Diving with diabetes

[kennedy]

I have been type 1 for over 40 years - and when I went on the pump 4 years ago I gained 15 pounds. Felt like over night. I'm sure it was ME - having "carb freedom" and getting used to having it. I joined WW and lost 30 pounds - but I constantly struggle with insulin and weight gain. I do find that diving on the pump is much better than when I took injections - it's easier for me to control my sugar on short acting insulin than with a long acting one. I wear an animas 1250 and get tired of the "hose" but I think I'll keep it around. Like every one else I test probably 15-20 times a day when I dive - before and after - never afraid to miss a dive if my sugar is too low. There will aways be another chance to dive and I want to keep it that way!!

 

[reticentDiver]

I've only noticed my blood sugar going up while exercising under 2 conditions:

1) I was running low on insulin. If you are already slightly high and start exercising you can get into trouble with high sugar and acetone levels.

2) I was under stress. If I am stressed out it seems that no amount of insulin helps. I assume adrenaline and friends block absorption, but I am not sure.

Regarding the weight gain, in my case it comes if I just keep adding insulin to compensate for the fact that I am eating too many carbs. Now as we all know, that is not the idea behind fast acting insulins and carb counting.... By being (relatively) strict with my diet (hey, I'm human too, ok?) I have managed to keep my weight under control.

I find that no amount of exercise helps if you do not take very good care to maintain that diet balance. It is hard, but hey, we want to be fit to dive, right?

 

[FrogManMike]

Over weight arthritic diabetic with high blood pressure and water therapy diving and snorkeling is my only avenue of physical fitness so anyone who tells me I cant can kiss my hairy but.

 

[sheephogan]

I'm insulin dependent Jerry, the gent that started this thread should have been treated NO different (imo) as any other guest on the ship with diabetes. Diving is strenuous and we have to be more careful with our carbs, sugar, and meds.. Really the only modification I have to make in planning is NO insulin or oral meds for two times the value of the half/life of the medication I am using.. Then check blood before the dive, if you are high, dive! If you are not, compensate with some carbs and or energy bars.. In my mind this is no more complicated than 'flying' after diving.. As opposed to some medical conditions, diving IS GOOD FOR DIABETICS!!!

 

[JasonRN]

I have been reading this thread with great interest. I am a diver, with IDDM (Insulin Dependent Diabetes Mel) I also use a insulin pump. I am also in the medical field. In my opinion, the divers who use pump therapy and are continuously checking their BG levels are on the right track with diving. For the most part, you would not take your pump diving, with the possible exception of dry suite diving. This being the case, once disconnected, insulin therapy stops. The insulin used in pump therapy, is either Humalog or Novolog. These are rapid acting insulin (3Hr life). Once disconnected the chance of having a hypoglycemic incident is greatly reduced, especially if a snack is ingested. An hour without the pump would not lead to dangerously hy BG levels.

The diabetics without pump therapy are a little bit mor complicated. Usually they are on 2 different types of insulin. A long acting insulin a a fast acting insulin. Its the long acting insulin that is the problem with diving. These have a life span of 12 or 24hrs. For example, someone may take one shot 48 units of Lantus (Such as what may have happened to the gentleman that created this thread). Lantus has a 24 hour lifespan. So that 48 units equates to a basal rate of 2 units an hour. This continuous rate is what can be problematic for diabetic divers. Its this continuous rate that can cause a hypoglicemic event while diving.

There was another diabetic who stated it was ok to just not take their insulin:
"Remember when diving it not a problem of having a high BGL it when hypoclicemia sets in that the problem starts. I've had my BGL up around 400 for over a week before (not a smart move...esp. long term) but the only problem I had was that I got ill a little quicker, mood changed to being grumpy and vision change."
I would not recommend this either, because while he has yet to experience problems, a BG of 400 could through some people into DKA (Diabetic Ketoacidosis) which can lead to cardiac problems.

 

[sheephogan]

Good info Jason.. I wish I could afford a pump.. I guess I'm doing pretty good because I have never had a BG level much over 300, but as in your study long term half lives on some medications could be problematic.. We need to really watch this and know for sure what our status is. I burn a lot of carbs when diving. The primary reason I carb up before a dive.. But then again I have never been Hypo unless I medicate.. Something to think about...

 

[diverdorr68]

Hi,

I am a type 2 insulin dependent diabetic diver who often dives solo. The first post of this thread should be a serious reminder to all divers with type 2 diabetes.

