NAUI and Diabetics

[MeiLing]

which cannot happen with a Type 2 who is not on insulin.

Actually, that is not true. They are at lesser risk and will probably not die from it, but nobody with a blood sugar of 50 is really in their "right" mind!

 

[MeiLing]

The only issue of safety in diving with diabetes is the risk of a hypo, which cannot happen with a Type 2 who is not on insulin. So I don't know why "cerich" has his approach.

The British HSE used to regard any diabetes as an absolute contraindication for working in diving (which includes ANY diving for money or where it would otherwise be considered work, even if no money changes hands). They have now relaxed that attitude as they realised it was unreasonable, and now allow diving professionals if their diabetes is well controlled and if a diving physician approves them. In the UK a diving physician is an expert in diving medicine etc and is specially licenced - there aren't many of them.

For anyone who doesn't know, the HSE's standards are by far the most demanding in the world, and have been adopted by many countries outside the UK for all forms of commercial diving. Their "basic" diving course is residential for over a month, extremely intensive and demanding, and is failed by many people who attempt it. They totally control all diving in the UK, recreational or otherwise.

There are no HSE rules on recreational diving, but they recommend the same standards be applied.

How do I know this? I am a type 2 diabetic (not insulin dependant) who was barred from teaching when I was diagnosed, but I appealed and was later allowed to resume teaching and still do so. I am specifically allowed to do all the teaching that I used to, which includes deep advanced trimix. I often do 3+ hour trimix CCR dives to great depths, and have never had a suggestion of a problem. The point being that my problem is blood sugar that tends to be too high, not too low.

The issue in the US is more of liability than of health. In the US, any idiot can do the most Darwin award winning thing that they've signed liability forms about and still successfully sue.

The McDonald's coffee case, is a case in point! Like who doesn't know hot coffee is hot?

 

[peterbj7]

But MeiLing, they still won't get a hypo. It is that and (normally) only that which may cause a person to black out. Dying from a diabetic condition is not the point or the risk, it's drowning because you've blacked out. As I am diabetic and a technical diving instructor you can be sure I've researched this a bit!

Interestingly it seems I contracted diabetes as a direct consequence of a severe viral trauma. I didn't have any of the normal risk exposures, but I had extremely severe hepatitis A shortly before I was first diagnosed. As I had two major medical examinations every year, both of which were inter alia looking for diabetes, it was picked up at the earliest possible moment, and no other cause could be found. Research into these aspects is still at quite a primitive stage.

 

[MeiLing]

But MeiLing, they still won't get a hypo.

Anytime anyone's blood sugar drops below normal, they are in a state of hypoglycemia. When there is not enough sugar in one's brain, one doesn't think well and depending on how low it is they can pass out. And a great many Type 2's have lows as their insulin resistance can tend to wax and wane. You might not, but others do.

One also doesn't have to be diabetic to experience hypoglycemia. Though if one does, it is indicator of poor glucose tolerance and is considered to be a pre-cursor to diabetes.

Not all type 1 diabetics have severe enough hypoglycemic episodes that they pass out. In fact, a great number of them never experience one bad enough to pass out in their lifetime!

If you have diabetes as a result of a viral trauma, are you really sure that you are a type 2? How where you diagnosed as a type 2? Do you take insulin or is your diabetes treated only by diet and oral medications? How long have you been diabetic? For these examinations that you had where they were looking for diabetes, what kind of testing were they doing to indicate that you had it. Glucose tolerance? C-peptide. Antibody tests?

Very often, diabetics who are over age 30 are misdiagnosed as type 2's and for a time, depending on how far the destruction of their beta cells has progressed, be successfully treated, for a while, with oral meds and diet. Doesn't mean, however, that they are really type 2 diabetics.

And I know a thing or two about it myself! I've also done quite a lot of research!

 

[peterbj7]

I'm not a doctor, but there seemed to be no doubt that I was type 2. I was diagnosed about 7 years ago.

As a diver I'm not concerned with what is going on in somebody's body, just what the practical effects of that will be. AFAIK, only a recognised hypo will impair the individual to the extent that it becomes immediately dangerous (from a diving point of view). I do appreciate that there's a scale, but by definition I'm only concerned with those people who get well down it.

It certainly sounds as if you know much more about it than I do. So do most doctors. That's not the point - I'm being quite pragmatic about it.

