Diving with diabetes

[BLR]

DAN has studied the issue of diabetics diving and has issued some recommendations for safe diving. There are some excellent articles by diving physicians online, too.

Resolve any issues before going to a resort or live-aboard. Regardless of what DAN and your doctor say, the resort or live-aboard still has the last say about whether you'll be allowed to dive. It would be best to have a regular dive buddy who is prepared to help you, rather than being assigned to unknown buddies. Be sure your buddy has the skills, fitness, and gear for self-rescue, in case you're not able to help him.

There are glucose gel tubes and cake frosting tubes that some diabetics take on dives in case they encounter a problem. Practice using something like this before you need to use it in an emergency.

Treating low blood sugar with carbs only may only provide temporary correction. Many diabetics find that they also need to have some protein with or soon after the carbs, or their blood sugar will go low again.

 

[TSandM]

Tod, I can understand your annoyance with having your trip cut short. But I have to say that the only person responsible for that is you, and that the boat crew and Coast Guard responded completely appropriately. The boat crew is not qualified to decide whether your problem was simple hypoglycemia, or whether you are likely to relapse into hypoglycemia (as can happen, even with food, with overdoses of either insulin or oral meds). The Coast Guard crew may or may not, by policy, have the option of consulting with medical control to leave you on the boat, but the safest thing for them to do is evacuate you.

If I had been the boat captain, I think I probably would have told you you could not do any more diving, even had the Coast Guard left you there. This is based on the fact that you had just given incontrovertible evidence that your diabetes was not well controlled and that you were not being diligent and thoughtful about its management while in a situation with limited medical resources.

It is no longer felt that diabetes is an absolute contraindication to diving, but safe diving with the disease requires considerable discipline. Shoot, safe LIVING with the disease requires considerable discipline. It sounds as though this incident was a wakeup call to you that the changed circumstances of a dive trip really require that you never allow yourself to be lazy or careless with your diet or your medications.

Glad the whole thing came out okay. If your bunkmates hadn't heard your odd breathing, you might well have ended up in seizures or worse.

 

[Crowley]

Here is a guideline from DAN (Diver's Alert Network) which is a summary of the research that has been published in relation to diving with diabetes.

I've said this a few times on this forum but speaking as a full time instructor (recreational) I would like to make a couple of points. Firstly - we are not doctors! I have a decent level of phsyiological knowledge but I'm a geek - many instructors, regardless of their training, will have only the basic diving-related knowledge. This is neither a failure on behalf of the instructor or their training - but until somebody makes med school a pre-requsite for instructor training, many instructors are going to take the view that "I don't understand it but I know it can be bad, therefore I am not accepting this student." Clearly neither good for the instructor (no money) or the diver (no diving). We therefore ask people to get medical clearance - but as has been mentioned above - how much does the doctor know about diving?

As always, if you have a concern over your diabetes/asthma/etc. then I'd strongly recommend you get full medical clearance from a relevant authority (DAN can assist with this) prior to any situation in which you are required to provide proof of medical fitness to dive. This will stop you being refused training, and potentially it may well save your life.

Back to the OP - with all due respect I would have followed the guidlines from DAN and would not have allowed them to dive or undertake training (sorry, buddy!) The guidelines recommend "No episodes of hypoglycemia or hyperglycemia requiring intervention from a third party for at
least one year" (direct quote). The OP has also, by his own admission owned up to the fact that he failed to manage his own condition - that's 2 strikes and it's diving, not baseball.

Tod - and others - I mean no disrespect by this (of course) and I hope you understand that from our point of view we have to really *KNOW* that somebody is fit to dive with us. Are we covering our asses? Yes of course we are!! Dive professionals get sued for all sorts of reasons; there are established medical guidelines for diving with diabetes and if we choose to ignore them we're placing ourselves in a very dangerous situation. Probably, 99 times out of 100, nothing will go wrong - but in that one case it does, what are the lawyers going to go for? Think of the long term effect on diving. For a long time, diabetes meant no diving. At all. Now we understand more about the condition and diving this has thankfully changed. However given the litigious society we live in, one underwater diabetic death might send that right back to the stone age and diabetes will become, once again, contraindicatory to the aquatic realm.

That was a bit more than 2 pennies' worth I guess, but I'm feeling literary!

Safe diving,

C.

 

[SharkDiver36]

Not to hijack or detract from this post, or the specific topic....hope I'm not.

I recently completed the Handicap Scuba Associations Instructor crossover course. It was a very illuminating and eye opening course - I'm glad I took it.

That said, it was lacking in the main reason I took the course, which is and was Crowley's point - Liablity. I was a little...disappointed at the lack of specific "yes you can" and "no you can't" in the course with specific medical problems/conditions, it seemed the course put all of it on the Instructor to talk with the Doctor to make a decision if someone could or couldn't dive. This is complicated by some Doctors, who might be great Doctor's, not understanding how it could be affected by pressure and we aren't medical experts.

I've debated instructors at the shop I was at more then once over what it seems to be 'picking hairs' over how bad a condition is, and in at least a couple discussions the group flat out said no on things I probably would have said yes to.

