History of Diabetes - I lie...

[Paulus Magnus]

When I started my OW in October I answered "Yes" and was promptly sent to the local dive doctor where we discussed my case. This resulted in me spending 90 minutes being tested before getting OW signed off but not Advanced. I've since continued diving and simply chosen to lie about my history as it makes life easier.

In November 1999 I was admitted to hospital with Diabetic Keto Acidosis with 10 litres of body fluid missing and told that I'd have been dead within a week or two. I admit, I was feeling a bit rough. After a week in hospital I was perfect, I had my 10 litres pumped back into me and been given Insulin non-stop. I was then told I was Insulin dependent for the rest of my life and had to inject 4 times a day.

After 9 months, I made a complete recovery. I stopped taking the Insulin myself but continued to monitor my blood sugar level, which remained fine. After 3 months I had an annual checkup and I confessed my heinous crime as the result of my checkup was perfectly healthy. I was then subjected to a glucose tolerance test to find out what degree of functionality my pancreas had recovered to. The letter from the hospital says that my pancreatic function was "entirely normal". This is where my "health problem" actually started. It seems rare for this to happen, possibly unique as I've never found anybody else that this has happened to.

My life insurance doubled when I became Diabetic, when I recovered I became an unacceptable risk.

My driving license was changed from the UK's standard until-you're-70 license to one that only lasted 3 years. I was banned from driving passenger vehicles and couldn't get a pilot's license. When my driving license expired I had to wait 4 months for medical reports to be exchanged before being granted my normal license back.

I told the dive doctor all this and had to undergo 3 blood sugar tests, 2 blood pressure tests and perform some squats. My blood sugar tests were fine except for the first one that was performed incorrectly and gave a coma-level reading. My blood pressure was normal (110/70) and it seemed that he erred on the side of caution when signing off OW. His reasoning for not signing off AOW was because there was greater exertion involved and therefore greater risk of hypoglycemia.

I've never had a hypoglycemic coma or collapse. I have recorded low readings after large amounts of physical exercise but never fainted or had a problem, just felt exhausted like most people do.

I don't like living a lie and don't like lying on my PADI form but I don't know how to sort this out and prove I'm not a risk to myself or my buddy when underwater.

Do I have to be subjected to some sort of physical stress test to prove this?

My own feeling is that if the UK driving license authority has accepted that I present no greater risk than an average person that PADI should be the same but any opinions or advice would be greatly appreciated.

 

[cliffdiver]

I have thoughts, but must first make it clear that I am not a doctor. I am a medical lab health professional with diabetic relatives and direct interests in diabetes. It's always hard to know the full story from posts such as yours (and yours was more generous of detail than most), so I can only work from what you've mentioned:

I get the impression from your post that there is some doubt as to whether you are actually diabetic now or just rather experienced (a rather serious) “diabetic event” in 1999. While we often think of "diabetes" as a simple permanent condition (Types I and II), it is so much more complex than that, especially with respect to cause. Many MDs will describe it as a "disorder of impaired glucose tolerance" or something close to that. While "once a diabetic, always a diabetic" is true in 90 - 99% of cases, in rare cases impaired blood sugar control or diabetes can actually be a temporary condition.

"Other specific types of diabetes [aside from Types, I and II and gestational diabetes] result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes may account for 1% to 5% of all diagnosed cases of diabetes." CDC (U.S.) diabetes facts web page

I'm not diagnosing you, but my point is that it sounds from your post like such a temporary (or similar) condition could have been what hit you in 1999, and that while you may have a "history of diabetes," I’m theorizing that you may not be diabetic today. I mean, your 1999 condition was either temporary, or it wasn’t. You’re either diabetic, or you experienced a temporary, “diabetes-like” condition then and you are not diabetic today. If you've not already, you need to meet with a diabetes specialist (probably an endocrinologist.)

If your 1999 condition was a temporary condition that can be documented as such, including exactly what the condition was, how treated, and how you/they know you're cured, prove it with the help of your 1999 records, your current diabetes doctor/endocrinologist, and recent test results. Perhaps you have a “history,” but you’re perfectly healthy today.

If you are in fact diabetic, you need to document how well controlled you are, including how you are controlling it (diet, exercise, etc.) and how well controlled you are (including fasting blood sugar and HbA1c, or glycosylated hemoglobin). You and your diabetes doctor get a good handle on this, and make sure it’s all in your medical files. This can even include a letter from your diabetes doctor stating that he/she believes you are in good enough control that you could handle such intense activities as mountaineering or diving. Heck, have your diabetes physician talk directly with your dive physician. The world is rife with stories of diabetics who've climbed the highest mountains, run marathons, done Ironman triathlons, and much more. If you are diabetic, you can still do anything and absolutely everything. I don’t know, but I’ll bet Deco Stop (another scuba board-like forum) has got members with diabetes, and they’re technical divers well beyond AOW.

It is possible for someone to not need insulin injections, be able to control their condition with good diet and exercise, have normal blood sugar levels, and still be diabetic. There is a very direct relationship between stress and blood sugar levels. Non-diabetics don't notice it much, but diabetics sure as heck do. If there is even the slightest twinge of possibility that you may be only ever-so-slightly impaired in your body's ability to respond to stress and the blood sugar fluctuations that come with it - and we know that diving can be stressful - then until you know the nature of your condition fully and completely and have it managed and under complete control, it is more than prudent for your dive doctors to err on the side of caution. You do not need to add to the risk of passing out while underwater.

I'm sorry, but I also detect some denial. Fact of the matter is, as wonderfully healthy as you could be today, you do have a medical history which could have bearing on any diving you do. Healthy people worldwide have on their medical records some past “serious” medical event - totally cured, but which nonetheless can affect some bit of them for the rest of their lives. A good and close friend of mine, totally cured of the common thyroid cancer she had 15 years ago, will forever have a “history of cancer." That part of it, I'm sorry, but you have to deal with that. The number of OW and AOW class registrants who cannot answer "no" to each and every one of the medical conditions on that form is much larger than you think, guaranteed. They too, must go through the "rigamarole" of seeing a doc and getting checked out. The divers nowadays who could indicate “no” to all could consider themselves fortunate and perhaps lucky.

Please, be honest with your medical form. Unless you personally can see from a technical, medical, expert perspective that you are in perfect condition to handle all the dive conditions you could face (and how few of us have that perspective), then you just don’t know. I emphasize: you don’t know. You don’t know what little, obscure, rarely described subtlety of your condition could affect you underwater, with ugly consequences. (O.K., sounds paranoid, but really it isn’t meant to, and isn’t.)

PADI is, rightfully, covering its butts and looking out for your best interests. However, that can go too far: discrimination. We are only recently making headway in the U.S. in fighting discrimination against diabetics (workplace accommodations, driver’s licenses, needles and syringes on airplanes, etc.). If you are diabetic and under control, I suggest you get your local and/or national diabetes advocacy groups (in the U.S. this would include the American Diabetes Association; I know you’ve an equivalent in the U.K.) involved. They and you (with your doctors and medical records) may be able to provide documentation and other evidence that diabetics can safely scuba dive, even beyond “AOW” conditions.

 

[Paulus Magnus]

I'm sure there is a degree of denial in my opinion but also a desire not to live my life conservatively because of what may happen in the future when I've never been given any evidence to suggest I should be overly concerned. I should say that the threat of Diabetes returning is something I live with daily and constantly aware of. I do test myself from time to time, particularly when I feel the low blood sugar levels or when I detect the symptoms.

The UK medical theory appears to be that if you're admitted to hospital with keto-acidosis that you're Type I Diabetic. I did meet one doctor that suggested that my Diabetes may have been triggered by my weight at the time, 261lbs (I'm 5' 10"). I was 225lbs when I recovered and now around 170lbs but this was a medical theory and not "accepted" as the cause of my Diabetic event.

By admitting to my history of Diabetes it seems that I'll be penalised because of the conservative nature of the medical/legal/insurance professions. As there is no accepted medical explanation for the onset of my Diabetes and the subsequent recovery nobody seems to be able to state what the risk is that I face during diving. Therefore, I choose to say 'no' until somebody can say otherwise, based on medical evidence, or until I discover that my Diabetes has returned.

I feel that the original medical decision was made incorrectly, it should have been that I'm safe to dive or not, not to a particular level. We all know that extreme physical exertion can occur on the simplest of dives due to current, visibility, temperature or conditions.

As I've never suffered from any adverse physical effects from low blood sugar at any point in my life I don't feel that the risk I face is any more than a "normal" person. I also feel that I'll never be able to categorically answer this question and that answering 'yes' and admitting my history will result in nothing but medical assessment after assessment as I dive and that those assessments will result in a variety of responses based on the doctor's own opinion rather than any medical evidence. It seems simpler to deny my history based on my informed opinion about the matter as this seems to be superior to the few doctors I have spoken to that simply cannot explain what happened to me 4 years ago.

 

[CBulla]

Even if you choose to not share that with someone during the time of training, at least wear the medic alert bracelet and/or let your dive buddy know that you are diabetic. I've got a little bit of medical training in my background and have seen the effects of what its like for one not to have advised people of a condition vs. those who have and it could mean the difference between having some poor folks feeling like they let you die not knowing what was wrong and living to dive another day because they knew to simply give you something sugary from your kit (my aunt carries a little kit with stuff for either situation).

Personally, I would have no problem diving with you if you told me you were diabetic from the get go. It wouldnt ruin my dive, I'm sure others feel the same way.

 

[diverbrian]

Until recently, I've had limited experience with diabetes. Now, one of my normal dive buddies is diabetic and takes medication. I let him set his own limits. I highly doubt that he will be doing staged decompression diving for instance as if he has a problem, we don't wish to be "stuck" underwater for the time required to do a decompression stop. This is cool by me.

The lady that I date is diabetic and I came in one night when she had to get her son to get her insulin as she forgot about it. Normally, it is not a problem to me.

Here is the problem, it is the people with a history that don't let someone know. One of my co-workers had a seizure that was due to his being diabetic. This happened at work. Had someone known, the panic from a guy convulsing for some unknown reason wouldn't have been near as great! The fact of the matter is that acute reactions such as passing out are generally quickly treated if you have a likely cause. If you have a person passing out or convulsing and you don't at least have a guess, it delays first aid remarkably.

If your case, I don't blame you for your actions. I have a couple of key people that know about me having a history of passing out from getting absent-minded and not eating when I am under stress. I would say that the last time that I didn't catch it in time was about 15 years ago in school for the military. If I disappear off the work floor for a few minutes to deal with it, nothing is said. Typically, I eat like a horse when I dive, so this doesn't enter in, LOL.

Just, if you don't want to tell anyone directly, please get something like a medic alert bracelet. That way if something does happen, the person administering the first aid has a chance of getting you stabilized quickly. Better yet, if you trust your dive buddy, tell him/her as well. I guarantee you that most experienced divers will let their buddy set their own limits unless they are "tech diving" in which the decompression stops set an artificial overhead environment. Your own limits will be be likely above a less experienced diver and you will be the one confined by their limits.

On a cheerful note, just enjoy your diving and find a dive buddy that you can trust! It will all work out as far as diving goes. (Now, for the licensing run-around that I find so ridiculous, discriminitory, and unbelievable, you will have to complain on your own, LOL.)

 

[DocVikingo]

I would very strongly recommend that you seek a second opinion.

Best regards.

DocVikingo

 

[bridgediver]

I think you should get a second opinon also. Not that familiar with how things are done in the UK but a doc clearing you for diving shouldn't be that difficult unless theres more to it.
As others have said, find yourself an instructor and good dive buddies who are willing to work with you and understand the risks. I friend of mine is an insulin dependant diabetic and he does alot of advanced dives and I wouldn't be surprised if he went tech. He wears an insulin pump under his dry suit and has a juice bladder rigged into his reg. He also has some glucagon on the surface and there are a few of us who "know" how it works.
The point is make sure that you're safe. You may need to modify your or even the groups diving behaviour. Most I think would be fine with this

 

[cliffdiver]

I would very strongly recommend that you seek a second opinion.

This is exactly one of the points I tried to make in my initial reply, Paulus. It seems far too clear to me - what with the lack of specifics about your condition in 1999 and today (and rightfully so, as it's not really my business) - that far too little is known about what exactly happened in '99 and your health today. You absolutely need to be evaluated thoroughly by a diabetes specialist who can later collaborate with a dive physician. In the end, it matters far less what happened back in 1999 than what you and your diabetes doctor determine your condition is right now.

Consider, BTW, the cases of women who experience gestational diabetes (diabetes during pregnancy.) In most cases, if properly managed, these cases of diabetes resolve once the woman gives birth. Without getting too far into that, point is, once diabetic, not any more. I remain under the impression from your two posts here that you may not be diabetic today. I don't know how/if you treat yourself specifically for diabetes (diet, exercise, medication) or how/if/how frequently you monitor your blood sugar.

If you're diabetic and under control, you take information demonstrating these two things to your dive physician. As a few others have noted on this thread, diabetes or not, you can dive your heart out! It takes management if you are, but you get used to that. Living conservatively does not mean living less than fully. I repeat my suggestion that you get the UK diabetes association(s) involved if you still run into resistance.

Even if you were someone like my father - who is refractory to insulin, wears a pump and goes through so much insulin he still has to inject frequently - I'd dive with you in a flash too. That's because he's done some learning about diabetes and controls it as well as anyone, and it does not dominate his life.

 

[dawn62669]

My husband is an insulin dependant diabetic diver. I feel completely at ease diving with him and would have no problem diving with another diabetic but I agree I would expect to be informed ahead of time in case there was a problem and you were in need of sugar. It would be quite a burden for someone to carry if as your buddy something happened to you and I could have helped if I was informed ahead of time. When you become someones buddy you are excepting the possibility of their life in your hands if something should happen to them and also putting your life in theirs. If you can't trust me with your medical history I don't want to be responsible for you. I don't dive with anyone I don't feel I could trust with my life!

 

[Paulus Magnus]

But I think we've missed the point, I'm not diabetic ... but I was.

I can't wear a medic alert bracelet as there is nothing to declare other than I'm medically fit and healthy. I can declare a history of being diabetic but I recovered. Diabetes to me was just like flu, it was something I had, I suffered with and recovered completely from.

I realise that this is unusual as all of the Diabetes professionals said that at the time. As I'm no longer diabetic I'm not in the diabetic care world any more and don't have access to diabetes specialists that could answer any queries.

Therefore, what am I getting a second opinion about? I've had a number of blood tests done in the last 4 years, including the one glucose tolerance test. All a second opinion is going to say is that I'm fit, healthy and suffering from no known problems.

As to having a second opinion of what happened 4 years ago, nobody seems to know, including the diabetic professionals I spoke to. However, I will try and write to the UK Diabetes association as I offer my case for research purposes. I'd love to have my life back and to be treated normally. I had a condition, I recovered from it completely but because it's Diabetes I'm not supposed to be able to do that. Here lies the problem, it seems.