fasting adds to this. A 2025 nutrition advisory on GLP‑1 medicines covers people with type 2 diabetes on glucose-lowering medicines.13 For them, it says intermittent fasting "may increase the risk of hypoglycemia".13 Our post on GLP‑1 medicines and low blood sugar gives the label figures in full.

The signs of a low include shakiness, sweating, a fast heartbeat, hunger, confusion, dizziness and nausea.15 Nausea is on that list, so on a GLP‑1, feeling sick during a fast could be a low as well as a side effect. Some people have a low with no symptoms at all.15

When the guidelines say to break the fast. IDF-DAR tells people with diabetes to break the fast if blood sugar is below 70 mg/dL or above 300 mg/dL.1 At 70–90 mg/dL, it says to recheck within 1 hour.1 Symptoms of a low, a high, dehydration or illness also mean breaking the fast.1 A Navratri review says patients and family should be ready "to break the fasts" if a low happens.4

What the Indian guideline describes for a low. RSSDI-ESI 2020 describes 15–20 g of carbohydrate, "four teaspoons of sugar or glucose", for a person who is awake.2 It says to repeat this if sugar is still low after 15 minutes, then eat a meal or snack.2 IDF-DAR stresses that a finger-prick test does not break a Ramadan fast.1 A 2015 Indian review says testing is "not forbidden in Hindu fasts".3

Get help now: call 112. The American Diabetes Association calls severe low blood sugar "an emergency".16 Its signs are an altered mental state, fainting, being too weak to help yourself, a seizure, or coma.16 For someone who is unconscious, RSSDI-ESI describes a glucagon injection or glucose into a vein.2

What do guidelines say about GLP-1 doses and injection day around a fast?

Ramadan guidelines say dose increases should be finished weeks before Ramadan starts, because stomach side effects cluster around each step up.

Your doctor sets every dose. What follows describes what guidelines and labels say. None of it is a plan to change a dose, skip one or move an injection.

On the US Ozempic and Mounjaro labels, most nausea, vomiting and diarrhoea happened during dose escalation (stepping up the dose).10,11 That is why the Ramadan guidance focuses on timing.7 The guidelines name different gaps:

  • IDF-DAR 2021: no further changes are needed once liraglutide, lixisenatide or exenatide have been dose-titrated "at least 2–4 weeks" before Ramadan.1
  • A 2023 review of GLP‑1s in Ramadan: dose increases "at least four weeks before Ramadan".7
  • India's RSSDI-ESI 2020: the dose "should be titrated 6 weeks prior to Ramadan and no dose adjustment is required".2
  • A 2019 Indian review (JAPI): for Navratri, GLP‑1 dose increases should already be finished before it starts. Its words: the dose "should be titrated prior to Navratri".5

A 2025 meta-analysis notes that guidelines advise against starting a GLP‑1 just before Ramadan, because of stomach side effects.23

Summarising IDF-DAR, the 2023 review adds that GLP‑1 users with diabetes should not stop for Ramadan "without consulting a healthcare professional".7

Weekly injections and fast days. Some people fast often, such as every Monday.3 For them, a 2015 Indian review suggests weekly GLP‑1 injections "on non-fasting days".3 The US labels have a general line on the injection day, not one about fasting.10,11 Ozempic's label says the day of weekly injection "can be changed if necessary".10 Both allow a change if doses stay at least 2 days apart for Ozempic, or 3 days for Mounjaro.10,11 What to do after a missed injection is in our answer What should you do if you miss a dose?

Rybelsus tablets are harder to fit around a fast. The US label says: one tablet on an empty stomach in the morning, with up to 120 mL of water.12 Food, drink and other tablets wait at least 30 minutes.12,9 In the Gulf study, 72% of Ramadan tablet doses were taken at iftar, the meal that breaks the fast.9 Before Ramadan, most were taken first thing in the morning.9 Iftar dosing differs from the label's morning instruction. The study recorded what people did, not what the label says.9,12 Our post on Ozempic tablets covers how the tablets work.

Sulfonylureas and insulin get the detailed changes. RSSDI-ESI 2020 lists changes to their timing and dose for Ramadan, such as moving a once-daily sulfonylurea to iftar.2 For a one-day fast like Karva Chauth, the 2015 review describes a lower sulfonylurea dose on the fast day only.3 It also says a yearly fast "does not justify changing therapy for the rest of the year".3

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Why do water and kidneys matter on a waterless fast?

