Diving with diabetes

[buckedoff96]

Ok this thread is super old but... I'm a type 1 on an insulin pump. During my dive trips I test my sugars about 15-20 times a day. Low sugar happens but is avoidable in most cases. I find the trick is to keep the sugars up without going to high. I also carry in my BC packets of liquid glucose that I can drink down just in case I'm not sure. I'd rather "spike" my sugars and correct with insulin later then to have hypoglycimia 100 feet down.
so far to date I haven't needed the glucose while I was in the water but it's nice to have it there. Keep playing with the levels of insulin for high activity and how much carbs you take in and what kind of carbs too.
just my $0.02

 

[reticentDiver]

just to add to the general advice here, even if the OP is gone...

I am a diabetic type-1 (insulin-dependent). I've been following the advice from DAN and it seems to work fine. Teh guidelines can be found in teh following link:

DAN Divers Alert Network : DAN and UHMS Publish Guidelines for Recreational Diving with Diabetes

In short, take two or three glucose measurements in the hour before the dive to know if you are on a upward or downward trend. Take ALWAYS a measurement immediately before the dive and make sure your glucose is high (the recommended levels by DAN work for me, >150 mg/dL or > 8.3 mmol/L). If glucose levels are not above the recommended minimum abort that dive, eat some carbs, and wait for the next one. Take always a test right after a dive to see how much energy you consumed. This will help you adjust your carb preload for different dives. DAN also recommends aborting a dive if glucose levels are too high (see the guideleines for details).

Keep in mind that even with carb pre-loading things like low water temperature will significantly increase your body's consumption of energy, so make sure you have adequate thermal protection. I've been surprised on a couple of occasions diving on 72F waters with a 3mm wetsuit when doing my after dive test because the levels were much lower than I expected (still ok though).

You must always remember that you don't dive alone, and you do not want to spoil some nice diving for you AND your friends by doing something stupid. After you are comfortable diving it is easy to think "ok, I feel fine, I don't need to do this test" AND this is where trouble starts. Consistency is the key. Never skip a test. Nobody will begrudge you doing it, it only takes 10 seconds and your safety and that of your group depends on it. If one remembers this very simple preventive steps there is great (and safe) fun to be had underwater!

I would add that, if like me, one carries glucose gels in his pockets, it is a good idea to practice swallowing one under controlled conditions (you are ok, your buddy is watching) every now and then. That way if you have to do it in an emergency, when you may be confused and your coordination may be worse than usual, you already have the procedure internalized (much like practicing donating air, etc...).

Be consistent, dive safe...
Carlos

 

[Scubamedicjoe]

my suggestion is go to the dan web site says its ok to dive with diabetic as long as its controlled Read it take it with you to your doctor appointment .

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... )

 

[Scubamedicjoe]

