diabetes

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IndigoBlue:
The terms are stated in the NAUI medical forms.

1. If you found "chronic heart disease" on a NAUI form, I still argue it doesn't make sense. If it's there, that's for a physician to interpret & decide which chronic heart disease a potential diver has, and whether or not diving should be contraindicated. It does not imply that all patients with any sort of heart disease should not be allowed to dive.

2. I don't see "chronic heart disease" on the NAUI medical evaluation and physician approval form. Furthermore, there are far more absolute contraindications to diving than the 4 you listed, and these are outlined nicely on their form. Regarding the four you mentioned, note that:
1. ACTIVE asthma is an absolute contraindication; adding that one word clearly opens this interpretation up to a wide range of debate, which has been beaten to death in other threads & forums, and need not be rehashed here.
2. Cerebral palsy without history of seizure is a relative contraindication only.
3. The only cardiovascular ABSOLUTE contraindications listed are asymmetric septal hypertrophy with valvular stenosis (more commonly referred to now as hypertrophic obstructive cardiomyopathy, or HOCM) and congestive heart failure. Multiple other "chronic heart diseases" are relative contraindications only...i.e., let the physician provide advice.
4. Diabetics requiring insulin or oral hypoglycemic agents are listed by NAUI as an absolute contraindication. This could be further discussed with a dive physician, as I believe that even these cases can be individualized.

jim
 
IndigoBlue:
Everybody has got to die sometime. Whether now or 50 years from now, what is the difference? (Quote by Achilles in "TROY".)

People with the following medical conditions should not be diving:

Insulin dependent diabedes
Asthma
Epilepsy or cerebral palsy
Chronic heart disease or PFO

Its a short list, and easy to memorize.

Thats funny, stats say that 30% of the earths population have PFO's. You may have one and not even know it or ever know it.
 
The issues around this have changed over the last few years. In the recent past, diabetes (of any type) was cause for a "no dive" call.

The major concerns seem to be threefold: hypoglycaemic shock leading to unconcious, cold and pressure masking hypoglycaemic symptoms, and inability to go directly to the surface to intake sugar if required. Stress, unfamiliar physical activity, and cold can increase sugar uptake and cause issues.

BSAC and PADI have changed thier tune last year and although a doctor's OK is still required prior to training, diving is permited if

1. The diabetic has not experienced any hypoglycaemic attack within the last year.

2. The diabetic has not been hospitalised for any reason connected with diabetes in the last year.

3. The physician in charge of the diabetic at the diabetic clinic must consider the level of control to be satisfactory. This implies that the long-term control of the diabetic condition must be good. A guide to this may be obtained from the HbA or fructosamine level. The physician must also be able to state that he/she considers the potential diabetic diver to be mentally and physically fit to undertake the sport of diving.

4. There must be no microalbuminuria present. Any degree of retinopathy beyond background retinopathy is not allowed. There must be no evidence of neuropathy (sensory, motor or automatic), nor of vascular or microvascular disease beyond the background retinopathy in the eye. (Heck - I don't even know what microalbuminuria is.... )


There are several countries like Eygpt and Malta that had "no diabetes" on thier web sites still.

A good dive savy doctor is essential to making this determination. Full understanding of the impact of diabetes for both the diver and thier buddy is critical as well as diving within the limits of safety, training, and comfort.


PS... I'm not a doctor but this is important to me.
 
Ontario Diver:
...There must be no microalbuminuria present. Any degree of retinopathy beyond background retinopathy is not allowed. There must be no evidence of neuropathy (sensory, motor or automatic), nor of vascular or microvascular disease beyond the background retinopathy in the eye. (Heck - I don't even know what microalbuminuria is.... )

Thanks for the informative post. I find the above quoted criterion particularly interesting, as it's saying that those with microvascular disease shouldn't dive. I'm wondering the rationale behind this. I would agree that those with autonomic neuropathy probably shouldn't be diving, as they may not have appropriate physiologic changes in heart rate & vascular resistance in response to pressure changes. As for the retinopathy & nephropathy, I'm curious as to why this would be a contraindication...not saying it shouldn't be, but I'd be interested in any available literature regarding effects of pressure on diabetic retinal eye disease, etc.

(Microalbuminuria, by the way, is urinary albumin excretion in the 30-300mg/day range, normal being < 30mg/day. Diabetes can affect the kidneys, and the earliest clinically detectable phase of diabetic renal dysfunction is microalbuminuria.)

Jim
 
I just did a MEDLINE search crossing (Diabetic Nephropathies/ or Albuminuria/ or microalbuminuria.mp. or Kidney Diseases/ or Kidney Failure, Chronic/ or chronic kidney disease.mp. or DIABETES MELLITUS, TYPE II/ or DIABETES MELLITUS, TYPE I/) AND (Decompression Sickness/ or Diving/ or scuba.mp. or Sports Medicine/ or Atmospheric Pressure/). Only 30 hits, only a couple of those relevant. (Notice the slant toward the kidney....sorry, that's my area, so I was selfish in my search....I included the Diabetes search terms to try and catch the rest...)

