diabetes and scuba?

[triton94949]

I'm currently taking the padi open water certification test, and I'm wondering what effect being diabetic has on it? I've had type 1 diabetes, insulin dependant (also known as juvinile onset) for 6 years, and have done fairly well managing it. I've never lost concousness as a result of a low sugar, and the worst low I've ever had was 21 shortly after I was diagnosed. I'd like to hear from anyone who has suggestions for how to cary sugar in case of a low, I was considering skittles, or mabey a tube of cake frosting, and does the presure have any effects in relation to diabetes I should be aware of?

Whether the food supplements are a good idea, I would think that if it comes to that, you need to get out of the water, or else not go in if the issue comes up before the start of your dive.

Since you are after all in the class, presumably the instructor sent you to a diving physician who signed your medical waiver. Presumably that means somebody with good credentials believes that it is safe for you to scuba dive.

Different store owners (course directors) take different views of this risk factor. At the one extreme, some welcome the additional business. At the other extreme, some draw the line at insulin-dependent diabedes and tell their instructors the answer is no to certifying such students.

You should always inform others of your situation, so that there is good awareness all around. Don't be surprised when some others bow out. This subject is controversial in the sport and business of scuba diving. DAN is always researching this and reporting back, but so far there is no industry-wide agreement.

Having said that, there is an insulin dependent diabetic in a dive club that I dive with. We always make sure the dives in which he participates involve as little exertion as possible, and we keep our depths shallow, never deeper than 45 ft, and we give him 2 buddies not just one. He normally does not dive repetitive dives either because we dive in cold water. You may want to think about those guidelines, and see if your current instructor can give you others as well which specifically take into account your special medical condition.

Now, also to address the bum-scoop factor that Intrepid might bring up. A 3 person dive team is less than ideal, and might be considered bum scoop by Intrepid. However in our dive club, we believe that the risks of an incident underwater with the diabetic diver and his single buddy are greater than the risks from a 3 person dive team. That is how we called it in our dive club.

 

[triton94949]

Sure, no sweat. Tell your wife you want to take HER to Vegas, and give her a couple hundred to gamble with, take in a few shows, etc. (Of course at least one of the shows you want to take in she'll have no interest in, but you can leave her at the slots while you're there...)

A friend of mine is a diabetic diver. He carries the small tubes of cake frosting - 100% pure sugar. He says its cheaper and easier to deal with than the glucose - FWIW. YMMV.

There is an article in the March/April issue of Alert Diver from DAN regarding Diabetes and Diving. You ought to read it. For additional information from DAN, there are three decent articles here (fifth topic down):
http://www.diversalertnetwork.org/medical/articles/index.asp

Hope this helps.

Intrepid, what about the buddy-dependent issues involved here?

Are you comfortable with the dive industry's carve-out for special-needs (handicapped) divers?

Or shouldn't all divers, from the moment they are first certified, be fully independent, thoroughly trained expert divers already? I am trying to understand your point of view.

Excellent DAN citation reference by you, by the way.

 

[Doc Intrepid]

Intrepid, what about the buddy-dependent issues involved here?

Are you comfortable with the dive industry's carve-out for special-needs (handicapped) divers?

Or shouldn't all divers, from the moment they are first certified, be fully independent, thoroughly trained expert divers already? I am trying to understand your point of view.

Excellent DAN citation reference by you, by the way.

Thank you. And sorry about the 'bum scoop' remark getting under your skin. I just call them like I see them. (As do you!)

First, I prefer three person dive teams for deep dives. The diving I prefer to do is on deeper wrecks, and involves trimix and one or two deco gasses. Many of us have scooters. IMHO, if someone should have a problem, a well-rehearsed team (of 3) is a better concept for response in those circumstances. We dive off sixpacks in either two teams of three or three teams of two. The guys I dive with generally are comfortable either way.

Second, I'm not sure what you mean by 'buddy-dependent issues'. I assume you're referring to the idea that it isn't always the buddy who needs rescuing. As you yourself noted elsewhere, there is theory and then there's reality. In theory one's buddy should be able to respond at all times to save one's own dying carcass. Does my diabetic buddy offer a slightly increased risk? Perhaps. But in reality its a calculated risk, and one I'm willing to take.

