Wife is a diabetic

[Dyno Bill]

And the medical practitioners come slowly out of the gallery. Just wished I knew what all the words meant.

 

[lulubelle]

And the medical practitioners come slowly out of the gallery. Just wished I knew what all the words meant.

Ask away. Bottom line is that insulin users with both types of diabetes (and to a lesser extent, the Type 2 patient who take and older class of oral agent which can cause hypoglycemia) have to be very careful when diving. Doc Vikingo was spot on that the blood sugars have to be tested pre and post dive, with an appropriate response to the information obtained, to dive safely. A lot of insulin using diabetics run their blood sugars a bit higher before a dive, and have a complex snack before the dive as well (i.e., NOT just simple carbs, but some protein/fat too).

The OPs wife being diet controlled makes the above unimportant in her case. She just needs a good physical with special attention to her cardio fitness.

 

[nelligoon]

I would consult Divers Alert Network. They are a great resource for this type of information. Not all private physicians are knowledgeable about scuba diving but DAN physicians are knowledgeable about diving with diabetes.

 

[padrogj]

That's awesome that your son can dive! I used to hate it when a child wanted to be a long haul trucker or commercial pilot as those are still off limits to an insulin user. But the rest of the world is not.

One small point of correction. In general, most Type 2 overproduce insulin. The issue is generally not a problem with efficiency in manufacturing insulin, it is in lack of efficiency in using endogenously produced insulin (insulin resistance).

I'm going to have to disagree with the assumptions you made from my comments. I did not comment at all on the underlying pathophysiology of Type 1 versus Type 2, I'm well familiar with that. I only commented on the implications of the therapy which must be used in Type 1 and might be used in Type 2. Regardless of the body's ability to produce endogenous insulin, or the body's ability to properly use the endogenous insulin it makes, the use of insulin (and to a lesser degree, the use of sulfonylureas in some Type 2s) is something that puts a diver at higher risk while diving than the other therapies due to hypoglycemia which can occur in every patient who uses insulin, not just the Type 1 patient.

I do not agree with your blanket statement that is "much more complicated" to dive safely if you have Type 1. It may or may not be. Patients with longstanding diabetes or poorly controlled diabetes often develop some nerve damage which impairs their ability to recognize hypoglycemia when it occurs. Personally, if both patients take insulin, I'd put my money on a newer Type 1 who has a history of good control than a longstanding Type 2 with a history of poor control in terms of their ability to dive safely. Now if both patients had longstanding disease and a history of poor control, then yes, the Type 1 patient will most definitely have a harder time diving safely. Type 1 patients who use insulin pumps are generally able to easily titrate their blood sugars around activities, it is a little harder to do if they take intermittent injections.

Let's not get into Type 1a.

Leslie,
I agree with your disagreement on the assumptions of my initial disagreement. And I am in total agreement with your agreement. Does that make sense?

I understand that you "toned down" the verbiage you used in your initial post for the general population of readers.

My son has his blood sugars well controlled (for the most part). I think converting over to a pump has greatly contributed to his improved control. He is a teenager and does have occasional lapses. However, if he does not have good control over his blood sugars or if he had significantly low blood sugars before a dive, there would be no question and the dive(s) would be called off.

Gary

 

[padrogj]

And the medical practitioners come slowly out of the gallery. Just wished I knew what all the words meant.

I concur and ask Lulubelle. Lulubelle is too modest. Ironic that she actually is a practitioner and has a wealth of knowledge with regards to Diabetes. Having a family member that has Type 1, I will not hesitate to consult with her in the future.

Happy diving everyone! Im going out to Cataline tomorrow!
Gary

 

[billsreef]

In general, most Type 2 overproduce insulin.

This is true at the start of the disease, before the BG hits levels that gets us diagnosed. Typically by the time we get diagnosed, it's because all that overproducing of insulin to overcome the insulin resistance has caused the pancreas to start burning out and not producing so much insulin. It's at that point the BG starts to rise and we get diagnosed from those high BG numbers and the high A1c.

I control mine with diet, exercise and metformin. The biggest trick I've found is to use my meter to test before and after meals, and before and after exercise and of course diving. This has taught me how different foods effect my numbers, as well as different activities. With this info, it's a fairly simple matter to keep good control, and figure how much and what I want to eat before a dive to maintain good numbers and prevent a low from the exercise. I time the eating before the dive such that my post meal spike would occur during dive, thus avoiding any highs as well as lows from the excercise. In case of the unexpected, I do carry a couple of tubes of glucose gel in my BC pocket. Just got to plan for the BG, no different than planning bottom times and air consumption

 

[lulubelle]

Leslie,
I agree with your disagreement on the assumptions of my initial disagreement. And I am in total agreement with your agreement. Does that make sense?


