Diabetes and Diving

[TSandM]

Having diabetes introduces blood sugar as something else that has to be monitored, with agreed upon and practiced backup plans prior to the dive.

A beautiful way to put it.

For the record, if I chatted pre-dive with a diabetic and felt that he had a good understanding of his disease and a good set of procedures for handling blood sugar while diving, I'd have no qualms about diving with him.

 

[coney]

TSandM,

that was very well put and quite insightful.
As a diabetic (type 11 diabetic) i always adjust my gloucose level to be a little high on dive days. Daily blood monitoring can be more more helpful for divers than just consider their AIC as the latter will give an average blood sugar level over a 3 month period, not at all accounting for blood sugar on the day of diving

 

[MasterFritts]

I worried about this initially. I am type 2 and just on oral medication. However since the doctor found the right level of medication to give me, I have been losing weight and my diabetes is under control. I do not have the issues I once had.

I am a martial artist and could not keep the weight off. Apparently something with the diabetes was causing my weight to go crazy. Now with the right meds I am dropping the weight which also helps the diabetes.

In all my times of being on the high/low roller coaster I never did experience panic, etc. If I was driving, I pulled over and grabbed either diet soda to drink (if the high feeling came over me) or something sweet (for the low times). If I was flying, same thing, however I did land quickly.

My diabetes is to the point where when I am preparing to dive or something like it, I just do not take my meds that day to prevent any low blood sugar attacks.

I was told no by a couple of places here in Knoxville but Rhea's Diving in Maryville took me in with a Doctor's note.

I begin my training on the 6th of Sept and looking forward to it.

 

[Nismo]

A few questions to ask is if they have had their diabetes under control or if they have been having difficulty with it lately. A check before and after would be greatly appreciated. Ask them if they have any little quirks to look for when their sugar drops. Some people get like a nervous tick when it starts to get low. Be aware that if it is high that can impair their judgement as well. If it's getting really high they will have an increased breathing rate too. I think the best thing to do is to find out how well they control it. If they keep undercontrol then you won't have much to worry about. A low sugar could result in panic due to them not being able to comprehend properly. The brain needs oxygen and sugar.

 

[sixgears]

I am Type II under oral meds and my doctor cleared me for diving. As long as that medical form is signed by your doctor EVERY YEAR you shouldn't have any problems with taking training classes/diving. Just keep that glucose under control and you should be OK.

 

[Doc]

What an interesting mixture of dead-on correct medical information as well as slightly off interpretations.

The problem to avoid: Low blood sugar at any point in the dive or in the industrial environment of the dive boat. Essentially the subject may get sleepy, non reactive/responsive to various situations & stimuli, and may have physical affectations as if he were intoxicated.

How does this occur?

Mark the time of first splash. Did the diabetic diver eat properly before his dive? Was breakfast 4 hours earlier? Did he have a coffee and a doughnut?

Diving is a physically strenuous activity not only in the use of large muscle groups, but also in terms of replacing lost body heat. This burns calories, this pulls sugars out of the blood.

If you go into the water with a low blood sugar level (the drop of blood on the meter check), you are likely to have issues. Some people consider low to be around 60. General working level? Maybe 100~175 or so. It is absolutely an individual measurement wholly dependent upon past experience. Noobs should step cautiously, old timers are well aware of their parameters.

The A1c, as stated above, is pretty much so an irrelevant measurement for the immediacy of a situation such as this.

Remember, it isn't over when they climb up that ladder and get seated. That's a great time to check your blood sugar once again. Short term quick fixes like OJ are okay, but should be followed with something more substantial with properties that make digestion and absorption a bit longer term.

Work with your buddy, know how his blood glucose meter works, understand how his "numbers" work for him. Essentially though, the meter is a short term diagnostic tool. If he's drowsy, that's what refined sugar is for.

Some divers I know carry emergency glucose ampules while underwater. They've never used them, but understand when and how to employ them.

 

[robint]

I am sooooo glad to see so many responsible diabetics who dive. I know a diver personally who is the opposite. This person is irresponsible in her daily life, doesn't check her levels often and is constantly having to get "help" from others. I wonder when she will kill someone when she driving and passes out. She recently got the "pump" which means now she hardly ever checks her sugar - pathetic and irresponsible. What is worse, she is a nursing student in college.

Anyhow, she is a diver and has passed out underwater and luckily her buddy pulled her up and screamed for help, another diver, a total stranger on shore was a nurse and brought glucose with her. The diver lived and still hasn't learned from this incident in my estimation.

Knowing this person and seeing her constant "issues" has really tarnished my attitude towards scuba and diabetes.

Anyhow, glad to see there are divers with diabetes out there who are responsible.

robin

 

[MasterFritts]

robint,

I have met people like that. I swore I would NEVER get to the point where I have to suffer from the bad side of diabetes. It is NOT something to fool around with, that is for sure. People lose limbs, die, etc from it. I will not be one of those.