I have not had a low blood sugar incident when diving, for the following reasons/tips.
1. Do not dive if your blood sugar is not controlled and reliably gives BG readings at expected levels.
2. Begin hydrating yourself(slowly, sips will hydrate, gulping will lead to urination) 15-30 minutes before every dive. This is important to all divers, but particularly important to diabetics.
3. If you use insulin, you must know what type of reading you should expect after moderate to strenuous exercise, and adjust or do not use your insulin accordingly.
4. Always eat a small amount of carbs prior to your dive. Better to error with a little above average BG then below.
5. Keep a candy bar or glucose kit in your BCD pocket. In the event you should notice your BS getting low, surface and eat. The same common sense techniques we use on the surface should apply to our diving practices
6. If doing multiple dives, check your BG levels between each dive. An ounce of prevention is a....
* Remember how a low blood sugar episode has affected you in the past. Sort of like being narked, but worse. Should you have a low blood sugar episode at depth the results could easily prove fatal to you and your buddy(as your actions will be highly unpredictable at best).
Take your responsibility to yourself and your dive buddy seriously and always be prepared physiologically before every dive. Important for all divers, and for diabetics divers it can not be overstated.

Some tips I have learned the hard way.
As diabetics a simple blister can keep us out of the water, and a moderate to severe blister may keep us off our feet.

1. Recommend to wear dive socks under your boots(help protect your toes from blisters and prevent most sand from getting on your feet causing possible abrasion issues).
2. Be certain your fins fit correctly, as a loose fitting fin can cause blisters which diabetics are not fond of :depressed:.
3. Buy the best boots you can afford. Seasoft Stealths and Mares Trilastics have been great for me. These boots have hard soles, fin strap guards and are very friendly on the foot on the inside.
4. Pay particular attention to keep your boots free from mildew. A good soak in fresh water with a bit of mouthwash works wonders. If weather conditions will not permit them to dry quickly, stuff a hand towel in each boot to wick away the moisture.

Hope this will help those who dive with diabetes now, as well as let those who are diabetics and are considering diving. Safe diving with diabetes is very possible with a little extra preparation.

 

[pasley]

5. Keep a candy bar or glucose kit in your BCD pocket. In the event you should notice your BS getting low, surface and eat. The same common sense techniques we use on the surface should apply to our diving practices

I would recommend a tube of glueclose or cake frosting be kept in the BCD pocket. It could be several minutes before you could safely (30 feet per minute from 130 would be 4.5 minutes assuming you do not do a safety stop or have deco stops to do) reach the surface to "eat a candy bar". A tube of glueclose or cake frosting can be used underwater instantly.

 

[diverdorr68]

I would recommend a tube of glueclose or cake frosting be kept in the BCD pocket. It could be several minutes before you could safely (30 feet per minute from 130 would be 4.5 minutes assuming you do not do a safety stop or have deco stops to do) reach the surface to "eat a candy bar". A tube of glueclose or cake frosting can be used underwater instantly.

Personally, I would recommend against that. If you find your sugar getting low, and are fortunate to notice it soon enough, cancel the dive and surface immediately. Taking even a very short time to try an fumble in a BC pocket(with possibly shaking hands and blurred vision) to get your kit will not cause the problem to go away, and is a worthless and counter-productive effort in this instance. The important thing to remember here is time management. Even with a glass of orange juice and a candy bar on the surface it still takes a minimum of 10-15 minutes before you 'start' to recover from a LBSE, and a good 30 minutes before you are close to back to normal. So the benefit of sugar consumption at depth will be limited to decreasing your overall recovery time only. But, because it offers no immediate relief to the problem, and that you may be beginning to suffer nark like symptoms(that will not fade as you reach the shallows), your first action should always be to ascend. Do not waste time. If it were me, and the situation appeared to be dire, I would be concentrating on two things, my accent rate and remaining calm. Also, if this is an absolute emergency, "safely" returning to the surface takes a back seat to not drowning(same as an out of air situation). Better to require a visit to the deco chamber or even take the risk of dying from DCS, then to guarantee death by passing out and drowning. That doesn't mean panic, it means plan and react accordingly.
Luckily I have not had the misfortune of a LBSE at depth. The symptoms of a Low Blood Sugar Episode come on rapidly. Under exertion on the surface they go from onset to dangerous very quickly. At depth, they go from onset to deadly even quicker. Get to the surface immediately, inflate your BC, eat and signal for help. Ultimately that scenario should never have to happen if you prepare yourself properly before the dive. For diabetic divers, prevention is the best medicine.

 

[diverdorr68]

As diving with diabetes is something that should be done with great care and forethought, after reflection I thought just giving my personal advise as a diabetic diver in the earlier posts without researching things was not the best way to suggest advise to fellow diabetic divers. So, I have included a couple links with info and studies on the subject. It turns out what I 'thought' happened to be correct, but could have just as easily went against the advise of the experts.
Most of all, unlike running out of air at depth where a buddy or pony bottle will help, having a hypoglycemic episode at depth has no immediate fix. The best advice that can be given is to make sure you are 'ok' before you descend. There are many articles on how to do this on the DAN(diversalertnetwork.org) site.

Divers Alert Network

http://www.cchphmo.com/cchrchealth/download/_pdf/e/e_db_eye_care.pdf

Control of blood glucose in a group of d... [Undersea Hyperb Med. 1997] - PubMed - NCBI

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