DAN recommendation for Diving with Diabetes

[wsgts]

Let me start off by saying that I very critical of the American Diabetes association and any agency the publishes guidelines for diabetics like myself. I was a bit concerned that the guidelines for diving with diabetes didn't include different guidelines for type I and type II, since I am type II.

I can't comment on the recommendation for Type I or insulin dependent diabetics, but it bothers me since I'm not dependent on insulin. I also have never had a low blood sugar enough to cause blackout (I have the opposite problem).

Of the recommendations, only two I have trouble with:

- HbA1c of less than 9%. I would consider this way out of control with one's blood sugar management. Without meds I can maintain about an 8, so why in the world would it be ok to dive with blood sugar out of control, which I guess goes along with my next problem.

- Blood Glucose between 150 and 300. This really bothers me, because as a Type II I really have no excuse for my blood sugar ever being as high as 150. The first time I measure close to 300 on the boat, no one is going diving, because the boat is going to the emergency room to get some insulin (or something).

Am I offbase here, or are those guidelines aimed toward insulin dependent diabetes? It seems to me that the medical community is almost uninterested in blood sugar control, and only interested in cholesterol as of late.

Later,
wsgts

 

[padiscubapro]

Let me start off by saying that I very critical of the American Diabetes association and any agency the publishes guidelines for diabetics like myself. I was a bit concerned that the guidelines for diving with diabetes didn't include different guidelines for type I and type II, since I am type II.

I can't comment on the recommendation for Type I or insulin dependent diabetics, but it bothers me since I'm not dependent on insulin. I also have never had a low blood sugar enough to cause blackout (I have the opposite problem).

Of the recommendations, only two I have trouble with:

- HbA1c of less than 9%. I would consider this way out of control with one's blood sugar management. Without meds I can maintain about an 8, so why in the world would it be ok to dive with blood sugar out of control, which I guess goes along with my next problem.

- Blood Glucose between 150 and 300. This really bothers me, because as a Type II I really have no excuse for my blood sugar ever being as high as 150. The first time I measure close to 300 on the boat, no one is going diving, because the boat is going to the emergency room to get some insulin (or something).

Am I offbase here, or are those guidelines aimed toward insulin dependent diabetes? It seems to me that the medical community is almost uninterested in blood sugar control, and only interested in cholesterol as of late.

Later,
wsgts

Just my 2cents..

I prefer an insulin dependent diver over one just on oral meds.. People on oral meds tend to get low blood sugar much more frequently thans omeone on insulin since you really cant regulate the doage on oral meds (the half life is really too long for short time changes).. an insulin dependent can lower his dosage to slow the dropping of the BS..

Diving burns alot of calories, its far safer to enter the water with a high reading than a low reading.. 300 before a dive really isnt that bad, between the body trying to regulate temperature and the excercise required for swimming, the diver should exit the water with a pretty normal reading.. entering the water with a real good reading invites a low BS incident.. Unless you BS gets really high immediate problems are not likely (you really need probably double this for any short termproblems), low BS causes problems quickly.. The most likely outcome is unconsciuosness and drownling.. High BS usually results in damage long time (although ski high readings can cause a coma).

Most diabetics I know eat something rich in carbs before entering the water and even some juice to make sure the BS is high during part the dive and normal towards the end..
also the longer you are a diabetic with "high" readings the more resistant your body becomes to high readings.. Someone whose BS spikes becasue of recently becomming diabetic may have serious issues below 500, while someone who has had high bs for a long time is not in any immediate danger..

For a short dive 150 is fine, for extended hard working dives I'd like to see it higher (or eat before getting in the water)

 

[wsgts]

I don't believe you will find very many Type II that ever really go low unless they are on a medication regime that actually makes more insulin from the pancreas or are on insulin. The medication that fight insulin resistance are very unlikely to cause low blood sugar as it is attacking the usual cause on Type II diabetes (insulin resistance) and not the symptom (high blood sugar). In my case that would be never.

Granted I know plenty of T2s around me that say "I'm low", need to eat something and don't actually check their blood sugar. I have found often encouragement to check the sugar indicates it was the opposite of low, something in the 200 range and then they justify it by saying "my doctor says it's fine".

I'm I just weird by saying that my blood sugar has to be normal or almost normal no matter what I'm doing? This includes working, scuba, snorkeling, mowing the grass, whatever?

Later,
wsgts

 

[DocVikingo]

Hi wsgts,

I'm (sic) I just weird by saying that my blood sugar has to be normal or almost normal no matter what I'm doing? This includes working, scuba, snorkeling, mowing the grass, whatever?

