Julie T
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Hi - My bottom line question is: is there a possible connection between the DCS I've experienced twice in the past year (but had never experienced before in over 20 years of diving), and my reactive hypoglycemia?
Long explanation below - apologies in advance, wanted to include all info that m8ght be relevant.
Background: last October (2022), following two days of conservative diving in Cabo Pulmo (warm water: mid-80s) - two dives each day, no deeper than 65 feet, didn't exceed any parameters, good surface intervals - I experienced pain in my upper abdomen during dinner, about 6 pm, about 5 hours after the end of the second dive on the second day. At first I though the underwire in my bra had busted through. Went home, removed bra. Pain continued to worsen and extend throughout my abdomen. It felt like I had been punched hard in the stomach. The pain was bad enough that I started putting ice packs on my stomach. The pain began lessening around 11 in the evening, and was substantially better by morning, with just some tenderness remaining. It finally occurred to my husband and me that I might have skin bends (his son had experienced them a few times the prior year - turned out he had a PFO), even though there was no skin discoloration. I then recalled that I had also had a similar, but more mild, experience when I had gone diving the previous June - that had been so mild I hadn't given it a lot of thought. I called DAN, and after some discussion and answering their questions about other possible neurological symptoms, etc. (none), and their consultation with the medical staff, they thought that I likely was experiencing decompression illness symptoms. However, since the pain was substantially diminished by that point, and I didn't have other symptoms of concern, and I was a 3 hour drive from the nearest decompression chamber, and by the time I got there it would be almost 24 hours since my last dive, they didn't think it was essential that I go to the chamber. Their recommendation was that I not dive for at least the next few weeks. And that, since this appeared to be the second time I'd had these symptoms, that I begin diving with Nitrox using air tables, don't do deep dives, and take a day off between dive days. They also suggested either diving in locations closer to decompression chambers, or carry my own oxygen tank with me and begin using the oxygen immediately if I had such symptoms again.
I haven't had a chance to dive again yet, but hope to within the next few months.
Basic data: I'm 66 years old, was scuba certified 25 years ago, began diving regularly in 2010, doing a mix of central coast California cold water diving, and warm water Mexico diving. Never had any DCS symptoms before these two incidents of abdominal muscle pain in the past year.
So here's the question...which also requires a little background. After a lifetime of struggling with my weight, in 2016 I had a gastric sleeve operation. I'm still somewhat overweight, but otherwise healthy, physically active, and am (luckily) not diabetic. However, among the things that weren't known at the time I had the gastric sleeve operation is that there is a risk, especially for non-diabetic patients, of developing reactive hypoglycemia after having the bariatric surgery. The causes are not yet fully understood, although there has been quite a bit of research in the past several years, but there appears to be a hyperinsulin response to eating and/or exercise (there's research suggesting about possible changes in GLP-1 and FGF-19 responses and stuff that's way over my head in terms of medical terminology).
The full name for what I'm dealing with is "post-bariatric non-diabetic exercise-induced reactive hypoglycemia." I finally found a doctor who specializes in this area, and she prescribed a continuous glucose monitor (CGM), which has made a world of difference in enabling me to exercise safely again - I had gotten to where I had to have my husband on alert to come give me a ride in case my blood sugar crashed while I was out on a walk. I'm also learning what to safely eat before exercising to minimize the chances of a crash, although I still don't have it entirely dialed in (the safest approach so far seems to be avoiding *all* carbs and caffeine during the few hours prior to exercise). My reactive hypoglycemia symptoms became very evident about 2 years after surgery (it's common for there to be a delay of 1 to 5 years before the reactive hypoglycemia sets in after bariatric surgery), and I basically was having to figure it out for myself, because most doctors aren't familiar with the issue in non-diabetic people, until I finally found my current doctor, although she's a full-time professor and there's a several month gap between appointments.
So here's the question: is there a possible connection between the DCS I've experienced twice in the past year (but had never experienced before in over 20 years of diving), and my reactive hypoglycemia? In doing internet searches for studies on post-bariatric non-diabetic reactive hypoglycemia, I came across the following paper, "Post-Bariatric Hypoglycemia is Associated with Endothelial Dysfunction and Increased Oxidative Stress." (https://www.researchgate.net/public...al_Dysfunction_and_Increased_Oxidative_Stress) In skimming through the paper, the following jumped out at me: "acute hypoglycemia impairs nitric oxide (NO)-mediated endothelial vasodilation".
I don't begin to have the medical background to fully understand this paper (e.g., I had to look up the definition of "endothelial"). But since the DCS I experienced may be related to how my body is handling nitrogen gases while diving (is that a correct understanding?), I wondered whether the many hypoglycemic episodes I've experienced over the past 4 or so years may have somehow impaired my body's ability to deal with nitrogen gas?
I realize that the primary issue I have to deal with, in terms of the reactive hypoglycemia, is being sure that my blood glucose is stable enough that I won't have a severe hypoglycemic incident while diving, and that it will only be safe for me to dive if my blood glucose is stable. That's priority number one.
But...given that the DCS developed after the reactive hypoglycemia began, I'm wondering if there may be a relationship between the two.
I'll be discussing this with my doctor at our next appointment in May. However, I don't think she has a background in dive medicine, so I'm not sure whether she'd be able to address this specific question.
