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Diabetes and Diving

OMNI DIVERS UNDERWATER SERVICES, L.L.C.
Diabetes and Diving

Ern Campbell, MD

Diving Medicine is the study, diagnosis and treatment of illnesses related to the undersea environment.

Diabetes and Diving

Non-insulin dependent diabetics can dive!

The mild diabetic fully controlled by diet and weight management can be qualified for sport diving without problem. The person with episodes of hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), ketoacidosis(acidic condition from breakdown of ketones) or end organ disease (kidneys, eyes, heart) certainly should be disqualified for any kind of diving. Note that any disease with any alteration of consciousness should disqualify unequivocably. An underwater reaction even in a well-controlled diabetic would be a fatal situation possibly leading to drowning. In addition, you would definitely be endangering your buddy. Most diving MD's advise against medication dependent diabetics from diving.

Diving Programs for Diabetics

However, there are those who are interested in diabetics learning to dive and have developed programs to assist them in this endeavor:

There is a "Camp DAVI" in the U.S. Virgin Islands, especially for divers with diabetes. It is run by Dr. George Burghen, Chief of Endocrinology and Metabolism at the University of Tennessee, and Stephen Prosterman, Dive Supervisor for the University of Virgin Islands, St. Thomas. You can probably get their addresses by contacting DAN. That number is 919-684-2948. Their diabetes Survey extension is 627. The DAN Diabetes Survey is a research project just getting started and you might want to participate.

The YMCA has a protocol for diabetic scuba divers. It carefully differentiates the divers with mild diabetes and those with frequent changes in blood sugar levels and hypoglycemia.

To summarize:

Insulin dependent diabetics should not dive.

Non-insulin dependent [Type II diabetics] --- Can dive but should meet certain medical criteria.

The mild diabetic fully controlled by diet and weight management can be qualified for sport diving without problem.

Medical Criteria

Medical conditions.

The diver should not have any of the long-term complications of diabetes, either insulin-dependent or non insulin-dependent diabetics. Type II diabetics are probably at greater risk of complications at diagnosis and are somewhat less able to look after their general health. Potential divers should be using only short-acting anti-diabetic drugs, if such a drug is necessary, due to the possibility of hypoglycemia. However, it does appear that non-insulin-dependent diabetics can generally exercise without fear of a deleterious metabolic response. The diving clubs in the U.K. (BSAC, SAA and SSAC) issue a common set of forms for the diabetic and his/her diabetologist to complete which ask if any of the following statements are true:

Has the diabetic's medication regime altered within the last year?

Have any episodes of hypoglycaemia occurred within the last year and if so, under what circumstances did these occur?

Has the diabetic been hospitalised within the last year for any condition related to diabetes?

Has the diabetic's level of control been in any way unsatisfactory throughout the last year?

Is microalbuminuria present?

Is there any degree of retinopathy present?

Is there any degree of neuropathy (sensory, motor or autonomic) present?

Is there any evidence of vascular or micro-vascular disease present and, if so, where?

The diabetologist is also asked to comment whether in his/her opinion, the diabetic is in any way mentally or physically unfit to undertake the degree of strenuous exercise that scuba-diving demands.

If the answer to any of these questions is "yes" then the diabetic would not normally be allowed to dive. An exception is normally made if the diabetic has only mild background retinopathy. The diabetic must undergo a complete physical examination on an annual basis and be passed as fit to dive by a physician with a special interest in scuba diving after reviewing the answers to the questions posed above. In addition, for diabetic divers over the age of 50, an exercise ECG is mandatory.

U.H.M.S. Guidelines

An entire day of the 1996 Undersea Hyperbaric Medical Society annual meeting was devoted to diabetes and diving! There is some thought in the diving medical community to relaxing the present stringent recommendations concerning diving and insulin dependent diabetes mellitus.

Current consensus guidelines should be used that minimize the chance of a serious reaction underwater that could lead to a fatal accident. As you are well aware your insulin requirements will decrease with heavy exercise and usually increase with acute illness.

Guidelines are:

Being in good basic control.

Being in good physical condition with good diving skills.

Do not dive if you have had a severe reaction in past 12 months.

Don't dive with retinopathy, neuropathy, coronary artery disease or renal failure.

Don't dive if you don't realize when you are having a reaction; or don't have a clear understanding of diabetes.

Do not dive if you have ANY concurrent illness.

Limit depth to 80-90 ft to avoid nitrogen narcosis which may be confused with an insulin reaction.

Always carry a source of glucose or sugar. A glucose gel in plastic container is recommended. Both the diver and his buddy (non-diabetic) should carry two tubes each.

Diver and buddy should have hand signals and other communication well established in the event a reaction occurs.

Blood glucose (BG) should be monitored before the dive. The BG should be 150 prior to the dive. Steve Prosterman who is an insulin dependent diabetic and a dive instructor in the US Virgin Islands recommends at least three BG measurements within 1 1/2hr prior to diving (eg 1hr, 30min, 5-10min prior).

The rate of drop of BG is more significant than the actual value. If the value is dropping it should be stabilized with a snack before getting into the water. If it's rising aim for 120-130mg/dl minimum before diving.

These are a few of the recent guidelines you should follow if you choose to dive. Remenber, diving is a buddy sport and you should never put your buddy at unnecessarily increased risk. As you can see, there are small but significant differences in recommendations that are made by various people and agencies in various parts of the world. Much work still remains to be done to determine which individuals with diabetes are able to engage in the wonderful sport of scuba diving without increased risk to themselves or others. In addition to the DAN and Virgin Island studies, Dr. Chris Edge, Chair of the UK Sports Diving Medical Committee, has developed a system of forms that allow close follow-up of diving diabetics, so far with happy results.

Christopher Edge

Chair, UK Sports Diving Medical Committee

Links

PADI Medical Checklist
Diabetes and Diving/SPUMS
Rodale's Risk factors
Diabetes Monitor
Medical Conditions
Doc's Diving Page
Couple of hundred links
Diabetic Wound Treatment

Diabetic Wound Care

Article by Cynthia Black, your Diabetes Guide, on wound and ulcer treatment for those with diabetes.

Dermagraft For Diabetic Foot Ulcers

Dermagraft, a living human dermal replacement for the treatment of diabetic foot ulcers.

Hyperbaric Oxygen Therapy

From the Undersea and Hyperbaric Medical Society, learn about a therapy known to help healing in the case of those with diabetes. Contact information available.

The Role of HBO Therapy in Diabetes

Just how does hyperbaric oxygen therapy relate to a diabetes ulcer or wound? From Wound Care Consultants.

Ern Campbell, MD Best regards for safe diving!
Ern Campbell, MD
Webmaster @ Diving Medicine Online
scubadoc@scuba-doc.com

If you need more information,
please e-mail us at
omnidive@omnidivers.com.



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