Generally, maintaining blood glucose levels within the limits directed by the treating specialist is in the patient's best interests.

That having been said, unless proscribed by the specialist, allowing bs to rise to say, the 200 level, just prior to anticipated vigorous or extended u/w exertion may afford a favorable risk-benefit ratio.

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. Discuss with your physician any plans to let bs vary outside of broad normal limits.

Regards,

DocVikingo

 

[Blueraven]

I am on an insulin pump . In my opinion just the sight of a pump ensures me that a diabetic is in constant touch with his diabetes control. I have found that the first pool dives can be the most variable. I use the protocol that sets blood testing times at 60min, 30min and 5-10 min before dive. I use these to see if a rising trend is indicated. If not I can adjust with Carbs and test again at 30min. I have come out of 3 hour pool sessions with blood sugar readings of 201, 136, 91, 93. In the last four sessions. The normal recreational time FOR ME is more like 50 to 75 minutes from the time I unhook from the pump to the time I surface. I have had a pump for 7 years and I have always maitained a A1c of 5.9 to 6.4 I would also like to say that as a diabetec I would warn against generalizing type I and II as each individual with diabetes is totally different than the next individual. There are some basic similarities for sure but I do know many Oral med users that go low, period.And needle users with long lasting insulin that have problems. TEST AND TEST OFTEN is good advice. I usually reduce the basil rate of my pump and hour before diving. I can also set it to increase the basil rate after I am done if I have a high reading. I would consider that an A1c of up near 9 or so to be out of control. Control is keeping your readings in a range that will not damge you long term as well as short term. A good diet and excercise with lots and lots of water will go a long way. I would also encourage anyone that is new and interested in diving to go to a health club or get with a buddy and use the tester and excercise to develop trends for excercise/BS control. If your pool sessions are 3 hours then see what being off your pump and excersizing will effect your numbers. Do it first for an hour then more till you are confident. Remember you can put yourself through these things safely doing laps in a pool and checking you numbers as you go. Diving will not be much different. The pool sessions can be slow at times so you won't get as much excersize. It takes some work but the rewards are worth it. Just for the records, my diabetes was the result of a Bering Sea exposure injury that lowered my core temperature enough to damage my pancreas. Not the worst that could have happened.

WW

 

[TSandM]

wsgts, I commend what must be a very diligent effort on your part to keep your blood sugar under such good control. But as an ER doc, I have to tell you that a) there are a LOT of Type II diabetics who routinely run blood sugars in the mid 200's, and b) I regularly see people on oral medications with low sugars, and they are a bear to treat because of the long half-life of the meds.

As Doc Vikingo says, eating something carb-rich to push the blood sugar up just a little bit before an activity like diving is probably preferable to running the risk of becoming hypoglycemic underwater. The fact is that no medication regimen does the same good job of managing blood sugar that an intact pancreas and normal insulin sensitivity does.

 

[Blueraven]

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[wsgts]

I understand what everyone is saying, I just think the medical community has accepted abnormally high blood sugars (especially in T2) as a fact of life. My Hba1c has been between a 5.2 to 5.8 for 5 years now. When my morning BG began to hit 160, I had to damn near threaten the doctor change my prescription, reason, HBA1c was 5.8 no treatment adjustment necessary. Just for reference, 160 is about 60 points away from where it should be, the goal is not to be "ok" for a diabetic, the goal is to have normal BG all the time. Might be more difficult for a T1, but for us T2, this manner of treatment can keep us insulin free for years, just takes a lot of work and fingerpricks and of course exercise underwater.

Seems to me the medical community has already thrown in the towel.

Later,
wsgts

 

[fisherdvm]

I think it is a tough job for any doctor to manage diabetics. Each person have their own lifestyle, and their own goals.

A person who keeps irregular schedule, eats whenever and what ever, and exercise inconsistantly and irregularly would be safer treated with much lax control of their sugar.

Whereas a regimented person who eats at exact time, and exercises daily with similar routines can be controlled more strictly.

Comparing all diabetics as a group and just looking at numbers is non-sense. If a patient is not willing to follow up with you but once every 6 months and has an IQ of a rock - you are not going to achieve much except to try to keep them out of ketoacidosis.

 

[TSandM]

wsgts, I can assure you that you are in the top tenth of one percent of diabetics in terms of your willingness to control your disease. You can't generalize your experience to the patient population most physicians have to cope with.