Diving with Type II Diabetes

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I'm a new diver and I'll be taking the PADI open-water certification course in a few weeks. I also have type 2 (adult on-set, or non-insulin dependent) diabetes which I know is something of a risk factor for diving.

I've been trying to research the issues around diving and diabetes but I'm finding that most of the information out there is for type 1 (insulin dependent) diabetes, which is quite different from what I have. Does anyone know of any resources and/or guidelines that are geared specifically for divers with type 2 diabetes?
 
The issues with both types of diabetes are similar. The only real difference is that Type I diabetics can get into serious trouble if their glucose gets at all high, whereas Type IIs are tolerant of higher glucoses. The danger of low blood sugar is the same for both.

If you are a Type II and have an exercise program at all, you'll have a sense for how you need to match your oral intake with your meds to allow you to exert yourself. This should be a pretty good baseline for diving. But when in doubt, with Type II, you are better off allowing your blood sugar to rise a bit than you are with it low.
 
I work in hyperbaric and deal with a lot of diabetics. Most patients drop 50 points in a 2 hour treatment to 2.5 ata. Make sure you cover with rising your blood glucose. Also make sure u let the boat stuff or dive buddy know that your diabetic and what to do. I'm not a doctor but carry a tube of oral glucose.


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Find a doctor who understands your desire to dive and your diabetes. As narcouted said you need to be on a high BG when you start a dive. Dan recommends 150 mg/dl which I would consider high for me, but "Lord, lord I get to eat biscuits at breakfast". Carry glucose tubes in your BCD let your buddies know that you are diabetic, check bloodsugar before and after you dive most type 2 diabetics can dive very safely, but get your doctor on board and fill out the medical releases correctly. If your BG testing shows your are controlling your doctor should be okay with filling in the part for doctor with no problem.

I am a diabetic diver and will tell you that I dive conservatively because of it, but I DIVE. In fact, I am at a diving place in Balmorhea, TX right now!!! Just be safe and if you don't feel well call the dive.. Now, I got to get some sleep for my two shallow long dives tomorrow. Good Luck.. Dive often and enjoy..
 
I have been a type II diabetic for the last 12 years and a diver for over 2 1/2 years. Diving starts as a moderately strenuous activity which becomes easier as you get more experienced. There have only been a couple times when I felt low on blood sugar after finishing a dive. They were easily remedied by drinking a soda or having some other snack. Soft drinks such as Coke are more easily available than glucose paste or tablets and just as effective.

Since I exercise regularly to help control my blood sugar, I'm accustomed to how much energy I need to take in to support different activities. I can also tell when my blood sugar is low by the way I feel. I'll have a good meal before going out for a couple dives, and snack a little between dives. Charter boats always have meals an snacks available because everyone gets hungry after diving. When I go out for shore dives, I carry water, snacks, and electrolyte drink in my truck. Then enjoy a burger and a beer afterward.


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Dan recommends 150 mg/dl which I would consider high for me, but "Lord, lord I get to eat biscuits at breakfast".

Actually, that 150 mg/dL recommendation is one of the things that concerns me. My glucose levels are very well controlled right now (fasting blood sugars of about 100 mg/dL) so 150 seems scary high to me. I'm wondering if that's a hard and fast rule or if I should modify that to suit my personal situation. For example, 130 or 140 would still be "high" for me, but I'm not sure if that would be high enough.

---------- Post added July 25th, 2014 at 11:30 PM ----------

Since I exercise regularly to help control my blood sugar, I'm accustomed to how much energy I need to take in to support different activities. I can also tell when my blood sugar is low by the way I feel. I'll have a good meal before going out for a couple dives, and snack a little between dives. Charter boats always have meals an snacks available because everyone gets hungry after diving. When I go out for shore dives, I carry water, snacks, and electrolyte drink in my truck. Then enjoy a burger and a beer afterward.

I also exercise regularly as a way of controlling my glucose levels. For example, I walk 7 miles a day and I work out at the gym 5 times a week. I know what it feels like when my sugar is low after exercising.

Would you say that diving burns glucose faster than say walking or running, or about the same? For example, I did the Discover Scuba program with a dive center in the Carribbean. That was a dive to 40 feet for 30-40 minutes and I had no issues. I'd say it felt about the same as walking at a good pace for hour or so. Now I'll be doing the OW course closer to home in Puget Sound where the water is a lot colder so I'm guessing I'll probably burn carbs faster, correct?
 
It depends on experience. Normally I find diving less tiring than walking, unless there is current etc. But I've been at it for 45 years. Cold indeed causes more calories burned. I'm not a diabetic but a pediatrician treating them. Always take some drinkable glucose whit you on the dive. Drinking is far easier than chewing down below. Abort when hypoglycaemic after taking the glucose!
 
Our cold water will definitely increase the metabolic demand of diving. This is primarily because of the increased exertion with getting in and out of thick exposure protection and handling much heavier equipment, but also swimming with significantly increased drag. In addition, if you begin to shiver, your metabolic demand will be massive.

With your diabetes as well controlled as you describe it, I would imagine you have a very good understanding of nutrition, and how to match your carbohydrate intake to your activity and your meds. I would highly recommend relaxing your discipline for dive days (I like the phrase, "I get biscuits for breakfast!") and seeing how it goes. 150 is not a scary number at all; many Type IIs walk around for years never getting their blood sugar that LOW. If you find that you aren't seeing much of a drop with diving, you can always be more strict with yourself. But as I said earlier, the big danger for YOU in diving is low blood sugar. Your A1C won't even notice a day where you hit 150 or even 200, so long as it isn't habitual.
 
I also have my fasting BG under control < 100 generally and keep my after meals generally < 130. So when I am going to be diving I hit a few carbs that I do not eat at other times (like bread and crackers) sometimes even apple juice at breakfast yum yum. As TSandM told you that 150 after a meal and before a dive will not hurt you in the long run and you are much safer from a hypo condition. Dex4 (tropical blast) is the glucose that I take with me underwater15 grams of fast acting carbs per tube. Smarties Candies work really well on land not so much underwater. If you feel light headed you can suck that gel down between breathes no problem "Then Thumb the Dive". I would even recommend at the end of a dive you test that to prove to yourself you can do it and it works.

The recommendation for > 150 is a just that "a recommendation": You may find that you can dive without going that high. I have only had a couple of hypos and never while diving, and I take Lantus a basal insulin twice a day. Long story but suffice it to say I can not take metformin due to kidney issues.

You really need to plan on doing lots more testing on dive days to make you confident that you have a good hand on what to do. If you are going to do cold water diving, as you were told, it will put a strain on your metabolism. That is why I stay in warmer waters (well my wife-buddy) does not like cold water dives too. She is shaking after about an hour on a shallow, warm easy dive even with air to spare "She calls all our dives".

I find diving much easier on me that rugged hiking which was our previous interest. Well that was the last interest before that we were into Power Lifting that was before my diabetes kicked in. You are on the right track with that exercising stay after it. :)
 
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