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Nearly 26 million Americans in the US have diabetes. Seventy nine million have pre-diabetes. Decades ago, diabetes raised a red flag among dive operators and those with the disease found themselves permanently on shore. Then in 2005 during a joint workshop with the Undersea and Hyperbaric Medical Society, DAN decided to throw up another red flag for divers with diabetes, only this one had a white diagonal stripe going through it. The two organizations reached the consensus that people with diabetes, who are otherwise fit, healthy and meet certain safety criteria, can step out into the open and take the plunge.
A Qualified OK
Before you dust off your C-card, know that an open-door policy doesn't mean everyone can just walk right in. While diabetes alone doesn't prevent you from diving, other related conditions may. You also can't have diabetes-related conditions like vascular disease, for instance. DAN has established a list of guidelines you can check out on its web site. Just go to diversalertnetwork.org and type diabetes in the search engine, and you'll find a downloadable pdf. The bottom line: People with diabetes need to be fit to dive, need to choose their dives carefully, and need to manage their diabetes on the day of the dive. Here's a snapshot of what you need to know:
Dive fitness: There’s no special fitness criteria above and beyond the norm. The underwater environment doesn't have any special effects on glucose utilization and blood sugar levels. If your diabetes is well-managed during everyday activities on dry land, you're generally safe to dive. The essential component of “well managed” is that you must be stable with your insulin regimen. You should wait three months after starting oral hypoglycemic agents (OHAs) and one year after starting insulin therapy before your first dive. You should also be free of any serious episodes (meaning you needed outside assistance) of hypoglycemia or hyperglycemia for one year before diving.
If you're prone to seizures, lack of coordination or impaired judgment when your blood sugar drops, you shouldn't dive. Nor should you dive if you don't know how exercise affects your blood sugar or if you can't sense when an episode of low blood sugar is coming on. Losing your faculties 40 feet below can have dire consequences. Certain diabetes-related health conditions can increase your risk for decompression sickness or other life-threatening complications. Don't dive if you have asthma, neuropathy (nerve damage), nephropathy (kidney disease), retinopathy (eye disease) or heart disease.
Dive selection. It's a good idea to avoid cold, long, arduous dives that could send your blood sugar spiraling. Shallow diving is your best bet. Avoid anything deeper than 100 feet. Keep your dives to 60 minutes or less in duration, so you're not going unmonitored for an extended period of time. Stay away from wrecks and other overhead environments. The easier it is for you to surface relatively quickly if needed, the better.
Dive day management. Check your blood sugar 60 minutes, 30 minutes and 10 minutes before making a dive, and then once immediately after you get back in the boat or on shore. Your blood sugar should be at least 150 mg.dL (8.3 mmol.L). If it's less than that or if your blood sugar level falls between two of the measurements, you're not safe to take the plunge at that time. Also stay ashore if your blood sugar is too high (above 300 mg.dL or 16.7 mmol.L). Continue to check your blood sugar frequently 12 to 15 hours after diving.
