Diabetic Diving

[DennisW]

HBO MD,

I for one am thankful for your insight into diabetics and diving. I assume the reason that DAN suggests that your blood sugar reading to be above 150 before you dive ( a bit higher than I normally want to see it) is to make sure your blood sugar stays high enough during the dive. I developed type 2 diabetes about 2 years ago and so far have had no problems diving. Granted, I am on metformin and my blood sugar has been well controlled since the beginning of my diagnosis.

Although I am extremely careful and carry a tube of icing in my BC, (I have practiced eating it under water) I have never needed it. I also brief any new dive buddies about my diebetes and that I could signal them with a "Low Blood Sugar" sign (an ASL "L" across my chest) if I feel my blood sugar getting low. An insulin dependent diabetic would have to be very careful indeed.

 

[TSandM]

Yes, one of the big differences between Type II and Type I diabetes is that Type II patients generally tolerate mildly elevated blood sugars well (although the dehydration issues that HBO MD talks about apply to them, too). On the other hand, there are Type I diabetics who are seriously ill with blood sugars of as little as 250. People who are like that probably do not have a large enough safety window to dive.

This is why it's almost impossible to give any kind of blanket statement about diabetes and diving. The referenced articles go through some of the parameters that have to be evaluated for any given individual, to decide whether the risks involved in diving can be ameliorated sufficiently to make it a reasonable undertaking for that person. And each of us assesses risk differently.

 

[HBO MD]

You're welcome DennisW
I would also suggest a follow up HbA1C measure when you return from a dive trip so you can reflect upon the relative level of control you had while away. Sounds like you are fairly scrupulous with your attention to glucose monitoring and levels, but this may be of interest.
Safe diving.

 

[DennisW]

Been there done that. My HbA1C is and has been about 6.5 - 6.7%. It was 7.2% when I was diagnosed with type II.

 

[HBO MD]

Not bad. Sounds like you've got a pretty good handle on how you can best manage your diabetes.
Stay safe and well.

 

[kennedy]

As some of you know I am Type 1 diabetic and have been for over 40 years. I have worn an insulin pump for almost 3 years and before that I was on injections. I have been certified since 2000 and have done around 400 ish dives. I take my blood sugar before and after each and every dive. Every single dive. I carry icing in my bc and so does my husband along with any other friends that are on a trip with us. I do not go in the water unless my sugar is over 250 (I have a high tolerance to high sugars) as it does tend to drop once I am in the water about 30 mins. I do not do a dive over 60 mins because of my sugar dropping. I have learned through trial and error to treat my blood sugar before a meal (and dive) and not to treat what I am about to eat. Makes my sugars almost perfect when I come up from a dive.

I agree each situation is different and a doctor should check the person out prior to signing a medical authorization. I have been cleared each year since I have been certified. The only place I have been denied to dive at is Australia last October. I never hide my disease and never will.

There are many views on diabetics and diving. I have missed many a dive due to my sugar not being high enough to jump in with my friends. NO dive is that important to me - there will always be another dive.

Best of luck!

 

[kennedy]

Another thing to remember about diabetes and diving is that insulin sensitivity changes with depth, such that less insulin is required to achieve stabilization. This is due to the effect of pressure on insulin receptors. It also doesn't take into account the effect of muscle activity or exertion on blood glucose and the effects of exogenous insulin.
I would advise against it, as the risk of hypoglycemia at depth is very real.

Thank you for this information. I rarely go over 80-85' on a dive - this is probably a good thing. I will certainly look for more information on this!!

 

[dschonbrun]

JD,

My dad is an adult onset diabetic taking Glucophage. He was diet controlled without medication until about 2 years ago (he's 65)... HBA1c is now 6.9 under Glucophage.

I've been investigating the possibility of taking him diving and the restrictions/risks.

The best medical reference material I've found is in "Bove and Davis' Diving Medicine". The 4th Edition, Chapter 26 on Diabetes and Diving is excellent.

Note, I'm not advocating this as a replacement for consultation with a qualified physician well versed in both Hyperbaric Medicine and Diabetic Complications. It is a simply nice source of information for those who wish to perform some research.

Cheers,
David

 

[JDMerk]

A couple things:

Some talked of getting certified...he is already certified and has been since 77'

His insulin pump is only waterproof to 6' or so...so its not coming along.

His A1C at his last checkup I believe was 7.1, but I think its usually in the high 6's

As for diving with him I was looking mainly for suggestions for what I as a buddy need to do to prepare for any special situations that might arise from his predicament.
I have already created some diving limits we will adhere to...no deeper than 60' BT no longer than 30min. Hopefully this will keep him safe.
He has been doing very well with his diabetes. As I said the pump has worked wonders for him. However I know that in the past he has had serious diabetic episodes resulting from both high and low bloodsugars, but these were 10+ years ago before he was on the pump.

 

[TSandM]

However I know that in the past he has had serious diabetic episodes resulting from both high and low bloodsugars,

This is bad news. The general approach recommended to diabetics is to PLAN to allow their blood sugars to climb a bit during the dive, since for many diabetics, mildly elevated blood sugars are far preferable to low ones. The truly insulin-dependent diabetic who goes into ketoacidosis easily is going to have a great deal of trouble figuring out exactly how much to change his insulin/food intake balance to allow a small sugar rise, but not enough to get sick.

I'd say at the very least, keep your dives very short and shallow. Be aware that erratic behavior from your buddy would definitely be a warning signal of low blood sugar, and an increased respiratory rate could be a sign that he's going into acidosis. But I'd be very nervous about diving, if I were a diabetic who required a pump for safe control.