 

[MeiLing]

I'm not a doctor, but there seemed to be no doubt that I was type 2. I was diagnosed about 7 years ago.

As a diver I'm not concerned with what is going on in somebody's body, just what the practical effects of that will be. AFAIK, only a recognised hypo will impair the individual to the extent that it becomes immediately dangerous (from a diving point of view). I do appreciate that there's a scale, but by definition I'm only concerned with those people who get well down it.

It certainly sounds as if you know much more about it than I do. So do most doctors. That's not the point - I'm being quite pragmatic about it.

All folks should make the best judgements based on risk. However, as treatments become more progressive, it can be better controlled in Type 1's as well. The major reason why Type 1's are usually so "brittle" is usually a combination of over-management, too few (yes, that is too few) injections and the variabiability of the absorbtion of the long-acting insulins, which if you're not on the pump and are a Type 1, you're likely being treated with in combo with a regular or fast-acting insulin. The long acting ones can have a variability of 32 - 52% in their absorption.:11:

I do know a lot about diabetes. And don't necessarily assume that just because someone has the initials M.D. after their name, that they know enough about it to be treating it. Medicine is huge field and there are a great many Drs. out there who probably know less than you about it. I've even know of a local diabetes specialist who I think is a real quack based on what he has recommended or not recommended for his patients. It's always wise to get a second opinion if you don't think that you're getting the best treatment possible for any malady.

I have a diabetic co-worker whose Dr. sent her home after her diagnosis with the directions, "Don't eat junk food!" Too bad he neglected to tell her that that included the two scoops of white rice everyone here tends to consume with every meal!

 

[MeiLing]

My approach is simple, if a person with type 2 hasn't been able to show control with their diabetes why should I expect they suddenly will be able to simply because they desire to learn diving? It isn't a matter of a diving-type 2 specific risk so much as the general risk of teaching a person who hasn't their disease under control.

The reasons why someone hasn't been able to control their diabetes my not be a lack of discipline as you seem to be assuming. Very often, diabetics are not given the proper tools for managing the disease. One of the major tools in managing diabetes is about managing carbohydrate consumption, yet you'd be surprised how few Dr's refer their patients to a diabetes educator whose job is to teach them how to use their diet as part of their toolcase for good control.

If the carrot of getting something they want such as diving, motivates any diabetic to get better control and seek out those professionals who will work with them to help them do so , it's not something that I think anyone should knock! Diabetes is a disease where those who haven't walked in the shoes of someone who deals with it on a daily basis really doesn't have much of a clue. For those that do, it is a 24/7 struggle they never escape from.

 

[uncleavi]

So, if I taught a diabetic and they died while I was teaching them due to diabetes, I would win in court when that family sues me? I can tell you for sure all paper work would be correct.
When I did my Naui and Padi instructor courses they hammered liability in our heads.
When you see an attorney on tv telling you about being injured due to the negligence of another. Can you see where some instructors would be afraid of teaching them?

 

[MeiLing]

So, if I taught a diabetic and they died while I was teaching them due to diabetes, I would win in court when that family sues me? I can tell you for sure all paper work would be correct.
When I did my Naui and Padi instructor courses they hammered liability in our heads.
When you see an attorney on tv telling you about being injured due to the negligence of another. Can you see where some instructors would be afraid of teaching them?

If you knew about it and it was contraindicated, no, you wouldn't win. Furthermore, would you really want to spend the bucks just trying to defend the suit?

Remember, we're talking about a legal system where if a thief breaks into your house, steals your TV, trips over the flower pot on your front porch on his way out, can't put out his hands down to break his fall cause he's hanging to your TV, and gets injured, maybe even dies, could win in court if he sued you for getting injured on your property!

American liability makes absolutely no assumption of personal responsibility on the part of those who'd do things wrong.

So if you are a diabetic, who feels that you're in good enough control to handle the dive profiles you plan to dive, can you begin to see why you would not be disclosing on the medical forms you fill out?

 

[peterbj7]

This board is used internationally, so let me point out that the insane liability laws that you are referring to apply in the US only. In every other country that I've lived in the initial presumption is "caveat emptor", modified according to what actually transpired.

The fact is that many diabetics do dive safely, so defending yourself in the event that your diabetic student died as a consequence of diabetes should be quite simple. Just quote cases to illustrate that your stance was reasonable.