GLP-1 labels link dehydration from vomiting or diarrhoea to kidney injury, and a fast without water removes the easiest way to replace fluid.

The US Ozempic and Mounjaro labels report sudden kidney injury since the medicines went on sale.10,11 Some cases needed dialysis.10,11 Most cases were in people dehydrated by nausea, vomiting or diarrhoea.10,11 The Ozempic patient guide says it is "important for you to drink fluids".10

A 2015 Indian review says people who skip water in the hot Indian summer risk dehydration and low blood pressure.3 IDF-DAR lists acute kidney failure in people prone to severe dehydration, "particularly the elderly and those with impaired kidney function".1 It also says to keep tea and coffee low, as caffeine can lead to dehydration.1

The early signs of dehydration, from the UK's NHS, are thirst, dark strong-smelling pee, peeing less, dizziness, tiredness and a dry mouth.17 The NHS says dehydration happens more easily with diabetes, after vomiting or diarrhoea, or in heat.17 Our answer on GLP‑1 medicines and the kidneys goes further.

Get help now: call 112. The NHS treats dehydration as an emergency with blue, grey, pale or blotchy skin or lips, or cold skin.17 The same goes for fast or difficult breathing, confusion, or being very sleepy and hard to wake.17 These can be signs of shock.17

What happens when you break a fast with a heavy, fried meal?

Long gaps without food can bring on GLP-1 nausea, and large meals make vomiting more likely, so a big fried meal after a fast stacks both.

A 2025 nutrition advisory on GLP‑1 medicines says nausea "often occurs in the morning or after longer periods without eating".13 It also says "vomiting is more likely to occur with large meals".13 A fast followed by a feast is both of those in one day.

Festival food is often fried. A 2017 Indian review says Navratri dishes at home and in restaurant thalis are often fried or oily.4 It names sabudana, singhara, kuttu, makhana and banana chips.4 The 2015 review calls Navratri fasts "more like celebrations" with foods "rich in sweets and fats".3 In Ramadan, IDF-DAR warns about iftar meals of more than 1,500 calories and eating fast.1 Festival sweets and late meals get their own post: Ozempic or Mounjaro at Diwali.

What the reviews suggest instead comes from diabetes care, not from GLP‑1 studies:

  • Replace "one major meal" at the end of the fast with small, frequent meals, snacks or drinks.4
  • Choose grilled, boiled, steamed, toasted or baked versions over oily ones.4
  • Low-fat milk, curd, paneer, lassi, chaach and nuts as protein on fast days.4
  • For Ramadan, open iftar with plenty of water and 1 to 3 dates, IDF-DAR says.1

India's ESI 2025 obesity guideline gives similar advice for GLP‑1 nausea in general.14 It suggests small, frequent meals and avoiding high-fat meals and fizzy drinks.14 It also suggests buttermilk or kokum juice in small amounts, and ginger or fennel seeds.14 More is in our Ozempic side effects, Mounjaro side effects and nausea posts.

Is intermittent fasting with Ozempic or Mounjaro a good idea?

A 2025 nutrition advisory warns that long fasts without enough protein can lead to nutrient shortages and muscle loss, and urges regular mealtimes on a GLP-1.

The advisory comes from 4 US nutrition and obesity societies.13 It notes that GLP‑1 users may "practice unintended intermittent fasting, due to not being hungry".13 It says that even on intermittent fasting, they "should be encouraged to consume meals at regular times of the day".13

It says long fasts without enough protein or food variety can cause nutrient shortages.13 They can also cause loss of fat-free mass, which includes muscle.13 For people with type 2 diabetes on glucose-lowering medicines, it adds the risk of low blood sugar.13 Several of its authors have declared ties to Novo Nordisk or Eli Lilly.13

Eating less without meaning to. On a GLP‑1, the advisory says, enough protein "may be difficult to achieve due to reduced appetite and/or taste aversions".13 Its suggestion is to eat protein-rich foods first in a meal.13 Indian protein sources are in our post on protein on a GLP‑1.

