Death at the Blue Hole in Belize

[tridacna]

or possibly insulin shock, newspaper article quoted friends as saying he was in "good health, except for diabetes". This of course is speculation, but autopsy as quoted didn't say anything other than drowning.

Could you explain the "insulin shock" theory please? Did he inject himself underwater with excess insulin? Did he have Type I or II diabetes? I think that you mean to say that he could have had a hypoglycemic incident. But this sounds so much more like a cardiac incident.

 

[izibo]

Could you explain the "insulin shock" theory please? Did he inject himself underwater with excess insulin? Did he have Type I or II diabetes? I think that you mean to say that he could have had a hypoglycemic incident. But this sounds so much more like a cardiac incident.

You are essentially saying the same thing - a hypoglycemic incident that causes a loss of consciousness = insulin shock.

Essentially, he would have had to inject himself with too much insulin causing him to become profoundly hypoglycemic and lose consciousness. Also, he wouldn't have had to inject himself with insulin underwater to cause a hypoglycemic event as it can take up to an hour or so depending on the specific type of insulin used (or as little as a few minutes).

 

[Troutmaster]

Well, if you have no other therapy to offer (drugs, shock, etc.) continuing CPR is unlikely to reverse the issue that caused the cardiac arrest in the first place. CPR can, if well performed, do a surprisingly good job of supporting the brain, which is what you mostly care about. But well-performed CPR requires trained people and VERY frequent rotation of providers. And in the absence of the ability to assess the rhythm, and with no ability to shock, and a 2 hour trip to shore, I would probably have called CPR fairly early as well. The people on the boat assessed the ENTIRE situation and made what was probably a very good call. Don't second-guess them -- the decision to stop resuscitation on a friend is something they will live with forever.

I agree CPR without ALS support is unlikely to get the guy back, and I will defer to the Doc on scene, he has a heck of alot more knowledge and experience with such things than I do, and he was there. I would have worked him longer, but that is me.

In my experiance if you are doing it right, you can provide CPR for quite some time without someone taking over for you. I am certainly no expert but I can do compressions for 20+ minutes without difficulty. I am going to hurt in the morning, but I can do it. I live and work out in the sticks so we (law enforcement) get alot of "opportunities" to do so. EMS can be 30 min out on a bad day or in bad weather.

You bring up a very good point, the ability to shock. This is probably an argument for another thread, but I think an AED should be standard equipment on dive boats.

 

[maxnico]

I dove the Bule Hole in Belize about a year ago.
I am a doctor.
My son is an insulin dependent diabetic on a pump since age 13.
Don't know what really happen to this poor soul except the obvious conclusion.
Rate of ascent and decent is critical to "free gas" and bubble formation on any dive at any depth.
Have enjoyed the comments and took home some tips to ponder.
In no way meant to offend anyone.
Love listening to the old timers. They know what they are talking about.
I don't think I spoke "nonsense" but and open forum is just that, "open".
I am well over 45 years of age so my view is tempered by my risk tolerance.
A firm advocate of more planning and redundancy than an Al80 and a well intentioned dive master and that is not what usually happens at the Blue Hole.

 

[Puffer Fish]

I dove the Bule Hole in Belize about a year ago.
I am a doctor.
My son is an insulin dependent diabetic on a pump since age 13.
Don't know what really happen to this poor soul except the obvious conclusion.
Rate of ascent and decent is critical to "free gas" and bubble formation on any dive at any depth.
Have enjoyed the comments and took home some tips to ponder.
In no way meant to offend anyone.
Love listening to the old timers. They know what they are talking about.
I don't think I spoke "nonsense" but and open forum is just that, "open".
I am well over 45 years of age so my view is tempered by my risk tolerance.
A firm advocate of more planning and redundancy than an Al80 and a well intentioned dive master and that is not what usually happens at the Blue Hole.

Don't think you did ((I would hope anyway).

A long time ago, I was incharge of dive operations on a liveaboard that did the Blue Hole every week....honestly, it is a somewhat silly dive on an AL80.

Given that all we know about the dive, and that he collapsed on the surface...it is pretty easy to say "what most likely caused his death". That however, may have nothing to do with what actually happened.

PFO event? Hypoglycemic event? Hard DCS hit? Heart attack? Cerebral Hemorrhage?

Fact is, deeper diving brings with it some added risks.

That should not have been, in any way, a strenuous dive. In fact, it should have been one of the easier dives...

I wish in cases like this the actual cause was later provided so we could all learn how to minimize events like this.

 

[DandyDon]

...I think an AED should be standard equipment on dive boats.

It'd be nice, but how many of us even bother to confirm the onboard O2 kit is functional? I've called for O2 for a diver once only to learn it was empty. How many of even bother to confirm that there are life jackets onboard? I confirm they weren't once on a boat that was going to take us on a channel crossing and went and got my own; now I just bring my inflatable one, wear it on small boats. How many of us bother to inspect compressors, intakes, etc, much less check CO content. I have done more dive trips without showing a C-card than I have when I had to, and this one always suffices in those cases. Click for larger...

