Table 3

Suggested pathway for discussions between healthcare professionals and people with diabetes intending to drive and fast during Ramadan (adapted from Beshyah e t al 34)

Before Ramadan: (evaluate and advise)
  • Ensure that patients were appropriately evaluated for driving with diabetes.

  • Ensure absence of any factors that would prevent driving (fasting with diabetes in general).

  • Advise on diabetes management during driving if fasting is agreed.

During Ramadan: (monitor)
  • Avoid all unnecessary journeys as a rule.

  • Avoid long journeys, early morning trips and driving within 2 hours before sunset and driving under bad weather.

  • Take breaks on long journeys (if you must do them).

  • Always keep hypo treatments to hand in the car (even when you are fasting).

‘if your blood glucose is 5.0 mmol/L or less, take a snack. If it is less than 4.0 mmol/L or you feel hypoglycaemic do not drive’.
  • Never ignore your hypo warning signs (eg, hunger, sweating, feeling faint and so on).

  • If you have a hypo while driving, stop the vehicle as soon as possible, switch off the engine, remove the keys from the ignition and move from the driver’s seat, take some fast-acting carbohydrate, such as glucose tablets or sweets, and some form of longer acting carbohydrate, and do not start driving until 45 min after blood glucose has returned to normal.

  • Manage hypoglycemia promptly and err on a wide safety margin.

  • If in doubt, suggest stopping either fasting or driving depending on the relative risk assessment and demands of the circumstances.

After Ramadan: (review)Review the patient in clinic or surgery within 2–4 weeks after Ramadan.
  • Appraise the experiences and outcomes.

  • Review the risk to benefit ratio of strategy adopted during Ramadan on an individual basis.

  • Review the diabetes therapeutic strategy.

  • Consider any ensuing legal implications.