Higher targets, such as 1.2–1.6 g of protein per kg a day, "have also been proposed" during weight loss.13 The authors add that it is unclear which body weight such targets should use.13 Strength training, enough protein and calories, and varied, minimally processed foods can reduce these losses, they write.13

The best fasting data are still from Ramadan and diabetes. A 2025 meta-analysis pooled 4 studies (3 randomised trials) of 754 people with type 2 diabetes fasting in Ramadan.23 It compared GLP‑1 medicines with other diabetes medicines, mostly sulfonylureas.23 GLP‑1 users had fewer documented lows with symptoms (risk ratio 0.38).23 The risk of any low did not differ between the groups, and no one in either group had a severe low.23 Side effects overall and serious ones were similar.23 But GLP‑1 users had more stomach side effects, nausea and vomiting.23 Three of the four studies used older daily medicines, liraglutide or lixisenatide; one used semaglutide.23 The authors call the evidence "limited".23

We found no trial of a fixed eating window on top of semaglutide or tirzepatide. Keeping muscle while losing weight is covered in our post on muscle and loose skin. Food on a GLP‑1 in daily Indian life is in Guide 8: Life on a GLP-1.

Questions people ask

Can you take Ozempic or Mounjaro during Navratri?

A 2019 Indian review says GLP‑1 dose increases should already be finished before Navratri starts ("titrated prior to Navratri").5 A 2015 Indian review says drugs that act only when blood sugar is high may need no change during fasts.3 Insulin and sulfonylureas taken alongside are the ones that may need a lower dose.3

Does fasting on a GLP-1 cause low blood sugar?

The IDF-DAR guidelines say severe low blood sugar is unlikely on a GLP‑1 alone.1 They say the risk may be higher with a sulfonylurea or insulin.1 Signs include shakiness, sweating, a fast heartbeat, confusion and nausea.15

Is a waterless Karva Chauth fast risky on a GLP-1?

We found no study of it. The US labels link dehydration from vomiting or diarrhoea to kidney injury.10,11 A 2015 Indian review says the fast lasts roughly 12 to 15 hours.3 It may or may not allow water in the afternoon.3

Does a blood sugar test break the fast?

IDF-DAR says a finger-prick test does not break a Ramadan fast.1 A 2015 Indian review says blood sugar self-testing is not forbidden in Hindu fasts.3 It advises people with diabetes to keep testing during them.3

When does Ramadan start in 2027?

Id-ul-Fitr marks the end of Ramadan.1 India's 2027 central government holiday list puts it on 10 March 2027, subject to the moon.19,1 Ramadan lasts 29 to 30 days, so by our arithmetic it begins around 8 or 9 February 2027.1

How we researched this

On 5 and 5 Oct 2026 we read the full IDF-DAR 2021 Ramadan guidelines and India's RSSDI-ESI 2020 diabetes guideline. We also read three Indian reviews of Hindu fasting (2015, 2017 and 2019). Then the UK South Asian Health Foundation's 2020 Ramadan summary and a 2023 review. Two studies of tirzepatide and semaglutide tablets in Ramadan, and the US Ozempic, Mounjaro and Rybelsus labels, complete the list.

Most of this guidance was written for people with diabetes, and says so. Indian reviews give GLP‑1 medicines only a line each for Hindu fasts. We found no guidance written for people taking them for weight. We also read a 2025 meta-analysis of GLP‑1s in Ramadan. Dates come from the central government's holiday orders and a dated news report. We left out a 2019 table's GLP‑1 dose cut for Karva Chauth. The table does not say which GLP‑1s that cell means, and it reads as dose instructions.

Before you move on

  • On a GLP‑1 alone, guidelines rate severe low blood sugar during a fast as unlikely.
  • Insulin and sulfonylureas (glimepiride, gliclazide) are where the fasting risk sits.
  • Ramadan guidelines have dose increases finished weeks before Ramadan; a 2019 Indian review says "prior to Navratri".
  • No water plus vomiting is the route to kidney injury that the labels warn about.
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Sources