Likewise, I don't know what the "dive industry's carve-out for special-needs (handicapped) divers" is. Can you clarify this a bit?

With respect to:

"Or shouldn't all divers, from the moment they are first certified, be fully independent, thoroughly trained expert divers already?"

I'm going to go with Sarcasm for $400, Alex.

But since you asked for my point of view, in my personal opinion the dive industry does new divers a grave injustice by dismissing all concerns about safety hazards underwater with the simple idea that buddy-diving will solve them all.

But philosophies regarding training new divers to be independent versus training new divers to be dependent on their buddies is likely a topic best debated in a separate thread.

Regards,

Doc

 

[Ann Marie]

Diabetes didn't cause this guy's issue, the cold water did. You've given no evidence that diabetes caused any issue for this guy. I've dove in water as cold as 37F and have had no trouble. I agree that you should actively pursue the ability of the student prior to accepting them into a class, but to make a blanket statement 'I wouldn't accept a diabetic student because...' on your limited exposure to the disease is not fair. Smoking and no exercise should also be reviewed and possibly a counterindication for any diver, not just diabetics.

Sorry if I come off harsh, but I've lived the last 21 years of my life striving to be no different than the next guy. People making a broad assumption on limited experience really gets under my skin.

Concur!

 

[triton94949]

...I'm not sure what you mean by 'buddy-dependent issues'. I assume you're referring to the idea that it isn't always the buddy who needs rescuing. As you yourself noted elsewhere, there is theory and then there's reality. In theory one's buddy should be able to respond at all times to save one's own dying carcass. Does my diabetic buddy offer a slightly increased risk? Perhaps. But in reality its a calculated risk, and one I'm willing to take.

Likewise, I don't know what the "dive industry's carve-out for special-needs (handicapped) divers" is. Can you clarify this a bit?

...since you asked for my point of view, in my personal opinion the dive industry does new divers a grave injustice by dismissing all concerns about safety hazards underwater with the simple idea that buddy-diving will solve them all.

But philosophies regarding training new divers to be independent versus training new divers to be dependent on their buddies is likely a topic best debated in a separate thread.

Regards,

Doc

Thanks, Doc. I agree with your opinions. I was just wondering where you draw the line.

By buddy-dependent issues, I was thinking in the extreme of scuba diving for handicapped divers. This is a new evolving issue within the dive industry. In theory, if these good people can be safely trained to dive, then the protocols established to do so should work as well for lesser handicapped divers, such as diabetics perhaps and asthmatics possibly.

I also meant what you inferred as well, that new divers tend to be dependent on their buddies, and this is in fact how the dive industry largely trains them. It is a subset of handicapped diving, in the sense that the training has been handicapped.

Like you, I do not agree that what the industry does is ethical, however I do believe it is what all of us must cope with. What the industry does is business, and the price that society pays is that sometimes divers die. The military and the colleges train all divers thoroughly, but the dive industry business largely does not, unless the new divers specifically choose to pay for more training.

It is intriguing to me that you feel the risk to insulin dependent divers is only slight. If that is true, then I myself have been worring too much about it, and the course director who trained me had also been worring too much about it as well. I appreciate your insights.

 

[616fun]

It is intriguing to me that you feel the risk to insulin dependent divers is only slight. If that is true, then I myself have been worring too much about it, and the course director who trained me had also been worring too much about it as well. I appreciate your insights.

I cannot argue that there isn't a risk of certifying an insulin dependant diabetic. I do, however, think your risk is less is the dive industry would relax it's view on the subject. If you define diabetes as a total contraindication (as some agengies have) the only thing you do is get divers that lie about their condition and you, as an instructor or buddy, is more at risk. What I mean is I signed a medical waiver, as did my doctor. I have made the decision to be an informed diabetic diver. I have a protocol that allows me to safely dive within limits. I inform my buddies that I am diabetic and of the protocols I follow. If you say I can't dive - most likely I'll hide all of that information from my buddies. Which do you say is a bigger risk again?

Should diabetics be doing trimix and decompression diving? Absolutely not. Should diabetics be removed from the sport when thousands of us have shown it can be done safely? Absolutely not.

IMHO triton94949, - I would guess that a responsible diabetic diver is probably a more safety conscience and aware diver than 99% of the divers out there.

