Diving with diabetes

Discussion in 'Divers with Disabilities' started by Tod, Aug 25, 2005.

  1. Tod

    Tod Nassau Grouper

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    While for some this may not be considered a disability, this seems like the best place on this forum to post this question.

    I have been an insulin-dependent diabetic for 25 years and a certified diver for over three years. I have recently completed a Solo Diving class through SDI, complete with two open water "check-out" dives with the instructor. After the completion of the course, I went on a weekend boat dive down in the Channel Islands with a group sponsored by my LDS. It was during this trip that I ran into a problem.

    After the second full day on the boat (12 dives so far for the trip) I went to bed around 10:00 PM. It turns out I had a very light dinner (few carbs) as I didn't care for the meal and because I was pretty tired, I didn't bother to try and fill-up on soda or snacks. Just before crawling in my bunk, I mistakenly took my regular dose of insulin before bed (out of habbit) and also neglected to test my blood sugar (too lazy). [This is the point in the story where I made my mistake. No denying it and no need to question it.]

    Sometime in the night, my blood sugar levels dropped (as would be expected) after the all the day's activities and partially due to the lack of calories during dinner. (I even did a night dive after dinner!) Anyway, as I slept I apparently started making some funny sounds (gurggling) and woke up some of the others near my bunk. When they tried to wake me I did not respond. This caused a bit of a panic as most assumed it was some sort of DCS or a stroke! My friend who was there with me (and who is also aware of my condition) informed them that I was a diabetic. The boat crew (by then) responded by providing me some glucose and I soon came out of it. Unfortunately, the Coast Guard was called and they sent a chopper out to the boat!

    Short version: Once they showed up, that was the end of my dive trip. Even though I was able to explain what had happened and was then able to walk around on my own, they insisted I take a ride in their chopper. I figured they were not bring me back and I was not happy. :banghead:

    At the hospital, they took some blood tests and found that I was going to live and soon let me go. Unfortunately, I had no money, few clothes, and no idea how I was going to get back to where I started (the Santa Barbara Harbor). I was taken to some place in Oxnard. (Longer story about how the GREAT hospital staff there helped me out!)

    Now on to the issue:

    A few weeks later, I ran into my instructor from the Solo Diving class. He told me he heard about my adventure and began to question whether or not I should even be diving! Further, he was going to hold my Solo Diving certificate until he reconsidered this, citing the fact that had I had such a reaction while I was diving I would likely not survive. True. But the particular circumstances that led to my issue were self-induced (by my neglect to test myself and by the fact I took too large of a shot). I told him that normally I am aware of where my blood sugar levels are BEFORE I don my scuba tank and that I wouldn't even think to dive if I felt I may become hypoglycemic at any time during the dive. He didn't seem convinced. It was only at this point that I felt like I was treated like I had some sort of disability.

    Finally, he settled upon letting me have my certificate if I could produce a letter from my doctor - which I now have.

    Has anyone else ran into any sort of question over being a diabetic?
     
  2. scubatim2004

    scubatim2004 Angel Fish

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    Sorry to hear of this probome I to am type 2 diabetic but control my sugar with Advandamet (pill) . No one has ever asked me or advised me not to dive but hearing this story I think it's time to call the Dr. whom knows I dive and get a letter of clearence incase a question from a charter comes in to play.
     
  3. PlanoDvr1

    PlanoDvr1 Nassau Grouper

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    I too am a Type 2 diabetic and have never had a problem. I control by diabetes by running and diet. I started out w/ glucovance (pills) controlling the spikes w/ insulin until I brought my weight down and that is where I am today. I have woken up dizzy w/ a very low blood sugar once before so understand to some degree what you were feeling.

    Diving w/ diabetes is always risky. Thats why the questionaire asks the question when you sign up to get certified. When your diving there's a huge risk that you could get low blood sugar and become disoriented. I'm not sure of a method to drink orange juice or get a quick sugar fix to handle the situation, its more a proactive situation then a reactive.

    It sounds like you understand the error made and always, always check those levels.

