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Diving with T2 Diabetes - tightly controlled by diet

Discussion in 'Special Needs' started by NancyLynn, Sep 27, 2016.

  1. NancyLynn

    NancyLynn Contributor

    # of Dives: 100 - 199
    Location: Ohio
    422
    0
    I have a dilemma. I was diagnosed with T2 diabetes a year ago and immediately began controlling it with diet. I'm not eating a strict ketogenic diet, but close to it. My blood glucose generally ranges between 75 mg/dl and 126 mg/dl.

    Since diagnosis, I have had no more than a dozen readings above 150 mg/dl - anytime it goes above that level, I adjust what I am eating, because my goal is to maintain normal (or as close to normal) blood glucose levels as possible (meaning never higher than 140 mg/dl).

    I have never had a hypoglycemic incident - and I don't expect I ever will unless my medication changes. (Hypoglycemic incidents occur when there are boy scouts (excess insulin) hanging about dragging the little old ladies (glucose) across the street (blood vessel walls) when the little old ladies need to stay right where they are to avoid a hypo. This only happens when you are directly or indirectly adding insulin to your system in a way that is mismatched with food-based glucose. Dietary mangement does not create excess insulin -the cause of diabetic hypoglycemic incidents.)

    My dilemma is that I'm about to start diving again after a few years off for unrelated (completely resolved) health reasons. I figured I'd take a new certification course to refresh my knowledge - but the new certification course requires a new medical disclosure. That gives me three options:

    • Nondisclosure (I'd have two normal A1C lab tests to "prove" I don't have diabetes - even though I know my normal values are the product of tight control, not lack of disease.)

    • Agree to intentionally create inherently unhealthy pre-dive blood glucose levels (150 mg/dl) that - over time - increases my risk for heart attacks. More immediately, blood glucose of 130 or higher impairs my mental acuity (my supervisor can tell within seconds when I hit 130 mg/dl or higher because of my change in affect - I don't always notice until she points it out, but when she notices it she is always correct). (With the sub-options of actually carrying it out, or pretending to.)

    • Skipping the new certification to avoid the question (but I'd still have to debate disclosure to an unknown dive buddy, since - in this circumstance I'll be randomly paired up.)
    I'm not a fan of hiding things from one's dive buddy. I'm also not a fan of destroying my health (or mental acuity during a dive) to satisfy a standard that - from a medical perspective - makes no sense for someone in my circumstances. (It makes perfect sense for T1 diabetes and for many with T2 diabetes - specifically, for anyone taking insulin, regardless of type, or for anyone taking a drug that disconnects pancreatic secretion of insulin from food intake (e.g. sulfonylureas). It does not make sense for either diet-controlled, or metformin-controlled diabetes - becuase people in the latter two categories are no more likely to have hypoglycemic incidents than non-diabetics.)

    All of the discussions of this question I've found are pretty old - and there are quite a few T2 diabetics who are now controlling their diabetes by diet - so I'm hoping there might be some new insight. (I've been through the DAN material & course - I'm more looking for insight as to how people who are not at risk for diabetic hypoglycemic incidents and are tightly controlling their diabetes have handled the dilemma of health v. disclosure.)
     
  2. tursiops

    tursiops Marine Scientist and Master Instructor ScubaBoard Supporter

    # of Dives: 2,500 - 4,999
    Location: U.S. East Coast
    11,683
    9,590
    I am not a doctor, but I was diagnosed with Type II NIDDM maybe 15 years ago. I did just diet for a while, but now take two Metformin a day...they do not provide insulin, but simply help my body use the insulin I do produce. I have no issues with hypoglycemic events.

    I also report YES on the diabetes question on the medical form along with a few other YES answers. My doctor checks my (always quite satisfactory) A1C three times a year, and always signs my medical form.

    You suggest three options: my view is the first is unnecessary, the 2nd is a bad idea (for the reasons you give), and the third is a bad idea too. In fact, for ANY (in water) dive class you want to take, you'll need to provide a medical clearance, so it is not just about redoing your current certification, but also about any additional classes you might get interested in.

    But here is the key: You do not even need to provide the medical YES/NO questionnaire in order to take a class, all you need to provide is the (page 2) doctor's sign-off giving you the OK. The purpose of the questionnaire is so the person asking for it can determine whether or not you need a doctor's signature; the purpose is NOT to allow them to evaluate your health. So, just provide the doctor's signature and you are good to go. And that signature is good for a year.

    Some instructors/dive-shops may argue they are required to have your medical info. They are wrong; tell them to check with their agency; they have no right to your private medical info. They only need to know if you are cleared to dive.
     
  3. NancyLynn

    NancyLynn Contributor

    # of Dives: 100 - 199
    Location: Ohio
    422
    0
    I like that option, in terms of the medical form.

    Do you disclose to new buddies - and (if so) have you ever had any balk at buddying with you if you choose not to carb up when your BG is in the range that is healthy for you?
     
  4. tursiops

    tursiops Marine Scientist and Master Instructor ScubaBoard Supporter

    # of Dives: 2,500 - 4,999
    Location: U.S. East Coast
    11,683
    9,590
    I wonder if you are overthinking this. If you are not going to go hypoglycemic, why bother with carbing up? Why bother with even raising the issue?
     