​

The point I am trying to offer is that evaluate resources aside, it's really up to ourselves to care of ourselves mostly, and adding requirements sledom helps.

I dove the Bule Hole in Belize about a year ago.
I am a doctor.

TY. That info helps in an informed discussion. By doctor I presume you mean physician at that.

My son is an insulin dependent diabetic on a pump since age 13.

Does he scuba. Some of our diabetic members carry tubes of cake frosting on dives and ingest as indicated.

Don't know what really happen to this poor soul except the obvious conclusion.
Rate of ascent and decent is critical to "free gas" and bubble formation on any dive at any depth.
Have enjoyed the comments and took home some tips to ponder.
In no way meant to offend anyone.
Love listening to the old timers. They know what they are talking about.
I don't think I spoke "nonsense" but and open forum is just that, "open".
I am well over 45 years of age so my view is tempered by my risk tolerance.
A firm advocate of more planning and redundancy than an Al80 and a well intentioned dive master and that is not what usually happens at the Blue Hole.

No problem. No way I would do that dive without a pony and extra reg large enough to handle the ascent from 150 if needed. It bothered me some that no one else thot such important, but I can only fix myself and suggest a limited amount to others. I wonder how many members here already have me on ignore.

Don't think you did ((I would hope anyway).

A long time ago, I was incharge of dive operations on a liveaboard that did the Blue Hole every week....honestly, it is a somewhat silly dive on an AL80.

Given that all we know about the dive, and that he collapsed on the surface...it is pretty easy to say "what most likely caused his death". That however, may have nothing to do with what actually happened.

PFO event? Hypoglycemic event? Hard DCS hit? Heart attack? Cerebral Hemorrhage?

Fact is, deeper diving brings with it some added risks.

That should not have been, in any way, a strenuous dive. In fact, it should have been one of the easier dives...

I wish in cases like this the actual cause was later provided so we could all learn how to minimize events like this.

That's info we hardly ever receive here. The best we can do is learn from the possibilities with regard to how we may prevent or deal with them ourselves if the time comes.

 

[nolatom]

Could you explain the "insulin shock" theory please? Did he inject himself underwater with excess insulin? Did he have Type I or II diabetes? I think that you mean to say that he could have had a hypoglycemic incident. But this sounds so much more like a cardiac incident.

I meant an insulin reaction, which causes hypoglycemia, which as I understand it is essentially going into shock. The reason I speculated on this (and it is speculation, but so's the cardiac theory, yes?) was the phrase in the paper, "he just looked at me, and fell off the boat". Didn't say grabbed chest or shoulder, so who knows but this sounded at least to me, like the cold-skinned, blank unseeing stare you get from a diabetic whose glucose is dipping below 30 or so. Even the best-planning diabetics occasionally get it wrong, eat too little for the insulin dose they took earlier, and get to the stage where they don't realize they're crashing.

I'm no doctor, just someone who has for a few decades had a loved one with type 2, and had to do the occasional OJ revival for the still-conscious state, and glucagon for the passed-out, can't-swallow state.

Do autopsies check blood sugar level? and are the readings reliable for the state at time of death?

But maybe it's cardiac. But I'd thought if so, the autopsy would've said what the underlying cause of the LOC was that caused the drowning.

 

[stakanak]

Quick question? Can you really drown by swallowing a small amount of water while you are under? I am a new diver and have done this a couple of times while simulating buddy breathing and checking my own octo underwater. I mean no disrespect to the deceased, I am just a little concerned about the article.

 

[DandyDon]

Quick question? Can you really drown by swallowing a small amount of water while you are under? I am a new diver and have done this a couple of times while simulating buddy breathing and checking my own octo underwater. I mean no disrespect to the deceased, I am just a little concerned about the article.

No, the quote was not accurate. You can choke on a small amount altho experiences vary, still - laryngospasm is a risk. It's often said that I worry too much, especially the klutz diver I am at other times, but I try to keep my reg in my mouth even on a still surface until completely on the boat and am especially careful with reg changes underwater. Should I have to wait long on the surface, I take my folding snorkel out and use the Velcro attachments on it and my mask strap to secure it, saving my remaining back gas for possible needs unforeseen.

 

[Troutmaster]

I am not a doctor, but I do conduct death investigations and am a deputy medical examiner. I have been to numerous autopsies. The pathologist performing the post is the most important variable, and the quality of labratory testing, if any is done. A cardiac event may or may not leave physical evidence detectable at post. In the event of a massive heart attack, the clot that causes it can often be found in the heart. All manner of things can kill you that are undetectable at post, also many pathologists do not open the skull in all cases, so any number of things can be going on inside the head that never get looked at.

I have no experience what so ever with autopsy of DCS victim so I have no idea what you would or would not see.

In answer to the above post, swallowing water will not drown you. Inhaling it can and does.