type 2 Diabetes and diving

[MnLakeDiver]

On thursday I was diagnosed with diabetes
and wanted the Doc's opinion on the effects of diabetes on decompresion and the effects of the metabolisum changes with blood sugar.

I have asked my doctor and he saw no problem if I tracked my blood sugar closly and didn't overexert myself. but he is not well versed in dive medicine.

I know you do not have all of my history and I am only looking for general information so I can make informationd decisions concerning risk tolerance.

I also can't spell worth a darn so I am sorry for the spelling mistakes in this post.

 

[scubadoc]

Hello MnLakeDiver:

Answers to questions are for information only, do not imply diagnosis or treatment and should always be used in conjunction with the advice of your physician.

There are no standardized rules governing who may dive with various conditions or not around the world. Add to this the liability incurred by training organizations and their agents (dive instructors and scuba shops), and it is not hard to see why each individual instructor pretty much makes his own rules and regulations when it comes to certifying diving with conditions
that would possibly be dangerous to a diver. The big problem with diabetes is the possibility of a low blood sugar while underwater, possibly brought on by the effects of immersion, cold, anxiety, exercise and a myriad of other things. I am not aware that a decompression accident (bubbles) would worsen diabetes or vice versa.

Non-insulin dependent diabetics (Type II) may dive. However, 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.

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. In addition, the Diabetes and Diving Committee of the Council on Exercise of the American Diabetes Association notes that there are currently a substantial number of diabetics, in the United States and elsewhere, who dive but it offers no guidelines.

Here are some criteria for diving with the condition:
--good control of blood glucose levels
--freedom from severe secondary complications of diabetes (eyes, kidneys, blood vessels)
--an understanding of the relationship between the disease and exercise

Diabetics who shouldn't dive are those who:

--have had a serious hypoglycemic episode within the past 12 months
--have advanced secondary complications of the disease
--have poor control of their blood sugar
--are unaware of the early warning signs of hypoglycemia
--lack insight into the relationship between diabetes and exercise
--glycosuria causing dehydration, a known risk for decompression sickness

BSAC recommendations for the UK are similar, though more rigorous. A questionnaire must be filled out by the prospective diver, and a separate one completed by the diver's physician. In addition, BSAC has developed guidelines concerning what additional gear and supplies diabetic divers
should carry, and proposes a pre- and post-dive plan in order to minimize risks.

The YMCA has an extensive diving protocol for diabetic scuba divers. It carefully differentiates the divers with mild diabetes and those with frequent changes in blood sugar levels and hypoglycemia. It might be wisest to have your husband contact the nearest YMCA program and enroll. This way he would be diving with professionals who have a definite diabetic program,
with instructors who understand the illness and probably can go on trips that are arranged for his peers. 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).

Here is information for contact sources for the YMCA:

YMCA of the USA
SCUBA Program
101 N. Wacker Drive
Chicago, IL 60606
(800) 872-9622
(312) 977-0894 fax
E-Mail: scuba@ymca.net

Here are a couple of web sites that might be helpful:
http://www.scubadiving.com/training/medicine/diabetes2.shtml
http://scuba-doc.com/endmet.html#Diabetes_and_Diving

Best regards for safe diving!
Ern Campbell, MD
Diving Medicine Online
http://scuba-doc.com/

Medical Editor, Rodale's Scuba Diving
DAN Physician Consultant

 

[DocVikingo]

Hi MnLakeDiver,

It's from one of my past Rodale's "Ask RSD" columns:

"Are there restrictions to diving with diabetes?" W.A., Bozeman, MT.

Diabetes, along with asthma & seizure disorder, ranks among the most controversial medical conditions affecting divers. Diabetes was considered by many in the medical & dive community as a contraindication to scuba until opinion began to change in the early & mid-1990s. At present, the Undersea & Hyperbaric Medical Society and the YMCA have detailed protocols for approving diabetic divers, and British Sub-Aqua Club allows certification with clearance from a medical referee. DAN is currently conducting an extensive study of diabetic divers, and additional guidelines will very likely result. In addition, there is an outstanding dive program for diabetics age 17 and older, Camp DAVI (Diabetes Association of the Virgin Islands) located on St. John. It is operated by the University of the Virgin Islands and has diving diabetologists on staff, some of whom have the condition themselves.

As you know, the body uses the sugar glucose for fuel, and the hormone insulin is necessary for cells to metabolize it. In diabetes, the pancreas fails to secrete enough insulin, or the body's cells resist entry of insulin, and glucose builds to dangerous levels in the blood. The immediate result is cells are temporarily starved for energy, while over time damage to the eyes, kidneys, heart or peripheral nerves can occur. Signs and symptoms of diabetes can include intense hunger, thirst and tiredness, as well as weight loss, frequent urination, blurred vision, and even seizures and coma.

For the diabetic diver, the most worrisome immediate risk is blood glucose falling to a level where hypoglycemia, or low blood sugar, is precipitated. This can result from events such as too much insulin, alcohol or exercise, or too little or improper eating. An episode can cause weakness, tremor, sweatiness or chilling, irritability, alterations or loss of consciousness, and convulsions.

The diabetic must also be aware of the possibility of hyperglycemia occurring when insulin runs low enough that the body breaks down stored fat for energy. This process can eventuate in breathing difficulty, alterations or loss of consciousness & shock. If left untreated, both hypo & hyperglycemia can result in death.

While the criteria for clearance to dive differ among agencies, they generally include such things as a demonstrated understanding of diabetes, awareness of when a hypoglycemic episode is imminent, good control of the disease with no severe episodes within the past year, and no related abnormalities of the eyes, kidneys, heart or nerves which pose an additional risk. Some protocols include depth limitations to those above which nitrogen narcosis is likely to occur so as to avoid confusion of this phenomenon with a life-threatening hypoglycemic episode.

Clearly it is unwise to deny or minimize this condition to yourself, or hide it from your instructor or the ops with which you dive. If you have diabetes and want to dive, or are already diving without medical clearance, it is critical that you consult a physician to obtain an appropriate medical work up & permission to dive. Even after clearance to dive, it is prudent to carefully monitor blood glucose throughout the course of the dive trip, especially prior to a dive. Measurements at 1hr, 30min & 5-10min prior to a dive would not be excessive. Finally, bring on board whatever substances you use for controlling abnormal glucose levels, and make sure your dive buddy also carries & knows how to use them."

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best regards.

DocVikingo

 

[MnLakeDiver]

Thank you both for your input.
I will continue diving after I get my blood sugars under better controle. My doctor sees no reason I shouldn't be able to dive his main concern is over exertion and cold (darn I may need to tell my wife I need a dry suit).in the mean time I may have to get my son traind as a diver so I have a buddy that knows how to handle low blood sugar problems and won't eat all my jolly ranchers

 

[bluebanded goby]

My doctor sees no reason I shouldn't be able to dive his main concern is over exertion and cold (darn I may need to tell my wife I need a dry suit).

No, you need to tell your wife you need more vacations in Cozumel. ;-)