Diving with diabetes

[buckedoff96]

Hi all
Ok I understand the challenges of diving while on insulin pump therapy. It's a challenge. I've often considered a case for an MP3 player. I've seen them made for diving. I'm not so sure of it since I'm a bit cautious about destroying my pump.
As far as the needle, I've never had an issue with it coming out while I' dive. I normally have a 7mm wet suit on. A dry suit would help but anytime I'm active I suspend the pump anyway. No need to wear a pump while I dive. I do carry an insulin pen with me just for back up. I also found liquid glucose packets that stay in my BCD pocket for back up underwater.
I test alot on dive days (usually about 20-30 times per dive day). I can't speak for the monitor but would water proof tape work? It could be that you may just have to take off the monitor and use a normal glucometer while diving.
I've been working with some disabled Soldiers, after seeing guys with one arm dive I don't even consider diabetes a disability anymore.

 

[mjennings]

I can't speak for the monitor but would water proof tape work? It could be that you may just have to take off the monitor and use a normal glucometer while diving.

You probably mean the transmitter (not sure what you mean by monitor). I've had problems with the adhesive on the infusion sets deteriorating from saltwater (I wear a 3mm wet suit and dive in warm waters only). When that happens, the infusion set peels off and is useless at that point. So I have to put in another.

With the CGM, you insert a sensor subcutaneously (just like an infusion set). That also stays in with an adhesive. Attached to that is a transmitter. The transmitter part does detach, and I can see that part staying on the boat (it would serve no purpose under water). Its the sensor that I am trying to figure out how best to keep in. Once removed, it cannot be re-used and they are very expensive. I either find a way to keep it in place (so I can re-attach the transmitter) or abandon using sensors altogether. I personally think the sensor will be fine and less subject to inadvertently coming out like an infusion set. Nevertheless, I would like to find a better solution for addressing the issue with the adhesive for both the infusion set and the sensor.

For the adhesives, I'm looking into some stuff that was given to me once by a nurse. It applies to the skin out of a small breakable tube and makes the skin very tacky. I have to believe that using this tacky substance in combination with any kind of medical adhesive (like an infusion set) would make it stand up to moisture of any kind; including salt water. I'm just trying to identify what this tacky liquid is.

I also found liquid glucose packets that stay in my BCD pocket for back up underwater.

I've read a number of times about these glucose gels. These are something that can be taken while underwater? I would really like to find something that can deliver fast acting glucose while at depths. I suspect it wouldn't hurt to practice taking something like this? More info on glucose gels (or liquid) would be appreciated.

 

[mjennings]

For the adhesives, I'm looking into some stuff that was given to me once by a nurse. It applies to the skin out of a small breakable tube and makes the skin very tacky. I have to believe that using this tacky substance in combination with any kind of medical adhesive (like an infusion set) would make it stand up to moisture of any kind; including salt water. I'm just trying to identify what this tacky liquid is.

Found out the substance is called Benzoin Tincture.

 

[pasley]

When I was on my way overseas they gave us a TB test and a clear band aid to cover it so it would not get wet. These clear 2 inch square waterproof bandages are available at the local drug store I believe. That may help.

 

[scottarquilla]

I have been a Type I since diagnosed in college almost 39 years ago. I learned to dive in the 1970's when I was on a two injection/day regimen. Over the years, I tend to take up diving every decade or so and only after taking a PADI Refresher Course. I always get my Doctor's approval. Before a few weeks ago, the last I dove was in late 1999.
I have been on the pump (the greatest thing since cracker jacks!!) for almost ten years and A1c's have always been in the 6.0 range since. I weigh what I did in college and I am an active walker (2 miles+/day). Before diving a few weeks ago in Grand Cayman, I reviewed a lot of internet comments about diving with Type I diabetes and had a plan to keep my blood sugar level or rising (minimum 150mg/dl) in accordance with suggested DAN guidelines.
I have not had an opportunity to discuss what happened with my doctor yet (my appt. is early next month) but I found the lack of basal insulin while diving through off the blood sugars for the rest of my day on the two I dove. Blood sugars were 138 and 158, respectively, and rising before the first tank and even higher after the first and after the second tank. It took much of ther afternoon for correction boluses and long walks to bring down the blood sugar to a normal level.
My analysis is that the blood sugars will naturally rise without the pump attached and no insulin being provided/absorbed. It might have been a mistake to have snacks (with fraction of required carb boluses) prior to diving to make sure the blood sugars keep increasing as suggested by DAN.
Also, Red Sail Sports requested a copy of the PADI Medical Statement but I never went through any issues with questions, fears of diving with a Type I from dive masters, etc. I think some of what people do is a reaction from hearing about bad experience about a diabetic without hearing or knowing all of the facts first hand. I simple explanation of how someone lives and what they must consider might be a good PADI instruction course rather than just turning away a diabetic because they are diabetic. I'd rather let someone know I am rather than keep it a secret. I, too, remember I had some concerns 20 years ago when I first saw physically handicapped divers in the water.
Any other comments from other Type 1 diabetics on pump therapy or endocrinologists would be appreciated. I've have appreciated the comments in this discussion board immensely.

