diabetes and scuba?

[triton94949]

... For my specific buddy, knowing this one guy (only) and how he deals with his diabetes, (plus the fact that he's a cave diving instructor with many hours in deep mixed-gas environments with the experience and situational awareness that provides) I am more than willing to accept any theoretically increased risk to my own safety that exists as a consequence of his diabetes.

But I'm unable to offer a blanket endorsement of insulin-dependent divers. Candidly I'm not a medical doctor and I don't have the qualifications to make any informed statements regarding that topic.

...

Intrepid, then basically you are in the same situation that we are in at our dive club. We are all emotionally involved. Therefore we want the person who has Type 1 diabedes to be able to dive if he wants. That is an emotional issue. Since all the world's physicians and all the world's training agencies do not necessarily agree however, then there might be a judgment issue involved as well. Emotions overriding good judgment. I don't know what the right answer is.

We have solved the problem of the added risk to the buddy of the diabetic diver in our dive club by creating a dive team consisting of 3 divers. If something does go wrong, it is a whole lot better to have 2 divers assisting than just one. That improves the odds for all 3 of them.

For agencies and stores that sanction certifying Type 1 diabetic divers, I would like to see them adopt the 3 person dive team rule as well. But what they do is up to them and not me.

 

[triton94949]

...
If a diabetic is willing to follow an established procedure - there should be nothing stopping them from diving.

Here is how it works in the real world.

Step 1, you become a certified diver. You can get your training in the colleges, or in the military, or from the private diving stores (LDS - local dive store). The military is the most rigorous, and they also have the most flexibility. However if you are a type 1 diabetic, you will not get into a military diving program. The colleges and the LDSs will need to have instructors affiliated with one of the training agencies: NAUI, YMCA, SSI, PADI, etc.

Step 2, you like diving so much that you become an instructor. This then becomes your second round with the training agencies: NAUI, YMCA, SSI, PADI, etc. You will also need to obtain agency-approved instructor insurance, once you meet all their requirements and learn all their policies and pass their ITCs. On your first time around with the agencies, you were only concerned with learing how to scuba dive for yourself. On your second time around, a major portion of your work is to become proficient with their policies and procedures.

Step 3, now you are subject to 3 sets of rules: (1) the rules placed upon you by the Agency (NAUI etc); (2) the rules placed upon you by the insurance company; and (3) the rules placed upon you by the LDS owner or the college P/E Dept chairperson.

Step 4, the insurance co and the agency will each have tremendous control over the LDS owner or influence over the P/E Dept chairperson as well.

The real world has an institution called civil procedure, under which you can be dragged into court and your judgment tried in front of a jury of your fellow citizens, by which your adherence to the rules of your insurance co and your training agency will be examined and cross examined.

Ignorance has nothing to do with it. It is all a matter of official policy, and following that official policy, or else you as an instructor are history, and worst case your car and your house and your bank account too.

 

[padiscubapro]

When you're right, you're right. I edited my comments. My apologies. I am very emotionally connected to the issue.

It only took me 10 years to get certified because of similar attitudes.

Let me add my 2 cents..

As a technical diver and technical instructor I see divers doing dives that most would consider quite difficult.. I know several divers who routinely do dives of several hours required decompression and ARE insulin dependent diabetics.. Their dive buddies know the facts.. The divers take precautions of having sugar "solutions" with them underwater.. Usually allow their BS to go higher than normal before they enter the water and usually make it a habbit of eating something high in carbs thats not too quickly digested...

I am not advocating every diabetic go jump in the water and start diving.. They should consult their doctors and speak with other diving diabeteics and adopt some type of formal protocol if they are going to dive..

I would take a diver dependent on insulin over a diver on oral medications since most diabetics that I know that usually have problems with low BS are usually those on oral medications.. A diver on insulin can lower the idsage to accomodate higher work levels, thos on oral medications don;t have the kuxury to do so and also many oral medications have a long halftime, so the medication levels remain fairly consistnt for an extended period of time..

I would not hesitate teaching a diabetic to dive providing they have medical clearance...

 

[Doc Intrepid]

Intrepid, then basically you are in the same situation that we are in at our dive club. We are all emotionally involved. ...then there might be a judgment issue involved as well. Emotions overriding good judgment. I don't know what the right answer is.

