“Diabetes and Diving”

Midwest Scuba Diving
DAN
Diabetes & Diving

Check your glucose and jump on in—the water is fine.
Over the last several years, studies have debunked the myth that all divers diagnosed with diabetes cannot safely continue to dive.
In June 1994, the Undersea and Hyperbaric Medical Society and the American Diabetes Association formed the Diabetes and Diving Committee to review existing data regarding diabetes in diving situations. The committee determined that a universal ban on divers with diabetes was not scientifically supported; physically-fit divers with well-managed diabetes could safely participate in the sport recreationally, if they maintain a diabetes management plan specific to diving.
In 1996, DAN conducted a member survey. Of the surveyed divers, 129 reported diving with diagnosed Type 1 diabetes without encountering any problems, prompting DAN to design a study to re-evaluate the old contention that individuals with diabetes could not safely dive.
Over the next three years, DAN gathered data about insulin-requiring divers and used it to develop safety guidelines for diabetic divers.
Signs & Symptoms
A report by the Center for Disease Control found that 7.8 percent of the population in the United States has diabetes, an endocrine system disorder that deprives the body of the energy it needs to function. Diabetes can also cause a host of secondary complications.
Diabetes is classified in two forms: Type 1 and Type 2.  
Individuals diagnosed with Type 1 diabetes require insulin therapy to manage the disorder, because this form of diabetes prevents the body from producing insulin. Type 1 generally begins during childhood or young adulthood.
With Type 2 diabetes, the body either does not produce enough insulin or the cells are unable to use it efficiently. Type 2 does not always necessitate the use of insulin therapy.
It is possible to overlook the symptoms of diabetes. Simple signs include abnormal thirst or weight loss, frequent urination, excessive hunger, fatigue and irritability. More severe symptoms may range from infections to wounds not healing properly or numbness in your fingers and your toes.
In a dive situation, the primary concern for insulin-dependent divers is the possibility of a hypoglycemic episode, which can be dangerous for both the diver and their buddy. A diver who experiences a hypoglycemic episode underwater could lose consciousness and drown. The possibility of a hypoglycemic event is higher for divers with Type 1 diabetes than those with Type 2 diabetes.
Onset of a hypoglycemic episode may be characterized by sweating, anxiety, exhaustion, increased heart rate, nausea, confusion, mood swings, convulsions or loss of consciousness. Its symptoms could easily be confused with nitrogen narcosis, which is why it is strongly recommended to explore shallower depths when diving with diabetes.
While there are increased risks, with careful, informed management, many divers with diabetes can still enjoy adventures under the sea.
Prep & Plan
When diving with diabetes, it’s important to recognize and consider factors that could provoke a hypoglycemic episode, such as overexertion.  It is recommended to plan a more conservative approach: the rule of thumb is dive shallower than 100 feet and for less than one hour. Remember, it is a lot tougher to rest underwater than it is while you are playing basketball or riding your bike. Furthermore, conditions can be unpredictable, such as stronger than anticipated currents, so dives may become more strenuous than originally planned. Other risk factors may include prolonged exposure to cold temperatures or diverting from your diabetic management plan.
Simply delaying a meal or exercising more without supplementary measures, such as adding calories to your regular diet or decreasing insulin dosages, can cause a hypoglycemic episode. Take snacks on your dive trips, stay hydrated and keep a close eye on your blood glucose levels, prior to and after dives. Avoid caffeine and fatty foods.
Delayed hypoglycemia is also a concern, particularly during a trip featuring several days of diving with multiple dives each day. A diver with diabetes could deplete their liver glycogen reserves, making them more susceptible to delayed hypoglycemia, which generally occurs six to 15 hours after the physical exertion. Even divers who have an excellent history of managing their diabetes can experience delayed hypoglycemia. To prevent this, divers engaging in a rigorous dive schedule should eat more complex carbohydrates, increase hydration, get a good night’s rest, relax before and after diving and maintain close management of both blood glucose levels and insulin doses.
Check your blood glucose levels 60 minutes prior, 30 minutes prior and just before you begin your dive. Delay the dive if blood glucose levels are lower than 150 milligrams or higher than 300 milligrams. It is also important to check your blood glucose levels post-dive and later in the evening or the morning after (about 12 to 15 hours after completing your dive).
You may also want to substitute any post-dive beers with water to avoid further dehydration. If you have a daily workout regimen, reduce your typical activity by a minimum of one-third before and after your diving activities.
If you plan on doing a night dive, discuss your management options with your doctor. It can be very hazardous to divert from your diabetic management plan—missing your regularly scheduled dinner could trigger a hypoglycemic episode.
The Buddy System
 It is vital that you share information about your condition with your dive buddy as well as the trip’s dive master, so that they can respond appropriately if an emergency situation arises. Your dive buddy should not have diabetes.
Before you and your buddy dive, discuss hand signals you can use in a diabetic emergency. It is also useful to practice your response plan in the pool with your buddy. Then, if something happens in open water you have a plan that both of you understand and can carry out effectively.
When diving, bring a safety kit and inform your buddy of its location. In a waterproof container, keep a copy of your diabetic management plan and response protocol, medical history, physician’s name and contact information, SMBG monitor and glucose oxidase sticks with administration instructions, glucose tablets and intramuscular glucagon injections. Both you and your buddy should also have glucose paste in your BCD pocket during the dive to allow underwater administration if necessary. It is advisable to practice underwater glucose ingestion in a pool, so that you are familiar with the process in the event of an emergency.
If you realize you are in trouble, inform your dive buddy, ingest glucose, safely surface together and exit the water. Once you are out of the water, check your blood glucose levels, and if necessary, seek medical attention.
Every diver is unique, so management plans and the decision whether to continue diving have to be made with your doctor to fit your specific needs. The most important consideration for determining fitness to dive for a diabetic is whether you have experience managing the illness in the context of exercise and are able to recognize the signs and symptoms of hypoglycemia in yourself.
 Discuss any medications you are taking and work with your doctor to develop a specific dive plan. Periodically meet with your doctor to reevaluate your management plans. To help with maintaining and adjusting your management plan, keep detailed entries in your dive log about your blood glucose levels and insulin administration. Be sure to note any adverse reactions so that your doctor can help you develop a safer diabetic dive management plan.
It may not be safe to continue diving if you have a history of severe hypoglycemia, secondary complications such as coronary artery disease, hypoglycemia unawareness or uncontrolled diabetes.
DAN Can Help
If you have any questions about diving with diabetes or need an evaluation by a diving doctor, DAN can give you a list of specialists in your area. DAN is also available to provide a consultation to your physician.
Contact the DAN Medical Information Line at +1-919-684-2948 or via email if you have any questions regarding diabetes and diving.
If you experience a diabetic emergency while diving, call the DAN Emergency Hotline at +1-919-684-9111.
For more information about diabetes and diving, check out the online diabetes FAQ as well as DAN’s online seminar, “Diabetes & Recreational Diving: History and New Guidelines.”



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