Thanks in advance for your thoughts!
Long explanation below - apologies in advance, wanted to include all info that m8ght be relevant.
Background: last October (2022), following two days of conservative diving in Cabo Pulmo (warm water: mid-80s) - two dives each day, no deeper than 65 feet, didn't exceed any parameters, good surface intervals - I experienced pain in my upper abdomen during dinner, about 6 pm, about 5 hours after the end of the second dive on the second day. At first I though the underwire in my bra had busted through. Went home, removed bra. Pain continued to worsen and extend throughout my abdomen. It felt like I had been punched hard in the stomach. The pain was bad enough that I started putting ice packs on my stomach. The pain began lessening around 11 in the evening, and was substantially better by morning, with just some tenderness remaining. It finally occurred to my husband and me that I might have skin bends (his son had experienced them a few times the prior year - turned out he had a PFO), even though there was no skin discoloration. I then recalled that I had also had a similar, but more mild, experience when I had gone diving the previous June - that had been so mild I hadn't given it a lot of thought. I called DAN, and after some discussion and answering their questions about other possible neurological symptoms, etc. (none), and their consultation with the medical staff, they thought that I likely was experiencing decompression illness symptoms. However, since the pain was substantially diminished by that point, and I didn't have other symptoms of concern, and I was a 3 hour drive from the nearest decompression chamber, and by the time I got there it would be almost 24 hours since my last dive, they didn't think it was essential that I go to the chamber. Their recommendation was that I not dive for at least the next few weeks. And that, since this appeared to be the second time I'd had these symptoms, that I begin diving with Nitrox using air tables, don't do deep dives, and take a day off between dive days. They also suggested either diving in locations closer to decompression chambers, or carry my own oxygen tank with me and begin using the oxygen immediately if I had such symptoms again.
I haven't had a chance to dive again yet, but hope to within the next few months.
Basic data: I'm 66 years old, was scuba certified 25 years ago, began diving regularly in 2010, doing a mix of central coast California cold water diving, and warm water Mexico diving. Never had any DCS symptoms before these two incidents of abdominal muscle pain in the past year.
So here's the question...which also requires a little background. After a lifetime of struggling with my weight, in 2016 I had a gastric sleeve operation. I'm still somewhat overweight, but otherwise healthy, physically active, and am (luckily) not diabetic. However, among the things that weren't known at the time I had the gastric sleeve operation is that there is a risk, especially for non-diabetic patients, of developing reactive hypoglycemia after having the bariatric surgery. The causes are not yet fully understood, although there has been quite a bit of research in the past several years, but there appears to be a hyperinsulin response to eating and/or exercise (there's research suggesting about possible changes in GLP-1 and FGF-19 responses and stuff that's way over my head in terms of medical terminology).
The full name for what I'm dealing with is "post-bariatric non-diabetic exercise-induced reactive hypoglycemia." I finally found a doctor who specializes in this area, and she prescribed a continuous glucose monitor (CGM), which has made a world of difference in enabling me to exercise safely again - I had gotten to where I had to have my husband on alert to come give me a ride in case my blood sugar crashed while I was out on a walk. I'm also learning what to safely eat before exercising to minimize the chances of a crash, although I still don't have it entirely dialed in (the safest approach so far seems to be avoiding *all* carbs and caffeine during the few hours prior to exercise). My reactive hypoglycemia symptoms became very evident about 2 years after surgery (it's common for there to be a delay of 1 to 5 years before the reactive hypoglycemia sets in after bariatric surgery), and I basically was having to figure it out for myself, because most doctors aren't familiar with the issue in non-diabetic people, until I finally found my current doctor, although she's a full-time professor and there's a several month gap between appointments.
So here's the question: is there a possible connection between the DCS I've experienced twice in the past year (but had never experienced before in over 20 years of diving), and my reactive hypoglycemia? In doing internet searches for studies on post-bariatric non-diabetic reactive hypoglycemia, I came across the following paper, "Post-Bariatric Hypoglycemia is Associated with Endothelial Dysfunction and Increased Oxidative Stress." (https://www.researchgate.net/public...al_Dysfunction_and_Increased_Oxidative_Stress) In skimming through the paper, the following jumped out at me: "acute hypoglycemia impairs nitric oxide (NO)-mediated endothelial vasodilation".
I don't begin to have the medical background to fully understand this paper (e.g., I had to look up the definition of "endothelial"). But since the DCS I experienced may be related to how my body is handling nitrogen gases while diving (is that a correct understanding?), I wondered whether the many hypoglycemic episodes I've experienced over the past 4 or so years may have somehow impaired my body's ability to deal with nitrogen gas?
I realize that the primary issue I have to deal with, in terms of the reactive hypoglycemia, is being sure that my blood glucose is stable enough that I won't have a severe hypoglycemic incident while diving, and that it will only be safe for me to dive if my blood glucose is stable. That's priority number one.
But...given that the DCS developed after the reactive hypoglycemia began, I'm wondering if there may be a relationship between the two.
I'll be discussing this with my doctor at our next appointment in May. However, I don't think she has a background in dive medicine, so I'm not sure whether she'd be able to address this specific question.
Thanks in advance for your thoughts!
