PUGMASTER:
Insight would be greatly appreciated
Pollock NW, Uguccioni DM, Dear GdeL, eds. Diabetes and recreational diving: guidelines for the future. Proceedings of the UHMS/DAN 2005 June 19 Workshop. Durham, NC: Divers Alert Network; 2005.
Workshop available at
DAN.
Table 1: Guidelines for Recreational Diving with Diabetes
Selection and Surveillance
Age ≥18 years (≥16 years if in special training program)
Delay diving after start/change in medication -3 months with oral hypoglycemic agents (OHA) -1 year after initiation of insulin therapy
No episodes of hypoglycemia or hyperglycemia requiring intervention from a third party for at least one year
No history of hypoglycemia unawareness
HbA1c ≤9% no more than one month prior to initial assessment and at each annual review -values >9% indicate the need for further evaluation and possible modification of therapy
No significant secondary complications from diabetes
Physician/Diabetologist should carry out annual review and determine that diver has good understanding of disease and effect of exercise -in consultation with an expert in diving medicine, as required
Evaluation for silent ischemia for candidates >40 years of age -after initial evaluation, periodic surveillance for silent ischemia can be in accordance with accepted local/national guidelines for the evaluation of diabetics
Candidate documents intent to follow protocol for divers with diabetes and to cease diving and seek medical review for any adverse events during diving possibly related to diabetes
Scope of Diving
Diving should be planned to avoid -depths >100 fsw (30 msw) -durations >60 minutes -compulsory decompression stops -overhead environments (e.g., cave, wreck penetration) -situations that may exacerbate hypoglycemia (e.g., prolonged cold and arduous dives)
Dive buddy/leader informed of divers condition and steps to follow in case of problem
Dive buddy should not have diabetes
Glucose Management on the Day of Diving
General self-assessment of fitness to dive
Blood glucose (BG) ≥150 mg·dL-1 (8.3 mmol·L-1), stable or rising, before entering the water -complete a minimum of three pre-dive BG tests to evaluate trends
60 minutes, 30 minutes and immediately prior to diving -alterations in dosage of OHA or insulin on evening prior or day of diving may help
Delay dive if BG -<150 mg·dL-1 (8.3 mmol·L-1) ->300 mg·dL-1 (16.7 mmol·L-1)
Rescue medications -carry readily accessible oral glucose during all dives -have parenteral glucagon available at the surface
If hypoglycemia noticed underwater, the diver should surface (with buddy), establish positive buoyancy, ingest glucose and leave the water
Check blood sugar frequently for 12-15 hours after diving
Ensure adequate hydration on days of diving
Log all dives (include BG test results and all information pertinent to diabetes management)
Diabetes & Recreational Diving: History and New Guidelines - Neal W. Pollock, Ph.D.
http://www.diversalertnetwork.org/training/seminars/diabetes/index.asp
Scuba diving with diabetes mellitus--the UK experience 1991-2001.
Edge et. al. 2005
RRR ID: 4036, PMID: 15796312
110 hits for a search of "diabetes".
List of other UHMS
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