    Good luck,
    Doug
     
  4. Wookie

    Wookie ScubaBoard Business Sponsor ScubaBoard Business Sponsor

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    with folks (not all divers, one a non-diving cameraman) who went into (insulin shock) too much insulin on one of our boats, one while at depth. Very freaky for the crew. Your boat crew did absolutely right to evacuate you, I'd have done the same. Our company policy is to allow diabetics to dive only with a letter from their doc stating clearly that the doc understands the dangers, your diabetes is under control, and you are cleared to dive. Not checking your blood sugar placed your boat crew under a tremendous amount of stress. You wouldn't have sued if you died, but what about your next of kin? A diver sick on the boat who can't be evacuated (the Coast Guard will not always fly) requires the entire boat to be brought to shore. I am not flaming, just giving you other things to think about.
     
  5. ppo2_diver

    ppo2_diver Scuba Instructor

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    I'm an insulin dependant diabetic as well. Only I control my condition with an insulin pump and not injections. This allows me to know worry too much about having low blood sugars on a dive since the pump is disconnected from my body, hence no insulin. I've been questioned about my condition and the steps I take to ensure my safety and the safety of my students. My tech instructor was OK with it as is my future trimix instructor. All this being said, instructors are not doctors and can't be expected to know how one's condition will affect them during diving. Hence it is always prudent to err on the side of caution.

    I don't know how SDI handles instructors withodling certification, but in the PADI world if you pay for the course and complete all of the diving objectives, the instructor cannot withold your certification. Did you fill out a medical form prior to taking the solo diver course? If not, then your instructor was covering his behind by not sending in your certification until he got a medical form. It should be filled out and signed by a doctor before any in water activities begin.

    Duane
     
  6. JKSteger

    JKSteger D/M Wannabee ! ! !

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    Simple solution here is to 1. check BGL 1 hour before dive 2. whether you need to or not (BGL reading fine or slightly high)...eat a candy bar or drink a high sugar drink. 3. before dive check BGL and make sure its around 200 min.

    I'm a T2 diabetic, have clearance letter from my Dr. and I ALWAYS make sure that I do the above. Heck, when I'm on a diving trip I will not even take insulin at all and eat whatever I wish. I like my BGL to stay between 200 - 225 when I'm diving trip.

    Also I will not dive on a trip unless my brother (dive buddy) is with me diving. End of story!

    Diving while diabetic is really no different than thoes that dive with heart conditions or any other condition.

    Remember when diving it not a problem of having a high BGL it when hypoclicemia sets in that the problem starts. I've had my BGL up around 400 for over a week before (not a smart move...esp. long term) but the only problem I had was that I got ill a little quicker, mood changed to being grumpy and vision change. When I got med. the BGL dropped back to normal and I'm here today. When my BGL has dropped very low thats when I couldn't think straight, lost ability to focus on any problem...in other words I was basically "drunk" and "incopasitated"(sp?).

    So like I stated above. On dive day or dive trip I make sure my BgL is very high as to avoid hypoglycemia.

    This just works for me.

    Jeremy
     
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  7. Tod

    Tod Nassau Grouper

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    Thanks for the comments, I appreciate them. I hope I didn't sound like I was bashing the boat crew for calling for help or doing their job. I believe they did the right thing under those circumstances and I would have done the same. My frustrations were two-fold: 1) that I had already came out of it and I felt like I was okay before the Coast Guard wanted to take me away; and 2) that I was upset with myself for allowing this to happen.

    I believe that had the USCG left (without me) the dive boat would have been free to continue the dive trip with me on board. I suspect that had that happened, the boat crew would also be at liberty to make a decision as to whether or not to allow be to continue to dive.
     
  8. Tod

    Tod Nassau Grouper

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    I did fill out a four page form before taking the class (that was full of legal waivers to release the instructor and SDI from any liability for teaching that class). One of those four pages was devoted to health questions, where I responded that I was a diabetic and even provided the dates of my last doctor's visit (as well as a phone number).