I suppose you are correct, I am in the same situation. I don't know however if I'd characterize it as 'emotions overriding good judgement'. From my perspective its all about personal choices. Diving, like mountain climbing, is one of the last frontiers where a person can, in a reasonably unregulated environment (compared to many others), make decisions that may well end in their own death...but they are free to make the choices. (The older I get the more I question 'good' judgement in general, whether its mine or anyone elses.) But its important to be able to make personal choices.

 

[babar]

Let me add my 2 cents..

I would not hesitate teaching a diabetic to dive providing they have medical clearance...

This is probobly the crux of the issue, as I see it. Both from a liability and a safety standpoint. It used to be that type 1 diabetes was an ABSOLUTE contraindication to diving. Plenty of dive docs still feel that way. Many dive physicians are now trying to risk stratify these people into groups. Their are several diffeent agencies that are writing protocols, and standards. Some of them are so rigid that the diabetic individual actually needs to be healthier than a non-diabetic. It is very controversial, but a way to increase the divers safety and decrease your own liability as an instructor is to refer these folks to a dive doc who is actually familiar with the issues.

That said, as a dive doc, and a diver, I think having a tube of glucose on you during a lengthy deco dive, at best would give you a false sense of security. If the diver himself feels something, and takes it on his own, that's one thing, but it will be worse then useless in an event where the diver winds up unconscious. Can you imagine, trying to get glucose into an unconscious diver underwater, while having deco obligation, without drowning him? I can see clearing well controlled diabetics for normal recreational diving. But tech, and deco diving is something else entirely. One issue among Docs is that once you clear a diver, you assume some risk. Because while you can give specific recomendations about safety, once you check the box, and their out the door, they can do whatever they want, because they've been 'cleared'.

I also realize that this is a very touchy subject for those people involved in this issue, but at the heart of it is safety.

Peace
Babar

 

[616fun]

Ignorance has nothing to do with it. It is all a matter of official policy, and following that official policy, or else you as an instructor are history, and worst case your car and your house and your bank account too.

From this post I am willing to wager that you are part of a certifying agency that lists diabetes as a total contraindication. I respect that you wish to follow the policies and procedures laid out by your organization - you wouldn't be a worthy diver/instructor if you didn't. However, policies and procedures will not change without an effort from the base population within the agency. DAN and other organizations are reviewing diabetes and diving and are saying, when reviewed on a case by case basis, a diabetic may be cleared to dive. I hope the certifcation organizations take notice that the dive medicine experts are changing their minds on the subject.

I still say that not every diabetic should be cleared to dive, but I stand by that every certification organization should review it policies and procedures in reference to diabetes and diving.

 

[616fun]

That said, as a dive doc, and a diver, I think having a tube of glucose on you during a lengthy deco dive, at best would give you a false sense of security. If the diver himself feels something, and takes it on his own, that's one thing, but it will be worse then useless in an event where the diver winds up unconscious. Can you imagine, trying to get glucose into an unconscious diver underwater, while having deco obligation, without drowning him? I can see clearing well controlled diabetics for normal recreational diving. But tech, and deco diving is something else entirely. One issue among Docs is that once you clear a diver, you assume some risk. Because while you can give specific recomendations about safety, once you check the box, and their out the door, they can do whatever they want, because they've been 'cleared'.

Babar
I agree with you totally. In a previous post I mentioned that tech diving was something that I , even as a diabetic, would not be comfortable saying any diabetic should do.
Funny - everytime I go see my doc - he asks me how diving is going and what training I'm looking into next. He likes to keep his pulse on what my next step is. In fact - he requested that I seek a new medical waiver every time I want to get a new certification. I imagine this is his way of keeping himself abreast of what avenues I'm pursuing - and putting his thumb on it if I get in over his comfort level.

Thanks for throwing in the doctors perspective on this.

 

[ppo2_diver]

Being an insulin dependent diabletic, a tech diver, and an instructor I'll throw my two cents in.

I feel that the decision for someone who has diabetes to dive is very subjective. I'll use my own experiences as an example. I have not had any episodes of low blood sugars in the past 4 years. My HA1C is slightly higher than a "normal" person's, but definately not high. It is important for a diabetic to be honest with him/her self about their condition when learning to scuba dive (wether recreational or technical). If I felt like I couldn't do the type of diving I want to do, then I don't do it. If my condition was not under control and I was having problems, then I wouldn't dive or teach. It's that simple. It's up to the individual and their doctor to determine their own personal limits in regards to the activities they take up. Scuba instructors are not expected to be doctors and have knowledge about medical conditions and medications and about an individuals specific condition. Therefore the liability falls back to the student and their doctor. This is how it was explained to me and I have discussed this with PADI education. Even if a student lies on the medical form, the liability goes back to the student.