Gary

 

[lulubelle]

Great drug, an oldie but a goodie. I'm trying to get my Mom on it as we speak.

Most Type 2s are hyperinsulinemic long after diagnosis but will still have high blood sugars due to inefficiency in using the insulin they make due to insulin resistance. It is pretty easy to determine whether or not that is the case in a Type 2, endogenous insulin levels are easy to measure, and sometimes that information can be helpful in guiding therapeutic choices. You have to do them fasting off of medication though. Those who take sulfonylureas such as Glipizide tend to burn out their pancreas more quickly than those who do not due to the mechanism of action of the drug.

It is completely different that the autoimmune destruction of the beta cells in Type 1. There is often a honeymoon period right after diagnosis, but it doesn't last long. Those cells are done.

Do you ever get hypoglycemic on Metformin? It is not frequently seen, but you are smart to carry the gel anyway.

This is true at the start of the disease, before the BG hits levels that gets us diagnosed. Typically by the time we get diagnosed, it's because all that overproducing of insulin to overcome the insulin resistance has caused the pancreas to start burning out and not producing so much insulin. It's at that point the BG starts to rise and we get diagnosed from those high BG numbers and the high A1c.

I control mine with diet, exercise and metformin. The biggest trick I've found is to use my meter to test before and after meals, and before and after exercise and of course diving. This has taught me how different foods effect my numbers, as well as different activities. With this info, it's a fairly simple matter to keep good control, and figure how much and what I want to eat before a dive to maintain good numbers and prevent a low from the exercise. I time the eating before the dive such that my post meal spike would occur during dive, thus avoiding any highs as well as lows from the excercise. In case of the unexpected, I do carry a couple of tubes of glucose gel in my BC pocket. Just got to plan for the BG, no different than planning bottom times and air consumption

 

[billsreef]

Do you ever get hypoglycemic on Metformin? It is not frequently seen, but you are smart to carry the gel anyway.

Hasn't happened yet, and I hope it doesn't. Typically it's only considered a danger if you don't eat and drink, or don't eat and do strenuous exercise, so is easily avoidable with just a little bit of thought. However, I do have a friend over on the ADA's message board on Met that does occasionally get hypoglycemic. He's since learned how to avoid that for himself.

If your Mom does go for the Met, make sure it's the extended release version, lessons the gastrointestinal side effects to a great extent. You can also send her over to the ADA's Type 2 message boards if she wants to talk to other diabetics about it. It's a good bunch over there, they taught me more about controlling this than my doc

 

[Dyno Bill]

Ask away. Bottom line is that insulin users with both types of diabetes (and to a lesser extent, the Type 2 patient who take and older class of oral agent which can cause hypoglycemia) have to be very careful when diving. Doc Vikingo was spot on that the blood sugars have to be tested pre and post dive, with an appropriate response to the information obtained, to dive safely. A lot of insulin using diabetics run their blood sugars a bit higher before a dive, and have a complex snack before the dive as well (i.e., NOT just simple carbs, but some protein/fat too).

The OPs wife being diet controlled makes the above unimportant in her case. She just needs a good physical with special attention to her cardio fitness.

Thanks for the offer, I was diagnosed maybe 6 years ago. I was a typical guy I guess feeling all my symptoms were a process of aging....... WRONG. I had a checkup at a Kaiser facility and was put on 4 500 Metformin a day, a blood pressure medication as well as something for cholesterol. I have been with a different physician for maybe 3 years now and I take no meds of any kind with exception of the small aspirin once a day. I have had the Thalium stress test and passed no problems, I have seen a cardiologist for what he called a pvc and felt it didn't need any treatment at this time. My A1c is 5.7 and my average blood pressure is 109/ 64 with daily treadmill and weight several times a week. I eat small portions frequently with no large meals to speak of. I can feel a blood sugar of 180 and if I get around 86 I begin to feel it strongly. If we have a nice dinner out when we get home she relaxes and I do a 20 minute run on the treadmill to avoid a high blood sugar. I take the small boxes of raisins when I'm out so I can have a fast acting shot easily in fact I also use them diving, just not in the boxes. I know lots of information you likely didn't want bit I am always looking for suggestions as to management. My second wife passed at 42 due to complications of Diabetes so I'm trying to stay as healthy as long as possible as I have seen the results of the disease up close and personal. Thanks again for any suggestions.