    My instructor was a retired dentist in his other life. I think this is partially why he got so concerned with the topic (after he found out about the boat trip incident). I also wonder if he ever read through my four page questionaire form after I filled it out! I suspect he may not have. Nevertheless, now that he knows I am a diabetic I worry that I will be treated differently when I attempt to take more classes and further my dive education.
     
  9. KOMPRESSOR

    KOMPRESSOR Regular of the Pub

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    Maybe you guys could tell me. My friend who is very eager to join me diving has diabetes 1 with good control, according to himself. His regular physician has doubts about him diving, and sent him of for a greater examination at a diabetes clinic.

    Problem is, I don't think anybody there has a clue about diving! How is the best way to come about this in a safe manner, and still not exclude him from diving if he can dive?

    I have told him he will always have to plan his dives according to his own premises, and with a buddy (me?) who is more than usual aware of his condition, and can take steps for him if he suddenly can't.

    -What to do buddies? Any tips how to go about it if the "insulin-physician" just prefers to have his own *ss safe?...

    (PADI OW starts monday. Diabetes examination wednesday... )
     
  10. Tod

    Tod Nassau Grouper

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    I don't see anything wrong with having him keep searching for a doctor who undersands diving and diabetes. If he is active and tries various physical things on his own, he should explain this to his doctor.

    Good plan. Speaking for myself, I take great comfort in knowing that my friend understands my condition and can assist if I am having any problems. But above that, I also need to understand that I have my limitations.

    This is really up to your friend. Personally, I don't like (okay, I hate) it when someone just tells me I cannot do something because I have Type 1 diabetes. Most professionals (doctors) I've talked with, however, are usually more than pleased to see someone like me wanting to remain active. That is one of the best things for my health. Sure my doctor sometimes cringes when I tell him what I've been up to, but since he has known me for 16 years he has grown to accept that I am who I am and that I will continue to be that way whether or not anyone else likes it!
     
  11. BLR

    BLR Angel Fish

    # of Dives: 100 - 199
    Location: VA
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    DAN has studied the issue of diabetics diving and has issued some recommendations for safe diving. There are some excellent articles by diving physicians online, too.

    Resolve any issues before going to a resort or live-aboard. Regardless of what DAN and your doctor say, the resort or live-aboard still has the last say about whether you'll be allowed to dive. It would be best to have a regular dive buddy who is prepared to help you, rather than being assigned to unknown buddies. Be sure your buddy has the skills, fitness, and gear for self-rescue, in case you're not able to help him.

    There are glucose gel tubes and cake frosting tubes that some diabetics take on dives in case they encounter a problem. Practice using something like this before you need to use it in an emergency.

    Treating low blood sugar with carbs only may only provide temporary correction. Many diabetics find that they also need to have some protein with or soon after the carbs, or their blood sugar will go low again.
     
  12. TSandM

    TSandM Missed and loved by many.

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    Tod, I can understand your annoyance with having your trip cut short. But I have to say that the only person responsible for that is you, and that the boat crew and Coast Guard responded completely appropriately. The boat crew is not qualified to decide whether your problem was simple hypoglycemia, or whether you are likely to relapse into hypoglycemia (as can happen, even with food, with overdoses of either insulin or oral meds). The Coast Guard crew may or may not, by policy, have the option of consulting with medical control to leave you on the boat, but the safest thing for them to do is evacuate you.

    If I had been the boat captain, I think I probably would have told you you could not do any more diving, even had the Coast Guard left you there. This is based on the fact that you had just given incontrovertible evidence that your diabetes was not well controlled and that you were not being diligent and thoughtful about its management while in a situation with limited medical resources.

    It is no longer felt that diabetes is an absolute contraindication to diving, but safe diving with the disease requires considerable discipline. Shoot, safe LIVING with the disease requires considerable discipline. It sounds as though this incident was a wakeup call to you that the changed circumstances of a dive trip really require that you never allow yourself to be lazy or careless with your diet or your medications.

    Glad the whole thing came out okay. If your bunkmates hadn't heard your odd breathing, you might well have ended up in seizures or worse.
     
