Diabetes
- Thread starter jakendal
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Scott Sayles
Guest
jackendal,
Before I give you my 2 cents I'm going to include a disclaimer... I am not a doctor, nor do I play one on TV. I am not familiar with her insulin pump or its operation. Consult with a diving doctor regarding her specific health condition.
Now, some thoughts. First, I too am diabetic, type 2 non-insulin dependent. I do take a minimum dosage of oral medication and follow a disciplined diet and exercise regime. Diabetes in itself is not a contraindicator to safe diving.
The related causes and risk factors associated with diabetes would be more concern as far as diving fitness are concerned.
-body weight: leaner body mass will make the diabetes easier to control and it's GREAT for diving.
-cardiovascular fitness: better fitness will generally equate to less demand for air, and less strain hauling gear, hiking to the beach etc.
glucose levels: if she has them under fairly tight control, a 1-2 hour period of leisure/exercise while diving should be no problem.
hope this helps. Give me a reply if you'd care to discuss anything more specific to diabetes. I am always intersted in learning more.
Cheers,
Scott
Before I give you my 2 cents I'm going to include a disclaimer... I am not a doctor, nor do I play one on TV. I am not familiar with her insulin pump or its operation. Consult with a diving doctor regarding her specific health condition.
Now, some thoughts. First, I too am diabetic, type 2 non-insulin dependent. I do take a minimum dosage of oral medication and follow a disciplined diet and exercise regime. Diabetes in itself is not a contraindicator to safe diving. The related causes and risk factors associated with diabetes would be more concern as far as diving fitness are concerned.
-body weight: leaner body mass will make the diabetes easier to control and it's GREAT for diving.
-cardiovascular fitness: better fitness will generally equate to less demand for air, and less strain hauling gear, hiking to the beach etc.
glucose levels: if she has them under fairly tight control, a 1-2 hour period of leisure/exercise while diving should be no problem.
hope this helps. Give me a reply if you'd care to discuss anything more specific to diabetes. I am always intersted in learning more.
Cheers,
Scott
TexasMike
Contributor
Jakendal posted his question in both the Dr. Deco forum and here. Since this forum was the most appropriate, I worked my moderator's magic and brought everything over here.
-TexasMike
-TexasMike
Campana
Guest
I've got a buddy that is diabetic and I looked up some stuff for him on the net. Divers Alert Network (DAN) has some studies going on in which they establish a suggested protocol for diving with diabetes. I think I remember that they suggest taking blood sugar levels 2 hours before you dive, immediately before you dive, and between dives. If blood suger is steady or increasing, you can dive. If it's decreasing, you don't.
They also want your "Hemoglobin A1C test" to be fairly good. I hesitate to put the actual number in here, you can get it from DAN, but the HA1C is a test that tells your Doc what your average blood sugar has been over a three month period, I think.
I also found that DAN guidelines are conservative. A review of studies that I read about 6 months ago said that no study has indicated that a diver had a serious problem because of his or her diabetes. That doesn't mean is hasn't happened, it just means that they didn't find any.
My suggestion is to read the DAN material and then to search online for other opinions.
The danger of concealing your wife's diabetes is of course that she might get into trouble and no one would know what to do. The reason I bring up the concealment issue is because that's what a lot of people do in order to be allowed to dive, or they just don't check anything on their medical form because they don't want to take a physical.
Talk to a diving Doc, weigh the risk, take precautions, and be realistic before she decides to dive.
Good luck.
Disclaimer: I'm not that kind of Doctor, this is just what I found on the net.
Dave
They also want your "Hemoglobin A1C test" to be fairly good. I hesitate to put the actual number in here, you can get it from DAN, but the HA1C is a test that tells your Doc what your average blood sugar has been over a three month period, I think.
I also found that DAN guidelines are conservative. A review of studies that I read about 6 months ago said that no study has indicated that a diver had a serious problem because of his or her diabetes. That doesn't mean is hasn't happened, it just means that they didn't find any.
My suggestion is to read the DAN material and then to search online for other opinions.
The danger of concealing your wife's diabetes is of course that she might get into trouble and no one would know what to do. The reason I bring up the concealment issue is because that's what a lot of people do in order to be allowed to dive, or they just don't check anything on their medical form because they don't want to take a physical.
Talk to a diving Doc, weigh the risk, take precautions, and be realistic before she decides to dive.
Good luck.
Disclaimer: I'm not that kind of Doctor, this is just what I found on the net.
Dave
Hello Jakendal:
Answers are for information only, do not imply diagnosis or treatment and should always be used in conjunction with the advice of your personal physician.