 

[mjennings]

I have been in touch with Medtronic, the manufacturer of the CGM system I am wearing. They have provided me information indicating that the sensor will be okay at depths (its just a subcutaneous soft wire), but the transmitter that attaches to the sensor and sends data relative to interstial glucose levels in the subcutaneous layer, has never been tested beyond 8 ft (snorkeling). Once you remove the transmitter from the sensor, simply reattaching the transmitter requires calibration 2 hours after re-attachment before data will start getting sent to the pump.

So the way I envisions CGM will work with diving is to continue receiving data (keep the tranmitter attached) during the 1+ hour boat ride to the dive site (I dive Cozumel almost exclusively) and receive the benefit of data up to the point I get in the water. This will mainly tell me trending (upwards or downwards) as blood glucose testing will be simultaneously taken every 15 to 30 minutes with a final check before getting into the water. CGM data of the insterstial sensor glucose usually lags around 20 to 30 minutes of a blood glucose reading, which is a greater indication of current/immediate glucose levels. Like all other diabetics who dive, the goal is to elevate blood glucose readings before getting wet.

Once out of the water and into the surface interval, I will not reattach the transmitter since I will likely be back in the water for my next dive before the transmitter is able to send data. In short, the transmitter will be reattached immediately after the last dive so that I can start receiving data again after 2 hours.

If I knew the transmitter could remain attached and safe while at depth, it would mean that data would start to be retransmitted once back at the surface. However, it will be absent data for the duration of the dive. Even though it would be nice to have glucose data continuously read once back on the surface, the net gain is only marginal. I will still have the ability to check blood glucose every so often while on the surface and before re-entering the water.

I hope to post more detail information based on my personal experiences, which will be later this spring during late May and early June.

 

[BLR]

Regarding blood glucose trending: I have observed that measurements from forearm sticks lag behind those of finger sticks by 15-30 minutes. Comparing the two might be a crude way to predict whether one's blood sugar is increasing or decreasing. I don't know the reliability of this and would be interested to hear opinions about it. Thanks.

 

[scottarquilla]

I saw my doctor this morning and we discussed my episodes of rising blood sugars during and after diving. Basically, he says the amount of carbs, amount of active insulin as well as amount of 'stress' can all influence blood sugars differently. But, most of the time, an 'in shape' Type I diabetic will experience rising blood sugars due to 'intense' exercise. I would say diving is intense, more mentally than physically, though. Despite not being physically exhausting, just the anticipation and thoughts of your next dive can increase blood sugar levels without much effort. See this article: Diabetics Develop Higher Blood Sugar During Exercise
My level of basal during the day is quite low, only .3 units per hour. So any level of stress will increase blood sugar quickly. That is the better news for me as a diver as my blood sugar won't fall when disconnected and diving. My doctor suggests taking one or more units of insulin between and after the second dive to bring gluconse levels back down to normal.
I hope this might shed some light to other Type I pumpers who have similiar experiences.

 

[buckedoff96]

I've noticed this same thing. I'd get so frustrated when I work out and then my sugars were higher.
Not sure if you've noticed but when I'm active I need less insulin during my "rest" time. I would like to think my insulin resistance is lower because of the exercise. Which if thats the case then I can live with high sugar after work out. I think that it comes down to this, no matter what just keep checking our sugar levels.
From the time I became diabetic to insulin shots and now the pump I gained weight. So I'm, when I can, hitting the gym in the mornings and biking in the evenings. Anyone else struggle with getting that extra insulin weight off.

 

[JKSteger]

If my insulin doseing is high over several days then I feel the weight comming on! It has been a constant struggle.