As for techinical diving, there are a number of techincal divers that are diabetic. Tech divers are known to be very detailed oriented and if one is a diabetic, part of their dive planning should involve their condition. It took me two years to evaluate my comfort level with tech diving and my condition. Other than being a little overweight (I'm working on it), I feel that my health is good enough to support the demands of tech diving and my pre dive planning involves what to do if I have a problem. My buddies are also part of this plan.

With all of this being said. I don't think that a blanket statement like insulin dependent diabetics shouldn't be allowed to dive is very false. Every person's body is different and how their body reacts to their condition is different. Therefore, it should be a decision made by the diver and their doctor. I meet with my diabetic doctor four times a year and we discuss my diving. I also get a medical sign off once a year whether I need it or not. This puts the liability back on me and not on somebody else.

Duane

 

[davidworkman]

The first thing you need to do is talk with diabetics that are divers. They can communicate intelligent information. I have been diving as a diabetic for 35 years. I have been a diabetic since I was 8. I started diving before they had glucose meters. The glucose in a tube is the best because it is water tight. Know your diving partner is the best insurance.

Whether the food supplements are a good idea, I would think that if it comes to that, you need to get out of the water, or else not go in if the issue comes up before the start of your dive.

Since you are after all in the class, presumably the instructor sent you to a diving physician who signed your medical waiver. Presumably that means somebody with good credentials believes that it is safe for you to scuba dive.

Different store owners (course directors) take different views of this risk factor. At the one extreme, some welcome the additional business. At the other extreme, some draw the line at insulin-dependent diabedes and tell their instructors the answer is no to certifying such students.

You should always inform others of your situation, so that there is good awareness all around. Don't be surprised when some others bow out. This subject is controversial in the sport and business of scuba diving. DAN is always researching this and reporting back, but so far there is no industry-wide agreement.

Having said that, there is an insulin dependent diabetic in a dive club that I dive with. We always make sure the dives in which he participates involve as little exertion as possible, and we keep our depths shallow, never deeper than 45 ft, and we give him 2 buddies not just one. He normally does not dive repetitive dives either because we dive in cold water. You may want to think about those guidelines, and see if your current instructor can give you others as well which specifically take into account your special medical condition.

Now, also to address the bum-scoop factor that Intrepid might bring up. A 3 person dive team is less than ideal, and might be considered bum scoop by Intrepid. However in our dive club, we believe that the risks of an incident underwater with the diabetic diver and his single buddy are greater than the risks from a 3 person dive team. That is how we called it in our dive club.

 

[zor]

QUICK UPDATE:
I just finished my open water certification this weekend. Had lots of fun trying to adjust the bg (blood glucose). For me, since I've never had any problems with hypo glycemia causing seizures or any other extreme symptoms that would interfere with me safely getting out of the water, diabetes is simply an inconvience for recreational diving. Aulthough I was usualy droping rapidly when I got out of the water, I was usualy alright, and only went low once on my open water weekend. My sugars were from 210-280 getting in and from 90-110 getting out. The only time I was low, I started having symptoms after I surfaced and was getting my gear out, and was 57 mg/dL. Aulthough that is fairly low for some people, I've been as low as 21 once and was still able to function. That was a rather scary experience a few months after I was diagnosed (which was 6 years ago I might add) and I wouldn't want to repeat it, but I do at least know I can function at very low sugars if it comes to that.
The reason I say it was an inconvinience is that its easy to cary sugar underwater and on normal recreational dives, if I were to get low, all I'd have to do is surface and eat some sugar. Possibly I wouldn't even have to surface If I can find a way to drink juice underwater. The real problem is balancing the sugar: I had to get in with a high enough sugar that I wouldn't go low, but not so high that I'd have to go to the bathroom really bad and get out early. Over all, the biggest problem was that I was so tired from the stress of my first real dives that I wanted to eat continuously and ended up pretty high a few times. However, just by my forth dive that was much less of a problem and I think a lot of that stress on my body will decrease with expreience, and that this will become simpler when I'm more relaxed in the water.