If the insulin pump contains air, it might implode on descent or explode on ascent. You might check with the manufacturer to see if it has been tested as waterproof at depth.
It is doubtful that anyone has a great deal of experience concerning diving with insulin pumps.
DAN ( Divers Alert Network) suggests that some diabetics may dive safely in controlled settings. The Diabetes and Diving Committee of the Council on Exercise of the American Diabetes Association notes that there are currently a substantial number of diabetics, in the United States and elsewhere, who dive.
Here are some criteria for diving with the condition:
--good control of blood glucose levels
--freedom from severe secondary complications of diabetes (eyes, kidneys, blood vessels)
--an understanding of the relationship between the disease and exercise
Diabetics who shouldn't dive are those who:
--have had a serious hypoglycemic episode within the past 12 months
--have advanced secondary complications of the disease
--have poor control of their blood sugar
--are unaware of the early warning signs of hypoglycemia
--lack insight into the relationship between diabetes and exercise
BSAC recommendations are similar, though more rigorous. A questionnaire must be filled out by the prospective diver, and a separate one completed by the diver's physician. In addition, BSAC has developed guidelines concerning what additional gear and supplies diabetic divers should carry, and proposes a pre- and post-dive plan in order to minimize risks. BS-AC monographs are at http://www.bsac.org/medical/index.html .
If she is taking an oral hypoglycemic in addition to the insulin pump, she should not take oral medication the night before or day of planned SCUBA dives, unless directed to do so by the diver's personal physician. In addition, she should not be taking other medication that might have a hypoglycemic effect, such as beta blockers. Prolonged low blood sugar is the very real danger with oral hypoglycemics. Hyperglycemia, although important over a several day period, would not be of major concern while omitting the drugs for diving.
The YMCA has an extensive diving protocol for diabetic scuba divers. It carefully differentiates the divers with mild diabetes and those with frequent changes in blood sugar levels and hypoglycemia.
Best regards for safe diving!
Ern Campbell, MD
Diving Medicine Online
http://www.scuba-doc.com/
Answers are for information only, do not imply diagnosis or treatment and should always be used in conjunction with the advice of your personal physician.
If the insulin pump contains air, it might implode on descent or explode on ascent. You might check with the manufacturer to see if it has been tested as waterproof at depth.
It is doubtful that anyone has a great deal of experience concerning diving with insulin pumps.
DAN ( Divers Alert Network) suggests that some diabetics may dive safely in controlled settings. The Diabetes and Diving Committee of the Council on Exercise of the American Diabetes Association notes that there are currently a substantial number of diabetics, in the United States and elsewhere, who dive.
Here are some criteria for diving with the condition:
--good control of blood glucose levels
--freedom from severe secondary complications of diabetes (eyes, kidneys, blood vessels)
--an understanding of the relationship between the disease and exercise
Diabetics who shouldn't dive are those who:
--have had a serious hypoglycemic episode within the past 12 months
--have advanced secondary complications of the disease
--have poor control of their blood sugar
--are unaware of the early warning signs of hypoglycemia
--lack insight into the relationship between diabetes and exercise
BSAC recommendations are similar, though more rigorous. A questionnaire must be filled out by the prospective diver, and a separate one completed by the diver's physician. In addition, BSAC has developed guidelines concerning what additional gear and supplies diabetic divers should carry, and proposes a pre- and post-dive plan in order to minimize risks. BS-AC monographs are at http://www.bsac.org/medical/index.html .
If she is taking an oral hypoglycemic in addition to the insulin pump, she should not take oral medication the night before or day of planned SCUBA dives, unless directed to do so by the diver's personal physician. In addition, she should not be taking other medication that might have a hypoglycemic effect, such as beta blockers. Prolonged low blood sugar is the very real danger with oral hypoglycemics. Hyperglycemia, although important over a several day period, would not be of major concern while omitting the drugs for diving.
The YMCA has an extensive diving protocol for diabetic scuba divers. It carefully differentiates the divers with mild diabetes and those with frequent changes in blood sugar levels and hypoglycemia.
Best regards for safe diving!
Ern Campbell, MD
Diving Medicine Online
http://www.scuba-doc.com/
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Hi Jakendal,
It's from one of my past Rodale's "Ask RSD" columns:
"Are there restrictions to diving with diabetes?" W.A., Bozeman, MT.
