Hello jon677:
Answers to questions are for information only, do not imply diagnosis or treatment and should always be used in conjunction with advice from your personal physician.
I'm afraid that I'm not going to be able to give you the information that you want to hear. There is a movement afoot that is giving fairly wide leeway to well controlled insulin dependent diabetics diving. However, a significant degree of retinopathy certainly would indicate that there is poor control of the disease and diving should be avoided. In addition, blood pressure problems usually indicate vascular and/or renal involvement - both possibly adverse to diving.
In the UK, the BS-AC has stated the following:
"A diver with diabetes mellitus may have a hypoglycaemic attack while in the water, which may be fatal to himself or to his diving partner. The hypoglycaemic attack may be brought on by poor control of the diabetic condition or by an increase in physiological stress due to exercise, cold, etc.
The BSAC Medical Committee has decided that diabetics may be allowed to dive provided that they are able to pass the standard BSAC medical examination and in addition, satisfy the following criteria:
1. The diabetic has not experienced any hypoglycaemic attack within the last year.
2. The diabetic has not been hospitalised for any reason connected with diabetes in the last year.
3. The physician in charge of the diabetic at the diabetic clinic must consider the level of control to be satisfactory. This implies that the long-term control of the diabetic condition must be good. A guide to this may be obtained from the HbA or fructosamine level. The physician must also be able to state that he/she considers the potential diabetic diver to be mentally and physically fit to undertake the sport of diving.
4. There must be no microalbuminuria present.
Any degree of retinopathy beyond background retinopathy is not allowed. There must be no evidence of neuropathy (sensory, motor or automatic), nor of vascular or microvascular disease beyond the background retinopathy in the eye."
You have posed a problem that is at once complex and difficult to answer, particularly from your doctor's point of view. The main question is - 'Should an individual with diabetes scuba dive?'. Most certification agencies, as well as virtually all textbooks and agencies concerned with diving (such as NOAA and the American Academy of Underwater Sciences) list diabetes (with either oral hypoglycemic agents or insulin therapy) as absolutely disqualifying from scuba diving. An instructor with an agency that excludes diabetics from acceptance for training, risks losing his/her liability insurance coverage if he/she accepts a diabetic as a student as he/she would be in violation of agency standards. Your doctor may be in the same boat re liability - hopefully he/she is mainly considering your well- being.
However, over the last several years, data collected by the Divers Alert Network and others have demonstrated that diabetics can scuba dive safely under carefully controlled conditions. The YMCA Scuba program has developed a particularly comprehensive protocol for the management of diabetics who dive (
http://www.traders.co.uk/insulintrust/database/id75.htm).
The principal risk to diabetics who dive is hypoglycemia, which can lead to loss of consciousness and drowning. In addition, the diabetic diver potentially places his/her buddy and other members of the dive party at risk if a rescue is required. Although the specific recommendations for diabetic dive planning are beyond the scope of your question, the key elements are to: insure adequate carbohydrate intake prior to diving (sometimes difficult to accomplish if seasickness is an issue); measure blood sugars several times in the hour before diving (to make sure that blood sugars are not dropping); maintain adequate hydration; and carry a source of glucose underwater. A diabetic who cannot recognize the early symptoms of hypoglycemia and/or who has frequent hypoglycemic episodes unequivocally should not dive.
For more information you may want to visit our web page at
http://www.scuba-doc.com/endmet.html#Diabetes_and_Diving
Best regards for safe diving!
scubadoc
Diving Medicine Online
http://www.scuba-doc.com/
