Diving with diabetes

[golf_bht]

I am a IDDM too. I have had no problem so far. One thing I would like to point out is keep doing what you enjoy but do it sensibly.

blood glucose can be unstable for up to a week after a 3 days trip. the glucose tend to be lower than usual so be very careful.

 

[Divalicious]

Wow. As a newish diver, it's really nice to see other diabetics out there.

I am Type I (IDDM), and I have been for 24 years. As a child I was quite active. I've gone through some natural ups and downs - sometimes I've been in really tight control, and I've had a few periods, like in college, of not-so-tight control.

Fortunately, though, I have never had a majorly bad episode, and I've never been what people would call a "brittle" diabetic - prone to really wild ups and downs in blood sugars. I.e., if I eat a bunch of cheesecake, it will go up. If I don't eat, it will drop.

I recently took up diving because it is something I've -always- wanted to do, and from the moment I put the reg in my mouth and went under, I knew I was an addict. It's about the closest to "zen" I can get.

However, this is probably the first time I've been really scared about my diabetes. For example, during my OW certification, which was in a lake, my sugar dropped from 180 before going in ... to 54 when I came out!

I had a GREAT OW instructor, and I am lucky to have my husband as a dive buddy, but it has been a real reality check. In the true OW of the open seas, for example, going low isn't the same as playing tennis on the courts or being out for a run.

I was fortunate to have a doctor who cleared me easily to dive, and I found the DAN guidelines helpful, but surprising at how high they did suggest having one's blood sugar.

Reading through this thread...

The poster who originally posted this topic may not still be here, but his original complaints of the live aboard's response... are misplaced. As a lawyer, in addition to a diabetic, anyone who did allow him to dive on their ship... after that episode would be CRAZY.

The instructor's refusal to certify him was a little sketchy, but... the point about instructors not being doctors and able to make a call about having someone in a class was valid.

IMHO, diabetes isn't a deal-breaker to diving, but it does require some added caution.

I am curious of the few posters to mentioned a pump... does it get dirty in the open water of the ocean? do you dive with it? i've long resisted switching to one, but am slowly considering it.

 

[pasley]

deleted double post.

 

[DocVikingo]

Hi Divalicious,

Given your experience, here's an article you may find informative (and useful):


1. "Accuracy and reliability of continuous glucose monitoring in individuals with type 1 diabetes during recreational diving.

Adolfsson P, Ornhagen H, Jendle J.

1 Goteborg Pediatric Growth Research Center, Department of Pediatrics, Institute for the Health of Women and Children, The Sahlgrenska Academy at Gothenburg University , Goteborg, Sweden .

Abstract:

Background: This study evaluated the accuracy and function of the Continuous Glucose Monitoring System (CGMS((R)), Minneapolis, MN) during recreational scuba diving in individuals with type 1 diabetes.

Methods: Twenty-four adults, 12 with type 1 diabetes and 12 healthy controls, were studied during five recreational scuba dives performed on three consecutive days. All the participants used the CGMS on all the days and during all the dives. Comparisons were made between plasma glucose at specific time intervals and the CGMS.

Results: The recording by the CGMS was robust, with few sensor problems. The mean sensor survival time was >48 h. Eighty-five percent of the individuals used one sensor during the entire length of the trial. The overall mean absolute difference (MAD) within the group with diabetes was 14.4 +/- 6%, and the corresponding daily figures were 23.2 +/- 19.3% on day 1, 11.6 +/- 4.5% on day 2, and 11.2 +/- 5.7% on day 3. A significant improvement regarding MAD when day 1 was compared with day 2 and 3 (P < 0.05). With a limit set at 70 mg/dL, hypoglycemia pre- and post-dive was detected with a positive predictive value of 0.39, negative predictive value of 0.98, sensitivity of 0.64, and specificity of 0.94.

Conclusions: We demonstrate that the CGMS was used with accuracy in such difficult conditions as scuba diving and provided robust information on glucose variations."


As for diving with an insulin pump, all manufacturers of which I am aware indicate that their units are not designed to be used while diving. Even those who have designed their systems to be waterproof only test and approve them to ~10-15 feet. I have heard several stories of pumps falling apart at depths in the 20-30 foot range. Moreover, even given a system that could withstand significant depths there are other issues. Divers I know who are on pumps disconnect and leave them topside while diving. See The Un-Tethered Regimen, written by a well-known diabetologist who has the condition himself, provides a protocol for controlling BG while diving, amongst other physical activities.