Diabetes, along with asthma & seizure disorder, ranks among the most controversial medical conditions affecting divers. Diabetes was considered by many in the medical & dive community as a contraindication to scuba until opinion began to change in the early & mid-1990s. At present, the Undersea & Hyperbaric Medical Society and the YMCA have detailed protocols for approving diabetic divers, and British Sub-Aqua Club allows certification with clearance from a medical referee. DAN is currently conducting an extensive study of diabetic divers, and additional guidelines will very likely result. In addition, there is an outstanding dive program for diabetics age 17 and older, Camp DAVI (Diabetes Association of the Virgin Islands) located on St. John. It is operated by the University of the Virgin Islands and has diving diabetologists on staff, some of whom have the condition themselves.
As you know, the body uses the sugar glucose for fuel, and the hormone insulin is necessary for cells to metabolize it. In diabetes, the pancreas fails to secrete enough insulin, or the body's cells resist entry of insulin, and glucose builds to dangerous levels in the blood. The immediate result is cells are temporarily starved for energy, while over time damage to the eyes, kidneys, heart or peripheral nerves can occur. Signs and symptoms of diabetes can include intense hunger, thirst and tiredness, as well as weight loss, frequent urination, blurred vision, and even seizures and coma.
For the diabetic diver, the most worrisome immediate risk is blood glucose falling to a level where hypoglycemia, or low blood sugar, is precipitated. This can result from events such as too much insulin, alcohol or exercise, or too little or improper eating. An episode can cause weakness, tremor, sweatiness or chilling, irritability, alterations or loss of consciousness, and convulsions.
The diabetic must also be aware of the possibility of hyperglycemia occurring when insulin runs low enough that the body breaks down stored fat for energy. This process can eventuate in breathing difficulty, alterations or loss of consciousness & shock. If left untreated, both hypo & hyperglycemia can result in death.
While the criteria for clearance to dive differ among agencies, they generally include such things as a demonstrated understanding of diabetes, awareness of when a hypoglycemic episode is imminent, good control of the disease with no severe episodes within the past year, and no related abnormalities of the eyes, kidneys, heart or nerves which pose an additional risk. Some protocols include depth limitations to those above which nitrogen narcosis is likely to occur so as to avoid confusion of this phenomenon with a life-threatening hypoglycemic episode.
Clearly it is unwise to deny or minimize this condition to yourself, or hide it from your instructor or the ops with which you dive. If you have diabetes and want to dive, or are already diving without medical clearance, it is critical that you consult a physician to obtain an appropriate medical work up & permission to dive. Even after clearance to dive, it is prudent to carefully monitor blood glucose throughout the course of the dive trip, especially prior to a dive. Measurements at 1hr, 30min & 5-10min prior to a dive would not be excessive. Finally, bring on board whatever substances you use for controlling abnormal glucose levels, and make sure your dive buddy also carries & knows how to use them."
Hope you found this informative.
DocVikingo
It's from one of my past Rodale's "Ask RSD" columns:
"Are there restrictions to diving with diabetes?" W.A., Bozeman, MT.
Diabetes, along with asthma & seizure disorder, ranks among the most controversial medical conditions affecting divers. Diabetes was considered by many in the medical & dive community as a contraindication to scuba until opinion began to change in the early & mid-1990s. At present, the Undersea & Hyperbaric Medical Society and the YMCA have detailed protocols for approving diabetic divers, and British Sub-Aqua Club allows certification with clearance from a medical referee. DAN is currently conducting an extensive study of diabetic divers, and additional guidelines will very likely result. In addition, there is an outstanding dive program for diabetics age 17 and older, Camp DAVI (Diabetes Association of the Virgin Islands) located on St. John. It is operated by the University of the Virgin Islands and has diving diabetologists on staff, some of whom have the condition themselves.
As you know, the body uses the sugar glucose for fuel, and the hormone insulin is necessary for cells to metabolize it. In diabetes, the pancreas fails to secrete enough insulin, or the body's cells resist entry of insulin, and glucose builds to dangerous levels in the blood. The immediate result is cells are temporarily starved for energy, while over time damage to the eyes, kidneys, heart or peripheral nerves can occur. Signs and symptoms of diabetes can include intense hunger, thirst and tiredness, as well as weight loss, frequent urination, blurred vision, and even seizures and coma.
For the diabetic diver, the most worrisome immediate risk is blood glucose falling to a level where hypoglycemia, or low blood sugar, is precipitated. This can result from events such as too much insulin, alcohol or exercise, or too little or improper eating. An episode can cause weakness, tremor, sweatiness or chilling, irritability, alterations or loss of consciousness, and convulsions.
The diabetic must also be aware of the possibility of hyperglycemia occurring when insulin runs low enough that the body breaks down stored fat for energy. This process can eventuate in breathing difficulty, alterations or loss of consciousness & shock. If left untreated, both hypo & hyperglycemia can result in death.
