Last year DAN and Duke University, along with others, held a medical academic workshop on Diabetes and diving.
You can get the entire
PROCEEDINGS of papers presented from DAN, order from the website. However, it is academic papers that most people won't follow; and will cost you $30.00 (including shipping) for 165 +/- pages.
They boiled the
consensus guidelines down to a one-pager that you can download in PDF format from this link:
http://www.diversalertnetwork.org/news/download/SummaryGuidelines.pdf
If you, or a loved one, are diabetic and dive, or if you are an instructor or divemaster who might deal with diabetic students,
I strongly encourage you to download the one-page PDF on the above link!
Recommendations for managing glucose levels prior to, immediately post, and for the next 12 - 24 hours are included. Testing is recommended for an hour pre-dive, and glucose levels are recommended to be 150 (and less than 300) mG-DL, and stable
or rising pre-dive. Those that are familiar with these values recognize that the glucose pre-dive is recommended to be
slightly high and rising immediately before the exertion of a dive. This is to minimize the risk of hypoglycemia during the dive.
Clearly, any major complications along with uncontrolled diabetes would be a contra-indication for diving, such as ischemia, amputation, coronary disease, or stroke.
Consensus for
both insulin-dependent and non-insulin dependent diabetics was that
every individual should be individually evaluated. This is contrary to the early 1990's (and before) attitude of
blanket contraindication, and shows that the diving medicine orthodoxy is coming around.
Generally, the real concern is now about
hypoglycemia (low blood sugar), although
hyper-glycemia can be problematic. There was
no evidence that DCS was any increased risk.
There should be no recent (although
how recent is recent was debatable) occurances of severe (hospitalized, or intervention by another party) hypoglycemia; and no cases of hypoglycemic unawareness. Nor should diabetics be involved in cave diving, due to difficulty in reaching the surface in case of hypoglycemia.
Insulin-dependent diabetics should not be diving, and all diving diabetics should carry glucose and have access to same at the surface.
Some posters above have suggested things like "I'll do what I want, regardless." Keep in mind that unless you are solo-diving (
NOT a good idea for diabetics) you are also responsible for a buddy. That buddy's safety, and their abilities, will be tested and at risk if the diabetic does have a severe hypoglycemic episode.
Probably the
most controversial issue to come out of the workshop was a possible recommendation with regard to
diving professionals. Consensus seemed to lean toward
diabetes, controlled or otherwise, as an absolute contraindication for diving professionals. There was an anecdote about one instructor who was able to intervene with a distressed student because he was able to recognize the symptoms of hypoglycemia (himself being diabetic). When his employer commended him on his actions, the instructor admitted how he was so experienced with the topic. Instructor was summarily fired the next day as medically unfit.
Issue goes to
ADA, the "Americans with Disabilities Act" and similar laws in most other western countries. Is diabetes a disability? If so, can a person be terminated from employment, even diving employment, for having it?
Instructors and divemasters as diabetics were contra-indicated, but not absolutely (yet?). Commercial divers were still determined to be
absolutely contra-indicated for
medical (but who knows about
legal...) reasons.
Outcome consensus of the workshop
were recommendations only, they had no enforcement authority, but expect some (if not all) certification agencies to pay attention.
]and can be found at:
