Heartbroken and need some advice...

[Duke Dive Medicine]

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. ​

Fair statement, but that's in a dry hyperbaric chamber, not immersed. Hypoglycemia increases the risk of CNS O2 toxicity, which is less risky and more easily managed in a hyperbaric chamber. I posted the references just to point out that the MD wasn't completely in left field being concerned about hyperoxia in a diabetic patient - those studies were done after lots of case reports of hypoglycemic diabetic patients seizing in the chamber. The DAN/UHMS recommendations for diving with diabetes are more pertinent to the current conversation though, IMO.

Best regards,
DDM

 

[Sidemount Serge]

Hey there,

Quick update, I went to my endocrinologist Today and he told me that the pills I take will not generate hypoglycaemia, so he wrote in my form that I could dive without restrictions.

I told my trainer about my condition as well as my visit to the dive doctor and my endocrinologist, so she told me that I needed to get them both to talk it out.

Not sure what it will achieve, but this is getting way too messy.

So the dive doctor is saying I can dive with restrictions because of my condition and my endocrinologist is saying I shouldn’t have any restrictions.

think this is getting way too complicated...

all the best,

Serge

 

[Duke Dive Medicine]

Hey there,

Quick update, I went to my endocrinologist Today and he told me that the pills I take will not generate hypoglycaemia, so he wrote in my form that I could dive without restrictions.

I told my trainer about my condition as well as my visit to the dive doctor and my endocrinologist, so she told me that I needed to get them both to talk it out.

Not sure what it will achieve, but this is getting way too messy.

So the dive doctor is saying I can dive with restrictions because of my condition and my endocrinologist is saying I shouldn’t have any restrictions.

think this is getting way too complicated...

all the best,

Serge

Serge,

I recommend you listen to the dive physician.

Best regards,
DDM

 

[tursiops]

Serge,

I recommend you listen to the dive physician.

Best regards,
DDM

His dive physician does not seem on top of things......maybe some other, more current, dive physician?

 

[Sidemount Serge]

The issue is that the Dive Doctor is not an endocrinologist, so their judgement is based on guidelines by DAN, who are just an NGO.

Also the logic behind it is completely flawed, since in various studies pressure does not affect glucose, the only factors would be exercise, cold and gasses. As far as cold and exercise is concerned, this should not affect a diabetic because all exercise and cold do is burn glucose and fat to keep the body heat up.

As for the gases, I have been diving nitrox for a while now and I have never really had a problem.

From what I understand, the issue is the depleting of glucose in the blood because of foreign factors and the extended time you spend underwater. Yet, since the medication I am taking does not have a single case of causing a hypo, I think I am just getting slapped with restrictions not because of my safety but because of perceived liability reasons.

I have been trying to find an Endocrinologist Dive Doctor, but still no luck.

 

[wstorms]

The issue is that the Dive Doctor is not an endocrinologist, so their judgement is based on guidelines by DAN, who are just an NGO.

Does being an NGO disqualify them from having an informed opinion? You are asking random people on the internet for medical advise, so DAN might one of the more reliable sources here.

Also the logic behind it is completely flawed

If you really truly feel you are qualified to make that call, who is going to stop you from acting on it? If your loved ones feel the same way, you are free to risk whatever you want.

As for the gases, I have been diving nitrox for a while now and I have never really had a problem.

I have broken the speed limit several times and yet I never crashed into a tree. Doesn't mean it will therefor never ever happen.

Yet, since the medication I am taking does not have a single case of causing a hypo, I think I am just getting slapped with restrictions not because of my safety but because of perceived liability reasons.

Obviously those go hand in hand; if everything was absolutely save, nobody would have any reason to sue. Are you willing to turn the argument around as well? Will you be thanking the training organisation, doctors, DAN, people on the internet for trying to inform you and keep you safe? Do you consider the fact that they can only advise you as long as they don't risk going to jail for mistakes you might make because of their advise?

I have been trying to find an Endocrinologist Dive Doctor, but still no luck.

Probably a bit of a unicorn, but who knows. Like suggested above, it might be better to have both specialists call each other, maybe with you in the same room as well.

Earlier in the tread you said you didn't want to just pay for a signature, but wanted solid medical advise. I understand it must be extremely frustrating if that advise doesn't go as you hope, but please make sure to hold on to your earlier statement. Go for proper medical advise and stay on the conservative end of that.

 

[Sidemount Serge]

Being an NGO doesn’t disqualify them from having an opinion, however they are not a government organization or an international health organization, they should have no say in laws or regulations, however some dive doctors take them like the law.

Their research is based on data of over 15 years ago, not to mention DAN is not an Endocrinological organization. So I would far rather trust a specialist on the subject, than an organization that makes blanket restrictions rather than stating each case should be evaluated.

Also, what is stopping me from training is the blanket statements from that organization, if I don’t have the form I cannot do the training. Furthermore, the liability waivers we always sign before a dive exempt the PADI and the Dive Center from libel. As far as the doctor is concerned in his profesional opinion (as a specialist in diabetes) and the studies on the medication I take, I would not be in danger. If something would happen I would not sue the doctor, Tec has risks and I am willing to take them.