I know others are the same way. It bothers me that people see the worst in diabetics and think we can't do anything. I see warning signs all over the place now that I never thought of before. Some are just downright crazy but to not understand the disease is to fear it.

It can be controlled, you can live a normal life, heck you can live an extraordinary life. All about attitude, discipline and determination.

 

[616fun]

robint,

I have met people like that. I swore I would NEVER get to the point where I have to suffer from the bad side of diabetes. It is NOT something to fool around with, that is for sure. People lose limbs, die, etc from it. I will not be one of those.

I know others are the same way. It bothers me that people see the worst in diabetics and think we can't do anything. I see warning signs all over the place now that I never thought of before. Some are just downright crazy but to not understand the disease is to fear it.

It can be controlled, you can live a normal life, heck you can live an extraordinary life. All about attitude, discipline and determination.

Great attitude towards diabetes Master Fritts. I was 8 yrs old when I found out. Luckily my parents decided that they would never let me be different because of it. That said, they also instilled in me the drive for perfection in control. My attitude is that someday there will be a cure and when that day comes my body will be in great shape.

Until that day comes I'll be carefully monitoring my glucose and happily blowing bubbles with the rest of you

 

[Gene_Hobbs]

Since I am the one to first bring up the A1c issue, let me ask a simple question, at what point did I say what I consider a low vs a high number? As a matter of judging people I have never seen before, I find that number as useful as watching a new diver set their gear up. I see patients every day that are only here because they did not control themselves and my comfort with poor management is probably higher than I should let it be. Stop making assumptions about what you THINK I consider low.

Going beyond this... Do they even know what their A1c is? I have been shocked once on a dive site when the person did not even know what his level was. From there is was not much of a shock that not only did he not have glucometer with him but he had not measured himself all day (dives were after lunch in the afternoon). Guess what, when he got on the boat, sand came pouring out of the bag that held his regs. Was I surprised?

Values for the day of diving... I think DAN did a pretty good job but I also trust that I will not have to check behind someone if they know the answers to my initial questions which do include where they are right now. (guidelines below)

I have only met a few diabetic divers that did not know infinitely more about their physiology than the average diver and to be honest they tend to be more fun for me on sites because they know enough to hold intelligent conversations about diving physiology (imagine that, I enjoy talking about physiology... ).

In short, don't assume you know what I mean, ask, I never mind explaining myself. I spend all my free time tying to make sure people have access to the information that makes all our dives safer, why would I mind expanding my position on a topic?

...since someone will click this thread that has not read the DAN guidelines and I hate to post without keeping my signal to noise ratio up:

Table 1: Guidelines for Recreational Diving with Diabetes

Selection and Surveillance
• Age ≥18 years (≥16 years if in special training program)
• Delay diving after start/change in medication -3 months with oral hypoglycemic agents (OHA) -1 year after initiation of insulin therapy
• No episodes of hypoglycemia or hyperglycemia requiring intervention from a third party for at least one year
• No history of hypoglycemia unawareness
• HbA1c ≤9% no more than one month prior to initial assessment and at each annual review -values >9% indicate the need for further evaluation and possible modification of therapy
• No significant secondary complications from diabetes
• Physician/Diabetologist should carry out annual review and determine that diver has good understanding of disease and effect of exercise -in consultation with an expert in diving medicine, as required
• Evaluation for silent ischemia for candidates >40 years of age -after initial evaluation, periodic surveillance for silent ischemia can be in accordance with accepted local/national guidelines for the evaluation of diabetics
• Candidate documents intent to follow protocol for divers with diabetes and to cease diving and seek medical review for any adverse events during diving possibly related to diabetes

Scope of Diving
• Diving should be planned to avoid -depths >100 fsw (30 msw) -durations >60 minutes -compulsory decompression stops -overhead environments (e.g., cave, wreck penetration) -situations that may exacerbate hypoglycemia (e.g., prolonged cold and arduous dives)
• Dive buddy/leader informed of diver’s condition and steps to follow in case of problem
• Dive buddy should not have diabetes

Glucose Management on the Day of Diving
• General self-assessment of fitness to dive
• Blood glucose (BG) ≥150 mg·dL-1 (8.3 mmol·L-1), stable or rising, before entering the water -complete a minimum of three pre-dive BG tests to evaluate trends
• 60 minutes, 30 minutes and immediately prior to diving -alterations in dosage of OHA or insulin on evening prior or day of diving may help
&#8226; Delay dive if BG -<150 mg·dL-1 (8.3 mmol·L-1) ->300 mg·dL-1 (16.7 mmol·L-1)
&#8226; Rescue medications -carry readily accessible oral glucose during all dives -have parenteral glucagon available at the surface
&#8226; If hypoglycemia noticed underwater, the diver should surface (with buddy), establish positive buoyancy, ingest glucose and leave the water
&#8226; Check blood sugar frequently for 12-15 hours after diving
&#8226; Ensure adequate hydration on days of diving
&#8226; Log all dives (include BG test results and all information pertinent to diabetes management)