Heartbroken and need some advice...

[BoundForElsewhere]

Hi Serge,

Diving is one of the few endeavors where I might hesitate to second guess a professional. I stress might but even still, you are breathing under fcking water.

And tech is going so deep you can't even breathe air. I'd error on the side of caution maybe a wee bit. Are there degrees of technical?

Maybe you could just stap on lots of tanks, buy a Shearwater and call it a day?

 

[Bubblesong]

I have decided that my path in diving with be to keep diving as long as i can, But go shallower and easier over time to just keep getting in the water. There are many avenues of fun, they don’t have to be tech to be striking out on new paths.

 

[Sidemount Serge]

Hey there,

It is not that I am second guessing the dive doctor, it is just that they told me “ you are fit to dive, but you have to have restrictions because you are diabetic and if I don’t give them to you my reputation as a dive doctor will suffer”.

The same thing happened to me when I was getting my medical exam during my driving test. When I came in to the center I told the people I had a Prosthetic leg, the doctor did a bunch of tests on me and signed me off without restrictions. When I was about to get the paper the receptionist went to his office and he doctor called me back again and said “you have to have restrictions because you have an artificial leg”. I know plenty of people that drive manual with a prosthetic.

If the dive doctor says I am fit to dive, however they have an issue with diabetic divers, and my endocrinologist tells me that I am also fit to dive and that my condition will not affect me, should I only take the dive doctors view? Even though they are not specialist in metabolic disorders and they are following DAN guidelines written more than 15 years ago?

The thing is that, as it was said, this would be a speciality within a speciality. So blindly trusting a dive doctor who didn’t inform me they would slap limitations in the form, even though I told them that it was to start a tec diving corse, makes me think they looked up the DAN guidelines and just put them there because It said so in the book.

Also, if I followed their guidelines I couldn’t dive for longer than 60 minutes, my longest was 70 min in a shallow dive, and I couldn’t go deeper than 30m or dive Nitrox, even though I have both those specialities and have done so in various occasions.

All the best,

Serge

 

[lexvil]

Can you feel a crash coming? I can but I usually make med adjustments depending on what sort of diving I’ll be doing, get back into some exercising to bring A1C down and worry less about situational spikes, if you feel the signs of a crash eat.

 

[formernuke]

I was completely asymptomatic when low, till I got really really low.

 

[Duke Dive Medicine]

I'm trying to find a polite way to say that I believe your doctor is full of crap. Definitely find another doctor!

Interestingly enough, he is not. Diabetics can drop their blood glucose levels precipitously during hyperbaric oxygen treatment. I've seen it happen myself. It doesn't happen terribly often and there is usually something else going on (e.g. a very sick patient who's on a continuous IV insulin drip, or a type I diabetic patient who takes his morning insulin but then doesn't eat), but it does happen. This may be where the physician got this statement. I'm not sure that the literature supports restricting diving on a well-controlled type II diabetic, but it's at least worthy of consideration.

Blood glucose levels in diabetic patients undergoing hyperbaric oxygen therapy - PubMed
Integration of Data to Establish a Standard Operating Procedure for the Diabetic Patient Undergoing Hyperbaric Oxygen Therapy - PubMed
The incidence of hypoglycemia during HBO2 therapy: A retrospective review - PubMed

Hey guys,

I got into diving two years ago, it stemmed from an obsession because a doctor in a resort in Maldives said I couldn't dive because I had Diabetes type II.

When I got back home I went to an endocrinologist to ask if he could sign my medical form, he said yes because I am young, in relatively good shape and have my Diabetes under control, only thing is that he recommended that I have a snack before I dive, which I have been doing as part of my pre dive rituals.

Skip a few years forward and I am now a Rescue Diver with over 60 dives under my belt, various specialties and I have dived in various locations around the world, I love diving it is my main hobby and when I am out of the water I am always thinking about how to tinker with my kit and how to improve my trim, etc.

I thought I was ready for my next step, Tec Diving. I have been planning this since the start of the pandemic, which set me back a few months but since things are starting to go back to normal I thought it would be time to take the plunge - excuse the pun -. So I got various pieces of kit that I needed, read through most of the PADI Tec Diver course (40-45-50) and even set up a meeting with dive doctor to get a check up to get started.

Today I received a call from the Doctor and I was told that everything was fine except that my A1C was a little elevated, which could be attributed to lack of exercise during the lockdown. In this regard, I was told that I was fit to dive, however I could not do decompression dives or go below 30 meters.

Right now I feel exactly the same as I did when the doctor in the resort told me I couldn't dive, all my life I have been told the things I couldn't do and I did them anyway - I am a right leg congenital amputee and I use a Dive Leg because I got tired of getting help when I was crawling to get my gear ready - but this time I am at a loss, if i take the form to the dive center it is likely that they will reject me.

Please give me some advice, I am considering going and having a chat with my endocrinologist to ask him what I should do next and if he could sign the doctors note. I hate that I have conditions that are underlined in some manual and that is enough to stop me from perusing what I want to archive.

Sorry for the long post, but I really need you guys.

All the best,

Serge

Hi @Sidemount Serge ,

There are published recommendations for diving with diabetes, linked below. This might help you formulate some questions for your physician.

https://www.diversalertnetwork.org/files/UHMS_DAN_Diabetes_Diving_2005_Workshop_Proceedings.pdf

Best regards,
DDM

 

[tursiops]

There is far too much Type 1 information and restriction being applied willy-nilly to Type 2, or, if you prefer, to NIDDM.

 

[Duke Dive Medicine]

There is far too much Type 1 information and restriction being applied willy-nilly to Type 2, or, if you prefer, to NIDDM.

Arguably so, which is where we turn to the (admittedly confusing) literature. From the first paper I linked above: "A statistically significant greater percentage of treatments of patients with type 2 diabetes resulted in a decrease in BGL (1598 or 77.5%) compared to treatments of patients with type 1 diabetes (169 or 51.5%) (χ2(1, N=1767) =55.37, p⟨0.001)."

Best regards,
DDM

 

[caydiver]

So since you have already done many dives that were outside the parameters you were given are you looking for someone to just say you go do what you want to do? No one has a crystal ball to confirm if the doc is right or wrong. But from another perspective I see people who end up in the chamber for dive related incidents. Some of them have dedicated their lived to diving and are there because fate intervened. Some are there because they pushed against the guidelines, but whichever, those that are told they probably should not dive again are devastated. I have 1000 dives give or take and just cannot imagine not diving but then again I love every dive where I get wet and the repeat dives are the ones where the biggest discoveries often happen. I loved taking courses and challenging myself, but I also love just diving for the sake of diving and would hate to jeopardize my ability to do that.

 

[tursiops]

Arguably so, which is where we turn to the (admittedly confusing) literature. From the first paper I linked above: "A statistically significant greater percentage of treatments of patients with type 2 diabetes resulted in a decrease in BGL (1598 or 77.5%) compared to treatments of patients with type 1 diabetes (169 or 51.5%) (χ2(1, N=1767) =55.37, p⟨0.001)."

Best regards,
DDM

Well, yes, but the conclusions of that linked study suggest this is not worth even worrying about, especially for type 2, NIDDM.

Conclusion: Our results suggest that HBO2 does not cause a clinically significant decrease in diabetic patient BGL. No patient in our study had deleterious side effects or required emergency care. We found that glucose level of ⟨90 mg/dL occurred more often in those who use insulin. ​