While the criteria for clearance to dive differ among agencies, they generally include such things as a demonstrated understanding of diabetes, awareness of when a hypoglycemic episode is imminent, good control of the disease with no severe episodes within the past year, and no related abnormalities of the eyes, kidneys, heart or nerves which pose an additional risk. Some protocols include depth limitations to those above which nitrogen narcosis is likely to occur so as to avoid confusion of this phenomenon with a life-threatening hypoglycemic episode.
Clearly it is unwise to deny or minimize this condition to yourself, or hide it from your instructor or the ops with which you dive. If you have diabetes and want to dive, or are already diving without medical clearance, it is critical that you consult a physician to obtain an appropriate medical work up & permission to dive. Even after clearance to dive, it is prudent to carefully monitor blood glucose throughout the course of the dive trip, especially prior to a dive. Measurements at 1hr, 30min & 5-10min prior to a dive would not be excessive. Finally, bring on board whatever substances you use for controlling abnormal glucose levels, and make sure your dive buddy also carries & knows how to use them."
Hope you found this informative.
DocVikingo
reddog
Registered
I am a type 1 Diabetic for 37 years, 30 of which I have been diving. I went on an insuling pump about 2 years ago. I am under excellent control and exercise regularly. This is how I manage my diabetes when I dive:
- I go off the pump. Firstly, because the combination of short-acting humalog with the amount of exercise in diving almost guarantees that your blood sugar will drop and secondly because I am afraid of the effects of increased pressure on the delivery mechanism, i.e. will it cause more to be squeezed out.
- I switch to NPH, long acting insulin. This has a peak time of 6 - 8 hours. That way you are getting metabolic coverage while you are exercising but with reduced risk of hypoglycemia while diving. In conjunction with this, I take Humalog to cover any food as I eat it.
- I test myself 1 hr before and right before. This establishes a directional trend that I can manage against. As someone else said, if I am going up or staying neutral, it's okay to dive, but going down needs immediate addressing. I also tend to let myself run a little high during a dive day.
- I keep coke or something nearby on board and bring glucose in sealed foil down with me, just in case. Never needed to use it.
- Drink a lot of water. Dehydration can worsen the effects of Hypoglycemia.
As everyone else has said, I am not a doctor so take this advice for what it's worth. I started out by sitting down with my Endocrinologist and thinking it through. This is what I got to. Good luck.
P.S. How does your wife go down with a pump? Where does she keep it? I can see it if yu are wearing a dry suit, but a wet suit eludes me.
- I go off the pump. Firstly, because the combination of short-acting humalog with the amount of exercise in diving almost guarantees that your blood sugar will drop and secondly because I am afraid of the effects of increased pressure on the delivery mechanism, i.e. will it cause more to be squeezed out.
- I switch to NPH, long acting insulin. This has a peak time of 6 - 8 hours. That way you are getting metabolic coverage while you are exercising but with reduced risk of hypoglycemia while diving. In conjunction with this, I take Humalog to cover any food as I eat it.
- I test myself 1 hr before and right before. This establishes a directional trend that I can manage against. As someone else said, if I am going up or staying neutral, it's okay to dive, but going down needs immediate addressing. I also tend to let myself run a little high during a dive day.
- I keep coke or something nearby on board and bring glucose in sealed foil down with me, just in case. Never needed to use it.
- Drink a lot of water. Dehydration can worsen the effects of Hypoglycemia.
As everyone else has said, I am not a doctor so take this advice for what it's worth. I started out by sitting down with my Endocrinologist and thinking it through. This is what I got to. Good luck.
P.S. How does your wife go down with a pump? Where does she keep it? I can see it if yu are wearing a dry suit, but a wet suit eludes me.
My wife has been given the OK from her diabetes doctor. We are planning to start taking classes this month. As far as diving with her pump, that is pretty much out of the question. I checked with Mini-Med and the pump won't take the pressure. However, their new model, due out this month, will be waterproof...to 8 feet!
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Hi jakendal,
Well, that is good news.
A pump good to eight feet, eh? Hey, on the bright side gas management skills & DCS are a nonissues while you're wearing that baby.
Hope your wife enjoys her training.
DocVikingo
Well, that is good news.
A pump good to eight feet, eh? Hey, on the bright side gas management skills & DCS are a nonissues while you're wearing that baby.
Hope your wife enjoys her training.
DocVikingo
reddog
Registered
Well, please let us know how she gets on. Personally, the worst part of the whole experience has been the instructors and the shops. It is not unusal to have them hand me the form and tell me to 'just answer no to all these medical questions'.
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