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Diving and Diabetes

Diabetes is one of those medical conditions that doesn’t prevent divers from seeking training, but may cause concern among dive professionals — even if they’re familiar with the condition.

Historically, the condition was an absolute diving disqualifier, but due to advances in treatment and continued research, many people with diabetes can now safely dive, provided they comply with some important guidelines. With millions of people living with diabetes or prediabetes (and that number appears to be increasing), it’s more likely than not that you’ll encounter a diabetic student in the coming years. Here’s what you should know:

Understanding the Condition

Diabetes is a disease that affects the endocrine system, a system of glands and metabolic pathways that produce hormones that regulate metabolism, growth, tissue function and many other biological necessities. The disease specifically alters the creation or uptake of insulin and glucagon, the hormones that maintain blood glucose levels.

Diabetes exists in two varieties, often called Type 1 and Type 2. With Type 1, the body’s immune system attacks the type of pancreatic cell that creates the hormone insulin, leading to a need for insulin to be injected to manage blood sugar. Type 2 diabetes is the result of insulin resistance or insensitivity of insulin receptors. This condition can be managed with diet and oral medications that increase insulin sensitivity.

Because the disease (and the drugs used to treat it) affect the body’s blood glucose levels, diabetic divers face a risk of hypoglycemia (low blood sugar) that their nondiabetic buddies do not. Hypoglycemia can lead to confusion, seizures and, in severe cases, loss of consciousness — all of which are incompatible with diving.

Diving with Diabetes

Even today there are some medical professionals who strongly disapprove of diving with diabetes, but research and experience have shown that diabetic divers can continue or begin diving with a few additional guidelines. Because the primary risk for diabetic divers is hypoglycemia, most of these guidelines focus on making sure divers can adequately maintain their blood glucose levels before and during a dive.

Diver should:

  • Be age 18 years or older.

  • Delay diving after starting or changing medication.

    • Three months with oral hypoglycemic agents (OHA)

    • One year after initiation of insulin therapy

  • Not have any episodes of hypoglycemia or hyperglycemia requiring third-party intervention for at least one year.

  • Not have a history of hypoglycemia unawareness.

  • Have a tested glycated hemoglobin (HbA1c) level equal to or less than 9% no more than one month prior to initial assessment and at each annual review.

  • Have no significant secondary complications from diabetes.

  • Make sure that blood glucose (BG) level is at or greater than 150 mg/dL (8.3 mmol/L), stable or rising, before entering the water.

    • Complete a minimum of three predive BG tests to evaluate trends at 60 minutes, 30 minutes and immediately prior to diving.

    • Delay dive if BG is less than 150 mg/dL (8.3 mmol/L) or greater than 300 mg/dL (16.7 mmol/L).

  • Carry readily accessible oral glucose during all dives.

    • If hypoglycemia is noticed underwater, the diver should surface with a buddy) establish positive buoyancy, ingest glucose and leave the water.

    • As appropriate, injectable (parenteral) glucagon should be be available at the surface.

  • Check blood sugar frequently for 12 – 15 hours after diving.

  • Ensure adequate hydration on dive days.

  • Log all dives, including BG test results and all information pertinent to diabetes management.

You can provide these guidelines to divers with Type 1 or Type 2 diabetes, but unless you’re a doctor, do not to give medical advice to diabetic divers. Being familiar with these guidelines and what divers must do to safely enter the water allows you to better organize predive events and provide proper supervision. There’s no reason that well-managed diabetes should keep an otherwise healthy diver out of the water, but its good to be informed before working with student divers who have the condition.

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