Blood Glucose Response in Insulin-Requiring Diabetics
BLOOD GLUCOSE RESPONSE TO RECREATIONAL DIVING IN INSULIN-DEPENDENT DIABETICS
D.M. Uguccioni, N.W. Pollock*, J.A. Dovenbarger, G.DeL. Dear, R.E. Moon. Divers Alert Network and Duke University Medical Center, Durham and *East Carolina University, Greenville, NC. (Sponsor: J.A. Houmard, FACSM)
Insulin-dependent diabetes mellitus (IDDM) has traditionally excluded people from participation in scuba diving. However, a growing record of safe diving in defiance of this ban is prompting reassessment. The purpose of this study was to measure blood glucose in divers with IDDM during the course of a multi-day diving vacation. Sixteen certified divers (nine male: 43±8 y [mean±SD], 85.1±14.1 kg, 1.77±0.12 m, 27.4±5.3 kg/m-2; and seven female: 44±5 y, 66.6±14.2 kg, 1.62±0.07 m, 25.3±5.3 kg/m-2) with a history of well-controlled IDDM (confirmed by HbA1c test no higher than 9% and physician documentation) participated in one of two, week-long subtropical diving trips.
Participants could dive up to four times per day, with blood glucose measured using a calibrated glucometer at 60, 30 and 5-10 min pre-dive, and immediately post-dive. Divers were restricted from diving if blood glucose level was below 80 mg/dL-1 immediately preceding a dive. A total of 131 dives were monitored. Divers conducted 8.2±3.3 dives per trip, 2.0±0.5 dives per day, with mean underwater time and depth of 38±7 min and 60±16 feet seawater, respectively.
Blood Glucose -60 min -30 min -10 to -5 min Post-Dive
Male (mg/dL-1) 188±71 203±75 210±68 159±59
Female (mg/dL-1) 196±56 237±58 248±49 193±60
Post-dive blood glucose was <100 mg/dL-1 following 13 dives, <80 following four and <65 following one (47 mg/dL-1). Divers refrained from making a dive in five instances because of inability to eat due to seasickness. There were no complications related to low blood glucose levels arising from any dives. These findings are consistent with recent observations that individuals with well-controlled IDDM may safely participate in recreational scuba diving under moderate conditions.
Supported by DAN Medical Research Program, Bayer Corp. and CAN-AM Care
Diving Medicine Articles
Summary Form - Guidelines for Recreational Diving with Diabetes
Table 1: Guidelines for Recreational Diving with Diabetes - Summary Form1
Selection and Surveillance
• Age &#8805;18 years (&#8805;16 years if in special training program)
• Delay diving after start/change in medication
• Three (3) months with oral hypoglycemic agents (OHA)
• One (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 &#8804;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) &#8805;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
Delay dive if BG is:
• <150 mg•dL-1 (8.3 mmol•L-1)
• >300 mg•dL-1 (16.7 mmol•L-1)
Rescue medications
• carry readily accessible oral glucose during all dives
• have parenteral glucagon available at the surface
• if hypoglycemia noticed underwater, the diver should surface (with buddy), establish positive buoyancy, ingest glucose and leave the water
• check blood sugar frequently for 12-15 hours after diving
• ensure adequate hydration on days of diving
• log all dives (include BG test results and all information pertinent to diabetes management)
1 For full text see: Pollock NW, Uguccioni DM, Dear GdeL, eds. Diabetes and recreational diving: guidelines for the future. Proceedings of the UHMS/DAN 2005 June 19 Workshop. Durham, NC: Divers Alert Network; 2005.
Additional Resources:
Table 1: Guidelines for Recreational Diving with Diabetes - Summary Form1
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 possi bly 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 mgádL-1 (8.3 mmoláL-1), stable or rising, before entering the water - complete a minimum of three pre-dive BG tests to evaluate trends
&#61550; 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
• Delay dive if BG
- <150 mgádL-1 (8.3 mmoláL-1)
- >300 mgádL-1 (16.7 mmoláL-1)
¥ Rescue medications
- carry readily accessible oral glucose during all dives
- have parenteral glucagon available at the surface
• If hypoglycemia noticed underwater, the diver should surface (with buddy), establish positive buoyancy, ingest glucose and leave the water
• Check blood sugar frequently for 12-15 hours after diving
¥ Ensure adequate hydration on days of diving
¥ Log all dives (include BG test results and all information pertinent to diabetes management)

For full text see: Pollock NW, Uguccioni DM, Dear GdeL, eds. Diabetes and recreational diving: guidelines for the future. Proceedings of the UHMS/DAN 2005 June 19 Workshop. Durham, NC: Divers Alert Network; 2005.

 

[TheScubaBOB]

Type 2 for 10 years, diving for 1, here's the "in layman's terms" methods I've been taught:

Normal Meds & testing leading up to the day of the dive.

On Diving Days, test early & often, take meds as usual keep snacks & glucose tabs close at hand.

An hour before diving, test repeat every 15 minutes right up to one last test before donning gear.

Numbers should fall anywhere between 150 & 300 (preferred range is 200 - 250).

Upon exiting the water, rinse test area with bottled water dry & test immediately.

During SI follow pre-dive testing schedule.

This has kept me safe for all of my 54 dives, including the week I spent in Subic Bay diving 2 - 4 times daily.

 

[buckedoff96]

Diving with diabetes isn't always easy but it works. Most important is be sure you partner(s) know whats up with you and never ever ever be afraid to call off a dive if you're not up to it. Or maybe I should say your blood sugar isn't up to it LOL

 

[Sheridan1069]

I have been going through this section of the boards because I am trying to find answers to me being able to dive or not.

I read the section in the DAN book I found when I visited a local dive shop and it left a very bad taste in my mouth and feeling down about my being a diabetic and not possibly being able to learn how to dive.

I want to lose weight first. I was 270 lbs. back in 2004 when I had fallen, injured my right knee (more on this injury later), my Mom noticed that I was very lethargic, drinking water without my thirst being quenched, and sweating. I was tested, told my primary doctor about when my surgery was to take place on my knee (09/17/04; dr.appt. was on 09/10/04), he told me "no, its not. I want you to wait a month to see if your sugar count goes down. Discussed this with my endocrinologist and knee surgeon. It was a 50/50 shot. I could wait and see if my sugar levels go down and possible waste a month if it didn't or just go ahead with the surgery. I went ahead with the surgery as it was set.

I lost 30 lbs. during my physical therapy and I have been steady holding at 240 lbs. for the last 5 years.