  5. NancyLynn

    NancyLynn Contributor

    # of Dives: 100 - 199
    Location: Ohio
    422
    0
    disclose everything even remotely relevant, but
    Because the DAN guidelines, regardless of type of diabetes or manner of control, include carbing up (or calling) any dive if you are below 150 - or your blood glucose is heading down, testing at least three times before each dive and upon surfacting. Among other things. Here are the guidelines:

    https://www.diversalertnetwork.org/files/DiabetesSummaryGuidelines.pdf

    They are ridiculous and unhealthy guidelines, as far as diabetes that is kept within normal blood glucose limits by diet is concerned. But I don't see an exception. The bottom dot in the first section includes this: "Candidate documents intent to follow protocol for divers with diabetes and to cease diving and seek medical review for any adverse events during diving possibly related to diabetes"

    I went looking so I could send a link to my doctor along with the medical form (in advance of my visit next week), so he could verify that the guidelines didn't apply to me because I have normal blood glucose levels controlled by diet - and discovered that apparently DAN (which the instructions for the form he has to sign tell him that he is to use for guidance) thinks they do apply to me.
     
  6. Dr. Doug Ebersole

    Dr. Doug Ebersole Instructor, Scuba

    1,759
    334
    It is never a good idea not to disclose a medical condition to the dive charter and/or your buddy. You just need a physician who is knowledgeable about diving medicine. There is no reason that your glucose has to be 150 mg/dl before you dive. That is simply a guideline for diabetics in general. Guidelines are simply that -- "guidelines". They are not "RULES". It sounds like your diabetes is under good control and you are not on medications likely to cause hypoglycemia. Contact DAN to refer you to a doctor in your area who is knowledgeable in diving medicine and you should have no problem getting a medical form "clearing" you to dive with your diet-controlled diabetes. Welcome back to the underwater world!
     
  7. NancyLynn

    NancyLynn Contributor

    # of Dives: 100 - 199
    Location: Ohio
    422
    0
    My issue is with the way the guidelines are written - and the guidance to doctors, which direct the doctor to document my intent to comply with the protocol as a precondition for medical clearance. The guidelines do do not limit the 150 mg/dl protocol to those taking medication that puts them at risk for hypoglycemic incidents - they apply to all diabetics, and I don't intend to comply with that part of the protocol. Were they written as flexibly as you are interpreting them, I would have no issue with them.

    I agree, non-disclosure is not a good practice - but disclosure, in this instance, puts me at risk of being coerced to implement unhealthy practices (at the threat of not being able to dive/not having a dive buddy becuase I expect to start every dive with a blood glucose level between 100 and 110 - which is pretty much where it stays all day, every day).
     
  8. tursiops

    tursiops Marine Scientist and Master Instructor ScubaBoard Supporter

    # of Dives: 2,500 - 4,999
    Location: U.S. East Coast
    11,683
    9,590
    Sorry, but I do not read the DAN guidance as being applicable to your case. It is about those who use medications, which you do not. It is concerned with hypoglycemia, which you say you do not get.

    I'd step back, take a deep breath, and just ask your doctor for a clearance to dive. Done.
     
  9. asimpkinsjr

    asimpkinsjr Solo Diver

    # of Dives: 50 - 99
    Location: Niantic, CT
    54
    5
    Most cert courses have or request a doc's review for a list of things they may list in their disclosure, like you I have T2 diabetes and so when I did my SCCR course TDI flagged in in the student profile card that it required a doctors review/sign-off...as long as you have a personal physician who is familiar with your health and glucose levels, etc...they can sign off. What I did was take my glucose for a month on a regular basis and then bring the medical release along with my glucose meter into my doc so she could see where my levels were at and be satisfied I was ok.
     
  10. NancyLynn

    NancyLynn Contributor

    # of Dives: 100 - 199
    Location: Ohio
    422
    0
    My doctor will have no problem clearing me. He has a year's worth of readings largely between 74 and 140, with fewer than a dozen above 150, as well as 3 normal A1c tests, a completely normal lipid panel, and blood pressure on the low end of normal. He is aware than I am at no more risk for a hypoglycemic incident than anyone without diabetes - in fact he is the one who first gave me that information, which I later confirmed through research to be the case.

    The challenge is that the directions say he is to document my intent to comply with the protocol. I have no intention of complying with the protocol as to achieving a blood glucose of 150 at the start of a dive, because that is unhealthy (generally), and as to me will result in decreased mental agility.
    Since you don't read it that way, can you help me out, then, and point out where I'm carved out from the requirement in the last bullet of the first section (to document my intent to comply with the protocol) or from the protocol in the last section?

    https://www.diversalertnetwork.org/files/DiabetesSummaryGuidelines.pdf

    I'm thrilled that no one, including the DAN medic I consulted, seems to think it applies to me. But I'm looking for something to hang my hat on in case someone to whom I've disclosed I have diabetes (buddy/divemaster/dive operation) questions why I'm not complying with the protocol. So far no one has been able to point me to an exemption.
    .
     

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