What is acceptable? 1 out of 1,000 diabetics dying on one dive? 1 out of a million? I'd like to think zero is a good answer....but then again we all dive and we know that the answer isn't zero....even 'healthy divers' die.

It does boil down to liability. Crowley may say yes to something I might say no to and visa versa... I guess I have to side with Crowley on this one, I wouldn't take a diabetic and certify them, even under HSA standards.

Tough subject and believe me, I hate saying no to people who obviously would love to dive....but sometimes I have to.

 

[zamburinha]

Maybe you guys could tell me. My friend who is very eager to join me diving has diabetes 1 with good control, according to himself. His regular physician has doubts about him diving, and sent him of for a greater examination at a diabetes clinic.

Problem is, I don't think anybody there has a clue about diving! How is the best way to come about this in a safe manner, and still not exclude him from diving if he can dive?

I have told him he will always have to plan his dives according to his own premises, and with a buddy (me?) who is more than usual aware of his condition, and can take steps for him if he suddenly can't.

-What to do buddies? Any tips how to go about it if the "insulin-physician" just prefers to have his own *ss safe?...

(PADI OW starts monday. Diabetes examination wednesday... )

My regular dive buddy has well controlled type-I diabetes (insulin dependent) and has been happily diving for 6+ months and around 50 dives. He was very wary initially as it takes some experimentation to find out how a new activity will affect blood sugar levels and, as several people have mentioned, you really don't want to go into hyploglucemia while under water.

The way he did is was to start with a very conservative approach as well as getting clearance from his doctor. The instructor and all his dive buddies were aware of the condition and he made sure he was on the high side of BGL when entering the water. He also measured his levels 30min and immediately before and after the dive. After a while, this gave him a very good idea of what the typical glucose consumption was and could adjust accordingly. We also both carry "energy gels" in case there is a need to deal with a "low on sugar" situation and have practiced him consuming the gels under water. It is very similar to any other skill that you might practice with your buddy under water. By now the whole checking blood sugar levels, etc is just another step in the pre-dive buddy check.

One final thing. My friend always makes sure to let the relevant people (buddies, DM, etc) around him know that he is diabetic and that they might see him doing a blood test or eating something under water. This allows them to raise any question they might have and to not freak out if they see something unusual going on. I would say the whole procedure is no different than explaining to new buddies an unusual piece of equipment. Up to now, nobody has ever objected and we've had some fantastic dives

 

[BarryTX]

I am the parent of a type-1 (Insulin-Dependent) diabetic in her teens, and our family has lived with this disease for 11 years. We have been active in outreach / support network for afflicted families for years, and another of my daughters now works at the Juvenile Diabetes Research Foundation. With this introduction, I think it is important that I address Tod directly on what happened, not from a scuba perspective but rather from an insulin dependent diabetes perspective. Although we have never met, we are part of an 'extended family' of people afflicted with this disease and their famililies, and I feel compelled to speak as bluntly to you as I would my own daughter or others in our circle of afflicted friends.

Tod, you state that you have been insulin dependent for years. This means you know what is required to mangage the disease, and yet you chose not to properly control your blood sugar - and in a situation where good blood sugar control is absolutely necessary. You know better, there is no excuse. I appreciate that you have admitted your mistake, but that does not change the fact that it happened and it never should have.

Insulin-dependent diabetes should not hold you back from experiencing life. We continue to teach our daughter and other afflicted youth that they can do anything they set their mind to - as long as they control the disease. Until a cure is found, the disease must be dealt with properly - this means every day, multiple times per day. You can never ignore it, especially in situations that have inherent risk or danger in them - these situations call for more monitoring, not less. That your incident happened at all shows either complacency towards the disease management or a form of denial. Either way, it is not acceptable.

I continue to support the medical research going on to find the cure for this disease. Until that cure is found you must accept that you have a responsibility to manage the disease carefully and completely. Right now you should be scared by what happened and by what could have happened. I hope this incident was a wake up call for you, and I am thankful that it did not end up worse for you or others.

You should not dive again until you truly accept and embrace that your blood sugar control must be in order before you start. This means increased carb loading for the physical exertion, and it means an increased frequency of testing your blood sugar levels, and it means no dive if the blood sugar is not in a safe range. In fact, you should also not drive a car or operate machinery if you are not willing to test your blood sugar before you start. It is that simple and that important. To choose differently puts yourself and others at risk. I hope you never are in a situation like this again, and I truly wish all the best for you.

 

[NJ to FLA]

Artificial Pancreas Project : Juvenile Diabetes Research Foundation International
it is still being tested but looks great in the tests so far Can't wait!

 

[tc]

Just a note folks- This thread is from 2005 and Tod hasn't logged on in the last 5 months.

Don't be surprised if he doesn't answer immediately.

 

[Gen San Chris]

I have had Type 2 for a long time and control it with Metformin and so far I have had no problems but if I do not feel totally OK then I do not dive

 

[BarryTX]

Short of an actual cure, the artificial pancreas is the best approach to controlling the disease in an 'auto' mode - like NJ to FLA, we anxiously await for it to become a reality for us!

TC - I didn't catch the thread date, thanks for highlighting that. I think the discussion is still relevant, and my hope for Tod is that he is well and in good control of his diabetes today.