There was an abstract from a tiny, poorly designed study in Undersea & Hyperbaric Medicine (24(3):201-7, 1997 Sep.) that concludes "it may be safe to allow well-controlled subjects with type I diabetes with no long-term complications to undertake scuba diving, and that high partial pressures of oxygen do not seem to lower serum glucose levels significantly in the diabetic diver during the dive." I wouldn't have concluded this based on their study of eight patients in a chamber...not exactly generalizable. Getting back to the question of needing to exclude those with microvascular disease, I was intrigued that they selected subjects with "no long-term complications;" not sure what these included, and I doubt highly that microalbuminuria was considered a long-term complication, for example. Need the full paper.

There was an interesting letter to the editor in Diabetes Care 18(7):1074, 1995 Jul. They offer "practical guidelines," but they were not physicians trained in dive medicine, and they self-admitted limited personal experience with diving. So, the "guidelines" are simply personal opinion based on a questionnaire that one endocrinologist and a couple of nurses sent to 18 diabetics who dive. I thought their recommendations were reasonable though, once one has decided that they are going to dive (or allow a patient to dive) with insulin-requiring diabetes:

1. Blood glucose should be measured and be greater than 150 mg/dl before the dive, and the dive should follow a meal.
2. If blood glucose before the dive is less than 150 mg/dl, 5 g of glucose for every 25 mg under 150 mg/dl should be ingested. Carbohydrates in the form of simple sugars should be ingested, such as fruit juice, milk, or glucose tablets/liquid.
3. The diver should carry liquid glucose in the wet suit during the dive and use as needed.
4. The diver should measure the blood glucose after the dive and ingest glucose as needed.
5. The diver should always dive with a companion who understands how to recognize and treat a hypoglycemic reaction. When under water, divers should have a pre-arranged means to communicate the likely presence of hypoglycemia.
6. Glycemic control should be stable during the days of planned diving.
7. Alcohol should not be used 24 h before or during diving activities.

Jim
 
Both OD and I have been looking at pages this weekend and have found alot of info concerning this issue. I will be passing them on to EM to consider asap. Links provided upon request.
 
GoBlue!:
... I find the above quoted criterion particularly interesting, as it's saying that those with microvascular disease shouldn't dive. ...


Hey Jim;

I (not being a Dr. but recognizing that I have more than two Grandparents who have died from diabetic complications and want to keep diving....) think that it is the combination of diabetes and microvascular issues should that cause a consideration of not diving.

My thought is that the microvascular issues may retard off gasing and make the current tables non-effective thus rather than developing specific tables - diving becomes contra-indicated.

A thought about the neuropathy (once again - I am not a Dr., nor do I play one on TV nor have I watched the entire series of ER!) being dumped into water (and especially cold water) can cause a need to ummm go. Perhaps these are linked?

As for the retinopathy, I am aware that the retina and cornea are especially susepable to O2 toxicity issues. Perhaps the vascular issues surronding the retinopathy make the retina more suseptable to O2 issues?
 
I started this because of myself and I wanted others to share their experiences. I'm glad to see such an interest and hope that we all learn something from it.

As in the case of myself, being a diet and oral controlled diabetic, I've never suffered from hypoglycemia and I ensure that my blood sugars are at a level whereby they will not drop below 7 after the dive. Also I have set a 90' limit, because the issue of getting narced is greater below that level. I also have good friends that I dive with who are worse than my mother in taking care of me, and I thank them very, very much for that.

PS:Ontario Diver: microalbuminuria is when the kidney or liver (I'm not sure which) excretes micro particles of protein (albumin) into the urine (uria). This is a sign of damage which occurs when a diebetic is not in control of his sugars.
 
My dive buddy is an Insulin Dependent Diabetic. He uses an insulin pump. He checks his blood sugar about 2 hours before a dive and then again right before suiting up. We both keep a tube of frosting in our bc pockets in the event that he feels low.

His endocrinologist knows and has okay'd his diving. He also has insurance through DAN which has no problem with him having diabetes.

He controls the diabetes, the diabetes doesn't control him.
 
IndigoBlue:
Everybody has got to die sometime. Whether now or 50 years from now, what is the difference? (Quote by Achilles in "TROY".)

People with the following medical conditions should not be diving:

Insulin dependent diabedes
Asthma
Epilepsy or cerebral palsy
Chronic heart disease or PFO

Its a short list, and easy to memorize.

I just have to chime in on this one...

I am 31 years old and have had Type 1 diabetes since age 13. I have been wearing an insulin pump for the last 3 years and have no problems diving. I consulted with my doctor prior to diving, got the OK, and went forward. Diabetes has never stopped me from doing anything in my life... it just requires managing your sugar and knowing your limitations. I rode hard core motocross for 15 years and my diabetes never interfered with that. No, diving is not the same but the condition you require for motocross is incredible. I met with several other diabetics who dive (one with over 2200 dives under his belt) who are of the same mindset. Watch your diet, test your sugars, exercise regularly and make sure you do not smoke… FYI if you know what an AC1 is, mine runs at around 5.8 to 6.2 since I went on the pump, prior to that 7.2 to 7.7. If you take shots, get an insulin pump. It allows you to live a better lifestyle as before that, I was taking 4 shots per day. Diving routine is simple... Test your sugar, adjust accordingly... I like to leave mine around 130-150 pre dive. Do the dive, surface.. test the sugar, adjust accordingly. If it will be a more active dive then I like the sugar around 150-160 pre-dive.

By the way, this is my first post here and I really enjoy the board. This is a great place for info.
 

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