Diabetic Diving

[ToddK]

Hi JD,
I've been Type 1 diabetic since 2003, and have done about 150 dives since then, down to recreational limits and beyond. I use basal insulin, rather than an insulin pump, so the night before a dive, I cut my basal insulin injection in half. I once ran into a Type 1 diabetic who was using an insulin pump, and he would unplug the pump prior to the dive. What I have noticed is that in cold water, the insulin needs to be cut down more. I also carry PowerBar Gel packs in my drysuit, and practice using them underwater. I would tell your dad that carrying and practicing the use of some sort of available extra sugar (icing tube or gel pack) is mandatory, though I've only had one instance of having low blood sugar in the water. Pre and post dive blood sugar measurements also need to be done. The post dive measurements are very useful in understanding how much the blood sugar drops during a dive. Keep in mind that this will vary with water temperature, amount of excercise and duration during the dive.
If his doctor is OK with diving, I would recommend starting slowly like you stated. Plan a dive in a calm location with great viz. Go into the water with at least a blood sugar of 150 (this is what I do, his milage may vary). Practice using the icing tubes or gel packs. What works for me is to take a breath, put some gel in my mouth, do another breathing cylce, and then work on dissolving the gel with my tongue.

 

[kennedy]

Carry the gel/icing in your bc pocket. Practice a few times with him too - make sure he's comfortable taking his reg out - squeezing the gel in to his mouth and putting the reg back in. I tell my husband and my buddies to look at my eyes if I am acting different to them underwater. I get a "distant" look and my response time is slow - that's time to call it quits, take some gel, and head up. As Todd posted - he goes in with his sugar at 150 - I go in with mine higher. Your dad will have to find what works best for him and go with it. I unplug my pump right before I go in and plug it back in when I get back on the boat. I do much better with the pump than I did on injections while diving, on injections I used both a long and short acting insulin. The pump uses a short acting - much easier for me to keep the sugar under control for dives - not so many drops as I had with the long acting. Good luck with your dad!

 

[DrSteveJohnson]

It is worth mentioning that the diabetic diver also has to take end-organ damage into account in the risk assessment for diving. In particular I would be concerned about cardiovascular risk especially in someone who has been diabetic for several years. Therefore I would be very cautious about assessing cardiac health and at least want to see a normal ECG (EKG), good blood pressure control, lipids, BMI and possibly an exercise ECG.

Glycaemic control is, sadly, not the only concern.

Best Wishes,

Steve

 

[TSandM]

Good point, Steve.

 

[dschonbrun]

Steve's point is a good one.

Remember that diving does not make one fit... one must be "fit" to dive.

Cheers,
David

 

[kennedy]

It is worth mentioning that the diabetic diver also has to take end-organ damage into account in the risk assessment for diving. In particular I would be concerned about cardiovascular risk especially in someone who has been diabetic for several years. Therefore I would be very cautious about assessing cardiac health and at least want to see a normal ECG (EKG), good blood pressure control, lipids, BMI and possibly an exercise ECG.

Glycaemic control is, sadly, not the only concern.

Best Wishes,

Steve

I totally agree - I have blood work done every 3 months, an ekg once a year and see my endo at least 4 times a year. I had a stress test done last year. I love diving but don't get me wrong - once the doc pulls my diving clearance.............I will be a bubble watcher from then on!!!!

 

[bvanant]

I think that everyone agrees that only your personal physician can really help you know if you are fit for diving or not and that good control (HbA1c near 7) is essential. As for chamber toxicity and blood glucose lowering, I think that suggests no Nitrox for T1 diabetics while diving. My bigger physiological concern is for folks who have had diabetes for a while. As we all know there are lots of microvascular changes during decades of diabetes and many of them lead to an increase in capillary fragility and stiffening of the microvasculature. I am worried about the effects of outgassing and very tiny bubbles on folks who have stiffer than normal vessels, particularly in the eye. I haven't seen any published data on gas distribution in the eye, but I would keep my dives relatively shallow and relatively short if it were me.

Bill

 

[padiscubapro]

My father is a type I, insulin dependent diabetic. He has been since he was 13. However he is a NAUI OW certified diver since 1977, but he may have dove a handful of times since then.
I just earned my NAUI AOW and am already an addict. I would like very much to share my new hobby with him and dive together when we go on our annual family vacation to the NC outer banks.
The only problem is that I am concerned about his diabetes. He is insulin dependent but he has been on an insulin pump for 7+ years. His blood sugar has been managed very well his whole life but particularly well since the pump. As diabetics go he is in very good health, he has no outstanding medical issues other than the diabetes and is in his early 50's.

I want to get him in the water but am not sure if its safe, before I got certified we went hookah diving to 20' but the dive op wouldn't let him do any more than snorkle, even as a certified diver. Their reasoning was because he was a diabetic.

Are there any diabetic divers on the board or do you personally know any or have experience with one? What special issues do they have to contend with?

PS. My mom is OW certified since 1978 but I cant drag her in the water with an anchor...she wants nothing to do with SCUBA other than taking pictures from the boat

I am no doctor but I am a diabetic and have been for a long time.. If your father is serious about wanting to dive he should seek out his prinmary care doctor and try to get referred to one specializing with dive medicine..

As a general rule of thumb.. days I will dive I lower my insulin dosage (I don't recommend people on oral medixcations to dive due to the long half time of the drugs) and immediately before entering the water I eat something high in carbs that will be released over the dive.. I keep a sugary solution that I can take during the dive if necessary..

For open water dives where a drift is possible and I might not be able to get on board for an extended period of time, I have a water proof cannister (200M) that I have filled with energy bars so I can eat in an extended surface drift)

This is for reasonable length dives (a dive of 3 hours or less).. WHen I am doing longer dives I have a "runners bag" filled with a fruity solution or "power drink" to periodically take drinks over the entire dive (for both sugar and for hydration), on really extended runs I even bring foods that I can eat underwater..

Rember you body wants to try and maintain its core temperature so even in warm water you burn more fuel (calories)..

I do not restrict my diving to recreational depths, in fact well beyond that to what most would call exploration diving.. To this day I have never had an issue in the water, In the last 15 years I had one episode where my BS was a bit low (I felt a little weak but it was still ok) after the dive and can priobably being attributed to not eating immediately after the dive (it was lunch time) but instead dragging all my gear (it was also a length that I would not have been eating underwater)..