  13. Crowley

    Crowley Master Instructor

    # of Dives: I'm a Fish!
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    Here is a guideline from DAN (Diver's Alert Network) which is a summary of the research that has been published in relation to diving with diabetes.

    I've said this a few times on this forum but speaking as a full time instructor (recreational) I would like to make a couple of points. Firstly - we are not doctors! I have a decent level of phsyiological knowledge but I'm a geek - many instructors, regardless of their training, will have only the basic diving-related knowledge. This is neither a failure on behalf of the instructor or their training - but until somebody makes med school a pre-requsite for instructor training, many instructors are going to take the view that "I don't understand it but I know it can be bad, therefore I am not accepting this student." Clearly neither good for the instructor (no money) or the diver (no diving). We therefore ask people to get medical clearance - but as has been mentioned above - how much does the doctor know about diving?

    As always, if you have a concern over your diabetes/asthma/etc. then I'd strongly recommend you get full medical clearance from a relevant authority (DAN can assist with this) prior to any situation in which you are required to provide proof of medical fitness to dive. This will stop you being refused training, and potentially it may well save your life.

    Back to the OP - with all due respect I would have followed the guidlines from DAN and would not have allowed them to dive or undertake training (sorry, buddy!) The guidelines recommend "No episodes of hypoglycemia or hyperglycemia requiring intervention from a third party for at
    least one year" (direct quote). The OP has also, by his own admission owned up to the fact that he failed to manage his own condition - that's 2 strikes and it's diving, not baseball.

    Tod - and others - I mean no disrespect by this (of course) and I hope you understand that from our point of view we have to really *KNOW* that somebody is fit to dive with us. Are we covering our asses? Yes of course we are!! Dive professionals get sued for all sorts of reasons; there are established medical guidelines for diving with diabetes and if we choose to ignore them we're placing ourselves in a very dangerous situation. Probably, 99 times out of 100, nothing will go wrong - but in that one case it does, what are the lawyers going to go for? Think of the long term effect on diving. For a long time, diabetes meant no diving. At all. Now we understand more about the condition and diving this has thankfully changed. However given the litigious society we live in, one underwater diabetic death might send that right back to the stone age and diabetes will become, once again, contraindicatory to the aquatic realm.

    That was a bit more than 2 pennies' worth I guess, but I'm feeling literary! :)

    Safe diving,

    C.
     
  14. SharkDiver36

    SharkDiver36 Scuba Instructor

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    Not to hijack or detract from this post, or the specific topic....hope I'm not.

    I recently completed the Handicap Scuba Associations Instructor crossover course. It was a very illuminating and eye opening course - I'm glad I took it.

    That said, it was lacking in the main reason I took the course, which is and was Crowley's point - Liablity. I was a little...disappointed at the lack of specific "yes you can" and "no you can't" in the course with specific medical problems/conditions, it seemed the course put all of it on the Instructor to talk with the Doctor to make a decision if someone could or couldn't dive. This is complicated by some Doctors, who might be great Doctor's, not understanding how it could be affected by pressure and we aren't medical experts.

    I've debated instructors at the shop I was at more then once over what it seems to be 'picking hairs' over how bad a condition is, and in at least a couple discussions the group flat out said no on things I probably would have said yes to.

    What is acceptable? 1 out of 1,000 diabetics dying on one dive? 1 out of a million? I'd like to think zero is a good answer....but then again we all dive and we know that the answer isn't zero....even 'healthy divers' die.

    It does boil down to liability. Crowley may say yes to something I might say no to and visa versa... I guess I have to side with Crowley on this one, I wouldn't take a diabetic and certify them, even under HSA standards.

    Tough subject and believe me, I hate saying no to people who obviously would love to dive....but sometimes I have to.
     
  15. zamburinha

    zamburinha DIR Practitioner

    # of Dives: 200 - 499
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    My regular dive buddy has well controlled type-I diabetes (insulin dependent) and has been happily diving for 6+ months and around 50 dives. He was very wary initially as it takes some experimentation to find out how a new activity will affect blood sugar levels and, as several people have mentioned, you really don't want to go into hyploglucemia while under water.