  1. International Diabetes Federation and DAR International Alliance. Diabetes and Ramadan: Practical Guidelines 2021 (IDF-DAR): ch. 2, 7 (§4.1, §4.2, §4.6, Figure 5), 8, 10 (§3.5), 15. All working-group members declared dualities of interest; prepared with an educational grant. idf.org (PDF)
  2. Chawla R, Madhu SV, Makkar BM, et al. RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020. Indian J Endocrinol Metab. 2020;24(1): fasting section and Annexure 9. No conflicts of interest declared. DOI · Full text
  3. Kalra S, Bajaj S, Gupta Y, et al. Fasts, feasts and festivals in diabetes-1: glycemic management during Hindu fasts. Indian J Endocrinol Metab. 2015;19(2):198–203. DOI · PMID 25729681
  4. Gupta L, Khandelwal D, Singla R, Gupta P, Kalra S. Pragmatic dietary advice for diabetes during Navratris. Indian J Endocrinol Metab. 2017;21(1):231–7. DOI · PMID 28217524
  5. Saboo B, Joshi S, Shah SN, et al. Management of diabetes during fasting and feasting in India. J Assoc Physicians India. 2019;67(9):70–77, Table 3. PMID 31561693
  6. Hanif W, Patel V, Ali SN, et al. The South Asian Health Foundation (UK) guidelines for managing diabetes during Ramadan: 2020 update (summary algorithm). Supported by an unrestricted educational grant from Boehringer Ingelheim. sahf.org.uk (PDF)
  7. Alayed KM. Glucagon-like peptide-1 (GLP-1) during Ramadan: narrative review of the published literature. J Obes. 2023;2023:8626081. DOI · PMID 38169925
  8. Rahman MH, Selim S, Afsana F, et al. Safety and effectiveness of tirzepatide during Ramadan fasting: real-world evidence from patients with type 2 diabetes in Bangladesh. Diabetes Obes Metab. 2026. Sponsored by Beximco Pharmaceuticals PLC. DOI · PMID 41342185
  9. Hassanein M, Alawadi F, AlKadhim I, et al. O-SEMA-FAST: oral semaglutide use in adults with type 2 diabetes during Ramadan. Diabetes Ther. 2025. Funded by Novo Nordisk. DOI · PMID 40016571
  10. Novo Nordisk. Ozempic (semaglutide) prescribing information and Medication Guide, US label, revised 05/2026: boxed warning, §2.1, §5.5, §5.6, §5.9, §6.1, §8.3. novo-pi.com/ozempic.pdf
  11. Eli Lilly. Mounjaro (tirzepatide) prescribing information, US label, revised 08/2026: §2.1, §5.2, §5.3, §5.5, §6.1. pi.lilly.com/us/mounjaro-uspi.pdf
  12. Novo Nordisk. Rybelsus / Ozempic tablets (semaglutide) prescribing information, US label, revised 1/2026: §2.1. novo-pi.com/rybelsus.pdf
  13. Mozaffarian D, Agarwal M, Aggarwal M, et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society. Am J Clin Nutr. 2025;122:344–367. Four authors declared Novo Nordisk ties and five Eli Lilly ties. DOI · Full text
  14. Madhu SV, et al. Endocrine Society of India (ESI) clinical practice guidelines for obesity 2025. Indian J Endocrinol Metab. 2025;29(4):355–365, Table 6. DOI · Full text
  15. American Diabetes Association. Hypoglycemia (low blood glucose): symptoms and treatment. Opened 5 Oct 2026. diabetes.org
  16. American Diabetes Association. Severe hypoglycemia (severe low blood glucose). Opened 5 Oct 2026 (US page; India's emergency number is 112). diabetes.org
  17. NHS (UK). Dehydration. Page last reviewed 1 May 2026 (UK numbers on the page; India's is 112). nhs.uk
  18. Department of Personnel and Training, Government of India. O.M. F.No.12/2/2023-JCA, 3 Jul 2025: holidays in central government offices in 2026, Annexures I and II. copy of the order (PDF)
  19. Department of Personnel and Training, Government of India. O.M. F.No.12/2/2023-JCA, 16 Jul 2026: holidays in central government offices in 2027, Annexure I. csir.res.in (PDF)
  20. Team Brut. Navratri 2026: date, 9 days, puja timing, significance, fasting. Brut India, 21 Sep 2026. brut.media
  21. PIB Research (Government of India). GLP‑1 Drugs: Use, Risks, and Regulation. 1 Apr 2026. static.pib.gov.in (PDF)
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  23. Kamrul-Hasan ABM, Pappachan JM, Ashraf H, et al. Safety and efficacy of glucagon-like peptide-1 receptor agonists in individuals with type 2 diabetes mellitus fasting during Ramadan: a systematic review and meta-analysis. World J Methodol. 2025;15(4):105478. No conflicts of interest declared. DOI · PMID 40900863 · Full text

Last checked 5 Oct 2026 · Next review due 5 Oct 2027 · Report an error

How this post was made. Written by the GLP Guidebook team from the sources above. It's general information, not medical advice. Talk to a qualified doctor before a fast, and before starting, stopping or changing any medicine. How we write