 

[Doc Intrepid]

Like you, I do not agree that what the industry does is ethical, however I do believe it is what all of us must cope with.

I'm not sure I'd go so far as to call it "unethical". Rather, its my opinion that based on a great deal of evidence (both anecdotal and empirical) from dive boat operators, divemasters, DAN, etc. that true buddy-diving frequently doesn't happen in the real world, it is an injustice to the student to train them to primarily rely on a buddy who may be unreliable.

It is intriguing to me that you feel the risk to insulin dependent divers is only slight. If that is true, then I myself have been worring too much about it, and the course director who trained me had also been worring too much about it as well. I appreciate your insights.

Hmmmm. Thats a broader conclusion than my statement meant. For my specific buddy, knowing this one guy (only) and how he deals with his diabetes, (plus the fact that he's a cave diving instructor with many hours in deep mixed-gas environments with the experience and situational awareness that provides) I am more than willing to accept any theoretically increased risk to my own safety that exists as a consequence of his diabetes.

But I'm unable to offer a blanket endorsement of insulin-dependent divers. Candidly I'm not a medical doctor and I don't have the qualifications to make any informed statements regarding that topic.

Moreover, while 616fun thought that the article in Alert Diver was unhelpful ("kinda stunk"), I was struck by the fact that the author (who IS a medical doctor) was suggesting that (some forms of) diabetes were a contraindication for diving (pending some 5 years free-of-symptoms - if I read it correctly). Given my buddy and my relative ignorance regarding diabetes and diving, it sounded a bit ominous. I'm relieved to discover that divers who are diabetic don't particularly agree with the article.

Perhaps it was you and your course director who were correct! Regretably I'm not in a position to make an informed argument either way.

 

[Doc Intrepid]

"IMHO triton94949, you and your Course Director are simply being ignorant to the matter at hand."

Brian, I appreciate the fact that you feel strongly about this issue - I suppose I would also in your position. But unless you're deliberately trying to provoke flames, chill out with calling people ignorant. Don't take offense where none was meant. I haven't seen a post in this thread where anyone has tried to reach out and yank your chain.

 

[616fun]

Moreover, while 616fun thought that the article in Alert Diver was unhelpful ("kinda stunk"), I was struck by the fact that the author (who IS a medical doctor) was suggesting that (some forms of) diabetes were a contraindication for diving (pending some 5 years free-of-symptoms - if I read it correctly). Given my buddy and my relative ignorance regarding diabetes and diving, it sounded a bit ominous. I'm relieved to discover that divers who are diabetic don't particularly agree with the article.

Perhaps it was you and your course director who were correct! Regretably I'm not in a position to make an informed argument either way.

I won't say that every diabetic should be diving either. I know people that are simply put, reckless diabetics. It's like any other buddy though. I've dove with people that I was glad when we surfaced and vowed to never dive with them again. If I saw a diabetic that was reckless diving, I wouldn't buddy up with him/her.

The reason I say the article stunk is that is really didn't give any information. In essence, it was fluff. Maybe it's because I have a much deeper understanding of what the author was speaking of. I am hoping that there is some real meat when they roll out the full report at DEMA.

In terms of a diabetic that has been symptom free for 5 years - I'd like to meet one. I am probably one of the most anal diabetics on the planet - I am a control freak when it comes to my diabetes. By a typical HbA1C (test that determines overall glycemic control - it's mentioned in the article) a physican could not tell I was diabetic, but I have symptoms that I am diabetic everyday. Someday's I run high, other times I run low, but I have the good sense to call a dive when my diabetes warrents it. I'll refer back to the protocol I follow before getting in the water:
http://www.diabetesselfmanagement.com/pdfs/pdf_1017.pdf

If a diabetic is willing to follow an established procedure - there should be nothing stopping them from diving.

 

[616fun]

Brian, I appreciate the fact that you feel strongly about this issue - I suppose I would also in your position. But unless you're deliberately trying to provoke flames, chill out with calling people ignorant. Don't take offense where none was meant. I haven't seen a post in this thread where anyone has tried to reach out and yank your chain.

When you're right, you're right. I edited my comments. My apologies. I am very emotionally connected to the issue.

It only took me 10 years to get certified because of similar attitudes.