    The way he did is was to start with a very conservative approach as well as getting clearance from his doctor. The instructor and all his dive buddies were aware of the condition and he made sure he was on the high side of BGL when entering the water. He also measured his levels 30min and immediately before and after the dive. After a while, this gave him a very good idea of what the typical glucose consumption was and could adjust accordingly. We also both carry "energy gels" in case there is a need to deal with a "low on sugar" situation and have practiced him consuming the gels under water. It is very similar to any other skill that you might practice with your buddy under water. By now the whole checking blood sugar levels, etc is just another step in the pre-dive buddy check.

    One final thing. My friend always makes sure to let the relevant people (buddies, DM, etc) around him know that he is diabetic and that they might see him doing a blood test or eating something under water. This allows them to raise any question they might have and to not freak out if they see something unusual going on. I would say the whole procedure is no different than explaining to new buddies an unusual piece of equipment. Up to now, nobody has ever objected and we've had some fantastic dives :D
     
  16. BarryTX

    BarryTX Surface Interval Member

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    Location: Katy, TX, USA (Houston area)
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    I am the parent of a type-1 (Insulin-Dependent) diabetic in her teens, and our family has lived with this disease for 11 years. We have been active in outreach / support network for afflicted families for years, and another of my daughters now works at the Juvenile Diabetes Research Foundation. With this introduction, I think it is important that I address Tod directly on what happened, not from a scuba perspective but rather from an insulin dependent diabetes perspective. Although we have never met, we are part of an 'extended family' of people afflicted with this disease and their famililies, and I feel compelled to speak as bluntly to you as I would my own daughter or others in our circle of afflicted friends.

    Tod, you state that you have been insulin dependent for years. This means you know what is required to mangage the disease, and yet you chose not to properly control your blood sugar - and in a situation where good blood sugar control is absolutely necessary. You know better, there is no excuse. I appreciate that you have admitted your mistake, but that does not change the fact that it happened and it never should have.

    Insulin-dependent diabetes should not hold you back from experiencing life. We continue to teach our daughter and other afflicted youth that they can do anything they set their mind to - as long as they control the disease. Until a cure is found, the disease must be dealt with properly - this means every day, multiple times per day. You can never ignore it, especially in situations that have inherent risk or danger in them - these situations call for more monitoring, not less. That your incident happened at all shows either complacency towards the disease management or a form of denial. Either way, it is not acceptable.

    I continue to support the medical research going on to find the cure for this disease. Until that cure is found you must accept that you have a responsibility to manage the disease carefully and completely. Right now you should be scared by what happened and by what could have happened. I hope this incident was a wake up call for you, and I am thankful that it did not end up worse for you or others.

    You should not dive again until you truly accept and embrace that your blood sugar control must be in order before you start. This means increased carb loading for the physical exertion, and it means an increased frequency of testing your blood sugar levels, and it means no dive if the blood sugar is not in a safe range. In fact, you should also not drive a car or operate machinery if you are not willing to test your blood sugar before you start. It is that simple and that important. To choose differently puts yourself and others at risk. I hope you never are in a situation like this again, and I truly wish all the best for you.
     
  17. NJ to FLA

    NJ to FLA Regular of the Pub

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  18. TC

    TC Miscreant Moderator Staff Member ScubaBoard Supporter

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    Just a note folks- This thread is from 2005 and Tod hasn't logged on in the last 5 months.

    Don't be surprised if he doesn't answer immediately.
     
  19. Gen San Chris

    Gen San Chris Barracuda

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    I have had Type 2 for a long time and control it with Metformin and so far I have had no problems but if I do not feel totally OK then I do not dive
     
  20. BarryTX

    BarryTX Surface Interval Member

    # of Dives: 0 - 24
    Location: Katy, TX, USA (Houston area)
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    Short of an actual cure, the artificial pancreas is the best approach to controlling the disease in an 'auto' mode - like NJ to FLA, we anxiously await for it to become a reality for us!

    TC - I didn't catch the thread date, thanks for highlighting that. I think the discussion is still relevant, and my hope for Tod is that he is well and in good control of his diabetes today.
     

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