Also the reason why I started this is because I was sad and wanted to hear the opinion of other divers and see if what I was thinking was unreasonable.

Also, I have been diving nitrox, been below 30m and diving wrecks because I have the specialities and training for it. So I do not appreciate your comparison to me doing something I am trained for to speeding. It is like me telling you that you to stop diving because you might drown.

However, if I had found that there were no diabetic tec divers, someone provided a reasonable reason why I shouldn't do it or if what the dive doctor (who is a GP by the way) said was coherent to what a specialist in my condition said, I would desist from it.

Finally, it is no ones job to keep me safe, I can do that myself. As a diver you should know that we all accept the risk of what we do, remember that to non divers we are insane because we are going to get eaten by a shark any day now.

What pisses me off about all of this is that this creates more risks for people with my condition, as they would have to lie about being diabetic to get their training.

 

[wstorms]

Also the reason why I started this is because I was sad and wanted to hear the opinion of other divers and see if what I was thinking was unreasonable.

I do sympathize, and don't think your line of thinking is unreasonable. However, you do seem very focused on the outcome you want to hear. This is perfectly normal, I think everybody would. But like I said before, please be aware of the bias this creates. Try to utilize your understanding of your situation to bring the conflicting specialists together. That is the only way you will truly get the best advise possible.
This might be "you can only dive with these limitations because of XYZ" or hopefully "yes go ahead".

Also, I have been diving nitrox, been below 30m and diving wrecks because I have the specialities and training for it. So I do not appreciate your comparison to me doing something I am trained for to speeding. It is like me telling you that you to stop diving because you might drown.

I did not mean to suggest you broke your training limits before and am sorry it came across like that.
However, just because you have done something in the past doesn't mean it's a brilliant idea to do it again. In this case, I was thinking about the higher O2 percentage that was listed as a potential contributor to your medical conditions.
Yes, you have done it, but in hindsight, was it a good idea? And does the fact that you don't have issues with nitrox (say 40% O2 max) mean you won't have an issue with 50% or maybe 100% O2?
This is exactly why a solid medical advise and understanding is important.

What pisses me off about all of this is that this creates more risks for people with my condition, as they would have to lie about being diabetic to get their training.

Or divers with medical risk indicators make sure the several medical professionals who are involved on the advise align and come to a consensus.

 

[Sidemount Serge]

It is not so much that I want my outcome, I wouldn’t even think of asking my endocrinologist if the dive doctor told me why I, as an individual, cannot go below 30m or do deco dives. The only thing I have seen is that they conducted a study down to 30m and there were no significant variations in glucose.

As for higher O2 Nitrox, I agree, I have only gone up to 40%, so I have no idea what it could do to me. However, from what the dive doctor said, it would lower my glucose and may cause a hypo. So if my meds won’t give me a hypo then this is a non-issue, because my body is insulin resistant, without the meds I have too much glucose In my blood so a hypo is highly unlikely.

I agree, however getting a consensus shouldn’t be this difficult. The dive doctor could of said on the statement, fit to dive but must consult with an endocrinologist about effects of diabetes, that would of saved me a lot of hassle and grief.

 

[wstorms]

It is not so much that I want my outcome, I wouldn’t even think of asking my endocrinologist if the dive doctor told me why I, as an individual, cannot go below 30m or do deco dives. The only thing I have seen is that they conducted a study down to 30m and there were no significant variations in glucose.

I am glad to see you remain cautious.
My guess would be that's because there simply isn't enough data available. Simply not possible to get a sample size big enough to draw conclusions from, so every medical professional will (and should) remain conservative.

As for higher O2 Nitrox, I agree, I have only gone up to 40%, so I have no idea what it could do to me. However, from what the dive doctor said, it would lower my glucose and may cause a hypo. So if my meds won’t give me a hypo then this is a non-issue, because my body is insulin resistant, without the meds I have too much glucose In my blood so a hypo is highly unlikely.

I do not know enough about diabetes to have any sort of informed opinion on my own on this. However, I do agree that if you have meds, hydration, sugar boost options (caprisun package) and other ways of dealing with it, this all should factor in in the discussion. If at all possible, involving your instructor might help as well in order to explain what you actually will be doing during the course.

I agree, however getting a consensus shouldn’t be this difficult. The dive doctor could of said on the statement, fit to dive but must consult with an endocrinologist about effects of diabetes, that would of saved me a lot of hassle and grief.

Unfortunately medicine isn't an exact science. Nobody can predict the exact outcome of doing certain dives with certain conditions. Doctors will remain conservative (as they should), and that means that if you want to get a doctor to back a riskier advise, the burden of proof (or at least facilitating the debate) lies with you. Obviously this is annoying or even frustrating, but once done, you will be rewarded with either a better understanding of why you are being advised against diving, or with a ticket to start your training.

I do hope it's the latter. Good luck, and good health to you.