I found out about Mrs. Roddenberry's passing, got back in touch with the world thanks to the gift of a laptop, and found out about the RDT and a special showing of ST: Eleven in Catalina Island (had a great trip). I also found out about the Long Beach SCUBA Show. If I were wealthy, I would have gone nuts shopping!

This is when my interest peaked about diving and I remembered how I got to experience diving when I went through a lifeguarding class at Fresno City College.

I had in my past been a certified Emergency Medicial Technician (Thanks to being influnced by Mrs.(Christine Chapel)Roddenberry).

I have wanted to get re-certified as an EMT and found through web surfing a wonderful school in the Southern California area called National Polytechnic College of Science and the Hyperberic training that can complement my EMT training and an Advance Medic Diver course as well.

Even they have something against Diabetics! Take a look at their Medical Acceptance Form. I tried to post the link, but, the system would not allow it.

I want to do more with my life and thanks to the inspiration of the late Mrs. Roddenberry and her son, Rod, I thought I had found a road that I can improve my life.

I don't want to get de-railed because of what other people who feel that they have the right to put me in a box, with limitations because they see it as a limitation were as I do not nor consider it a problem, at least with regards to my knee.

As far as the way my right knee was injured, I was walking down a planked ramp, a board went down about a half an inch, the toe of my shoe caught the lip of the next board down and I fell on the outside of my right knee. I was a volunteer with the State Park and it was a workman's comp situation. Everyone seemed to have a problem with my knee except me. I wanted to get back with that group soooo badly. I loved the dances and I missed it terribly. For some reason, I found out that people in the group resented me and things were being asked (money) that they had no business asking another. They should have come to me if they wanted to know what was going on. Nobody else knew what really was going on, except me.

As far as certification problems go, I too know how it hurts when a doctor is being a jerko. I wanted to become a truck (18 wheeler) driver. I was told by the recieptionist that if I were sent home, came to the doctor's office, the doctor would not see me. I could sit there from the time that the office opened to the time it closed and he would not see me. I was feeling hopeless, but, a local doctor in Phoenix saved the day and told me that I was a mild type II diabetic.
That's a little bit about and with me. Sorry if I bored anyone.

 

[pasley]

I don't want to get de-railed because of what other people who feel that they have the right to put me in a box, with limitations because they see it as a limitation were as I do not nor consider it a problem, at least with regards to my knee.

Each person is one of a kind and others should not put limitations on them as a general rule based only on blanket assumptions. I have dove with diabetics before, and helped friends of mine train diabetics to dive. So I say go for it if the doctor clears you, but be sure to tell your dive buddies of your diabetes before they dive.

Your actions and physical condition does affect others in some situations. Diving is one of those situations. If you were to have a medical issue during a dive, your dive buddy and possibly others would be the ones doing the rescue and/or other wise endangered. So your Dive Buddy has some rights to information about you regarding your health before the dive so that they can determine 1: If they are equipped (knowledge of what to do and/or equipment) that might be required if a situation arose and 2: If they are comfortable with the requirements that could be placed on them if something were to happen. All divers assume some risk, but they do have a right to know what they are.

Some jobs have concerns that are legitimate too. EMT is one area where your knee or diabetes could be an issue. Can you do the heavy lifting safely wiht your knee? Do you require special equipment (knee brace or refrigeration for insulin) to do so safely. Would the long hours and back to back calls as an EMT put you and others at risk (if your blood sugar when through the floor on a call, you have a medical emergency and are unavailable to assist in the medical emergency you were responding to)? So they are correct to ask questions, require further testing to access the exact situation and then based on that information unique to you, make a determination if the situation poses an unacceptable risk to you or others.

 

[Sheridan1069]

Some jobs have concerns that are legitimate too. EMT is one area where your knee or diabetes could be an issue.

Can you do the heavy lifting safely wiht (with) your knee? Do you require special equipment (knee brace or refrigeration for insulin) to do so safely.
I also mentioned that I went through phyiscal therapy on my knee. I did have a knee brace at one point, but, I have not worn one since 2005 (mid year). As for lifting, I use my quad muscles and not my back. As for insulin, I do not take insulin. I control my diabetis through diet and medication.

Would the long hours and back to back calls as an EMT put you and others at risk (if your blood sugar when through the floor on a call, you have a medical emergency and are unavailable to assist in the medical emergency you were responding to)?
I currently drive as a commerical driver (18 wheeler) and I could run (drive) any where from a couple to few hours up to 11 hours within a 14 hour period. I have been an EMT before and done ride alongs on ambulances and even did a full shift in an ER. During these stressful times on my body I have never had a problem with my blood sugar going "through the floor on a call" as you put it.

 

[SkydiverChick]

My 12 year old is a type 1 diabetic (insulin dependent) and he was just certified to dive last week. The scuba shop was more than happy to work with him as long as I had a medical release from his endo dr.