Regards,

DocVikingo

 

[pasley]

...
However, this is probably the first time I've been really scared about my diabetes. For example, during my OW certification, which was in a lake, my sugar dropped from 180 before going in ... to 54 when I came out!...

...In the true OW of the open seas, for example, going low isn't the same as playing tennis on the courts or being out for a run....
... I found the DAN guidelines helpful, but surprising at how high they did suggest having one's blood sugar....

Your own experience tells you why DAN's recommended blood sugar level is so high. As you have stated having a diabetic episode under water is not the same as on a tennis court. SCUBA diving is strenuous exercise, therefore you must start high to finish at a level above that which would cause a medical emergency at depth or on the surface. Such medical emergency would of course place both you and your dive buddies or others (Divemaster etc) in danger. Many diabetic SCUBA divers carry a tube of cake icing or other glueclose source that can be administered at depth in the event of an emergency when they dive. Of course as with all medical conditions it is polite to always tell your dive buddy of your condition and if you are caring a glueclose source where it is and how to use it underwater if the need arises.

SCUBA can be enjoyed by people with controled dibabites with good monitoring, recording your test results and establishing a base line so you can fairly accuratly predice what your post exercise numbers will be before you start strenous exercise and the adjustments you need to make to finish at a safe number. If a persons numbers are wildly fluxuating, then it could be argued the diabiates is not yet under control and SCUBA should not yet be undertaken as it places them and others at risk.

I am curious of the few posters to mentioned a pump... does it get dirty in the open water of the ocean? do you dive with it? I've long resisted switching to one, but am slowly considering it.

At present I do not believe there are any that are water proof to 5ATA? A drysuit would potentially be less of an issue for a pump, as the unit would normally not get wet but would still be a concern as sometimes leaks happen. If the pump were to have water intrusion at depth, what would happen? Would it simply stop working, or would it malfunction first and pump lots of insulin while it was shorting out? I do not know the answer. Perhaps in time, when there are enough SCUBA divers with diabieties, someone may make a unit designed for SCUBA, but for now it is not recommended.

...The instructor's refusal to certify him was a little sketchy, but... the point about instructors not being doctors and able to make a call about having someone in a class was valid...

The instructor upon learning the OP had had a medical emergency related to his diabetes following SCUBA diving was acting prudently and in the OP&#8217;s best interest (and his own regarding liabilities). The OP is sketchy on if he had disclosed his diabetes to the instructor before the class. All diving in is adaptive diving as we are not meant to breathe underwater. But in the case of a diabetic SCUBA diver additional steps (adaptations) must be taken to dive safely, specifically a good solid base line of blood glucose levels must be established. Glucose levels must be tested before a dive and after to avoid a medical emergency such as the OP had.

Enjoy your diving, dive safely and remember to have fun.

 

[Divalicious]

Thanks Docvikingo

Maybe I'm (getting) old, but I've been waiting until they have a really good synched CGM and pump to bite the bullet and make the switch.

Being light hearted, I boggle with what they can do with an I-phone these days, and can't believe someone hasn't hit the motherload in advancing the technology more on this front... but I shouldn't complain since I was diagnosed around the time the very first electronic monitors came on the market. So what there is today is -way- better than then!

I also wonder at the effects of basic adrenaline. I've about 15 decent dives logged so far and I've been surprised to find my sugars lower than I'd expect at times- but mostly when I'm doing something kind of "stressful"... like going for a certification dive, and in pretty poor dive conditions, ... rather than a more relaxed pleasure dive.

Pasley-

In regards to the original poster...eh... I can still see both sides of the coin.

Like I said, any instructor is free to refuse to take on a risk, but assuming the original poster's rendition of what happened was correct... the subsequent inquisition and withholding the cert by the instructor would have ticked me off, too.

I.e., that instructor had nothing to do with the incident, and while it was dumb and avoidable, the original poster's low was pretty explainable. The poster noted that he had been foolish to forget and take his regular dose without eating enough, so he went low during the night. His dive trip ended, and it should have, but the instructor sure sounded like he was on a pretty high horse withholding the cert and questioning whether the guy should be diving at all.

It's definitely not my intent to minimize the real factors associated with diabetes in general or diving and diabetes, but treating a diabetic like a freak or an irresponsible child...sucks.

* * *

One thing I have learned, though...even in the short time I've been at this is that I don't like to be rushed and I'll never be down with "cattle car" diving or dive ops.

Unfortunately, it makes it a bit more expensive to have my own DM or instructor with me, but... until I feel really secure with like 30+ dives under my belt, it's been a worthwhile expense to have someone with a bit of experience personally on hand.

 

[mjennings]

I've been type 1 1/2 (I somehow fall in between juvi and adult onset), but am insulin dependant for the past 15+ years. I've been scuba diving as a diabetic for 10+ years and wearing an insulin pump during that time (well not while in the water).

My experiences have been very good. I make certain the DM knows my condition (medical release form when getting signed up), have breakfast early and allow plenty of time for my blood sugars to stabilize (actually rise) during the boat ride to the dive site, and test frequently leading up to getting into the water and immediately getting out. Like others, I carry plenty of snacks and glucose tablets to help control and allow my blood sugar to rise throughout the boat ride to the dive site to something above 180.

I just recently started using CGM, which I must say is very impressive in giving great information about your trending (upward/downward). After all of these years learning to deal with pre-dive prep as a diabetic, I now have a new variable (CGM) to try and utilize in a dive scenario.

I'm trying to figure out how to be able to leave a sensor in while diving, and only disconnect the transmitter (and pump) while submerged. The sensor will be an invaluable tool giving out a high level of information regarding BGL trends leading up to getting into the water. When I reconnect the transmitter after getting out of the water, I'm a little unsure how quickly the transmitter will start sending data to the pump (where you can read out the results). I suppose this will be learned through the experience itself, but if anyone has any prior experience, it would be nice to have this shared.

One of the things I am trying to decide is whether to disconnect the transmitter, or just strap it down good (inside a wetsuit) so it is all still be intact when I get back to the surface and hook the pump back up. I suspect I'm just as well off to disconnect the transmitter while in the water and reconnect once back on the boat.

Another thing I'm trying to find is this liquid that looks similar to iodine in color. You spread this on the site where you want to insert an infusion set and it makes the skin very, very tacky. Saltwater seems to deteriorate the adhesiveness of the infusion set quickly and likewise the IV preps I use to hold down the transmitter. I'm trying to figure out what this iodine looking liquid is that makes the skin so very tacky.

Any thoughts would be appreciated. Great thread btw......

 

[pasley]

I've been type 1 1/2 (I somehow fall in between juvi and adult onset), but am insulin dependant for the past 15+ years. I've been scuba diving as a diabetic for 10+ years and wearing an insulin pump during that time (well not while in the water).

Glad to hear it and I assume you are mentoring other diabetics that they to can get out there and live life to the fullest, just need to monitor and adjust.

...I just recently started using CGM, which I must say is very impressive in giving great information about your trending (upward/downward). After all of these years learning to deal with pre-dive prep as a diabetic, I now have a new variable (CGM) to try and utilize in a dive scenario.

I'm trying to figure out how to be able to leave a sensor in while diving, and only disconnect the transmitter (and pump) while submerged....

Two words Dry SUIT
I cannot advise you to leave the sensor in during the dive. I can tell you I have forgotten my digital camera, car keys, wallet in the pocket of my safari shorts and taken them diving with no ill effects. Catastrophic flooding of a properly maintained Dry Suit is rare but can happen so you need to be aware of that. But usually if a suit leaks you just get a little damp at the neck or wrist, or at the pin hole site. But as I said catastrophic flooding can occur particularly if you forget to zip the inner zipper :shocked2been there done that, but only once). Repeat after me, the inner zipper is much more important than the outer zipper.

So why worry about salt water deteriorating adhesive when you can dive dry and not have salt water on the site and stay warmer too.

 

[tc]

You might also want to check on what pressure/depth the pump is rated to.........

 

[mjennings]

My questions are more along the line of logistics and procedure.

The pump is not designed to be submerged. It disconnects and will remain on the boat during my dive.

The sensor is nothing more than a wire like device that is inserted subcutaneously. The sensor does nothing more than read interstitial fluid (it doesn't read blood) much like litmus paper reacts to fluids (nothing mechanical or electrical with the sensor). I don't need to wear it during a dive, but would like to leave it in so when I surface, all I need to do is attach the transmitter and put it in range of my pump so I can have the benefit of data at the earliest opportunity once at the surface.

I have a lot of experience diving as someone who has worn a pump for 15 years. However, the CGM aspect is new. As I stated, I can always bypass the CGM, but I would like to have the benefit of the information leading up to the dive and immediately following the dive. Blood glucose testing will certainly accomodate the need for data, but sensor data is far more frequent. More data equals a more informed dive, right? I'm just trying to determine if using CGM is feasible and possible given the conditions associated with scuba.

Dry suit may be an option in the future. For now, I'm trying to work out the details of being able to dive and have the benefit of significantly more data provided through CGM.....