Scuba diving and Diabetes

by Dr Ahmed Sakr

I’m so glad to be able to ask this question, as I have been unable to get a definitive answer anywhere else.
I am currently a controlled diabetic (insulin and tablets), and before and after dives I test my levels to make sure I am OK. Should I be doing anything else specifically for diving safety? None of the dive organisations appear to have a policy or guidance. Oh, I also let the guide buddy know what to do if the worst happens!
Phil

Dear Phil,
before answering your question, we would like to explain to the reader a little hint about Diabetes Mellitus, it is a condition where there is reduced production or reduced response to Insulin which is a hormone produced by the pancreas and is responsible for the metabolism of glucose.

Failure to produce insulin or the body failing to respond to insulin causes improper metabolism of glucose and its accumulation which in turn will precipitate complications.

There are 2 types of diabetes; * Type 1 which is insulin dependant,  state of body failure to produce insulin, requiring insulin injections and more common in juveniles and * Type 2 which is non insulin dependant, failure of the body to use insulin properly and sometimes associated with deficiency of insulin and there oral hypoglycemics are commonly used as medications.

There are 2 main issues when we discuss scuba diving  in a diabetic, the main concern are hypoglycemic episodes where the blood sugar drops fast leading to drowsiness or loss of consciousness which can be fatal during a scuba dive, this might be precipitated by hypothermia or swimming against a strong current, etc,.

The second issue in case of a diabetic that suffers complication due to inadequately controlled diabetes, these might affect the physical performance while scuba diving ex. cardiovascular complications .

There has been many opinions whether diabetics should scuba dive or not and many accidents occurred that were attributed to diabetes but thorough analysis revealed that diabetes was not always fully responsible. Lately, a more clear situation has evolved from research organizations as DAN (Divers Alert Network), and UHMS (Underwater and Hyperbaric Medical Society), have released guidelines that are designed to allow scuba diving while having diabetes but within safe and scientific parameters.

Divers can check these guidelines on www.scubadoc.com, www.daneurope.org, www.uhms.org,

We will mention some of these conditions;
Selection of divers;
Minimum recommended age is 18 years, and other relevant medical disorders must be excluded, complications as diabetic retinopathy, neuropathy and vasculopathy is a disqualifying factor, HbA1c should be less than  9%.

Recommendations for diving parameters;
– Relatively shallower { 20 msw }, and shorter { 40 minutes }dives are advisable, avoiding Deco dives and the dive buddy should be informed of the condition and familiar with handling emergency management procedures.
– Glucose management during a diving day;
Ample hydration is very important besides checking blood sugar before and after each dive, in case of fever or diarrhoea it is preferable not to dive until cured.

Please remember that the above are some of the guidelines, and there will always be special cases that require different consideration and management.

Following up with your endocrinologist and reviewing the case with a diving medical specialist is essential to obtain a conclusive evaluation and decision regarding scuba diving.

Hopefully, we have managed to clarify the condition and answering your question.

Best regards,
Dr Ahmed Sakr