Diabète et plongée récréative

What You Need to Know About Diving with Diabetes

Dear Divers,

Some of you might be wondering, "What if I have diabetes?" It's a great question, and it's wise to know what you can and cannot do. I'm not a doctor, but I've gathered some information that I hope will be a helpful, albeit brief, summary.

Diabetes is a major chronic disease that affects millions worldwide. For a long time, the diving medical community traditionally viewed it as a contraindication to diving. However, successful dive experiences by diabetics have prompted a reevaluation of this stance. In June 2005, a workshop on diabetes and recreational diving, sponsored by the Undersea and Hyperbaric Medical Society and Divers Alert Network, brought together experts to examine data, discuss concerns, and develop consensus guidelines on diabetes and diving—specifically recreational diving.

The guidelines emphasize personal responsibility (what's new, right?) regarding health and safety, advising divers to adhere to them for their protection and that of their buddies.

General Guidelines for Diabetic Divers

Diabetic individuals who wish to dive must undergo the same medical fitness evaluation as other candidates to ensure, firstly, that no other exclusionary conditions (like epilepsy, lung disease, heart disease, etc.) are present; and secondly, that there are no diabetes-related complications that could increase the risk of accidents while diving. They must follow a well-established treatment plan, maintain stable blood glucose levels, and be able to manage these levels effectively despite the changing demands of daily activities. Diabetic candidates and divers should have an annual medical examination and, if over 40, be regularly assessed for silent cardiovascular disease. This last point applies to all of us, diabetic or not, I think...

How to Dive with Diabetes

Have you completed your fitness assessment and standard dive training? Congratulations! Now, follow the diabetic diving protocol. Dive only in favorable environmental conditions—no cave diving! Your dives should not exceed 30 meters in depth, last more than an hour, or involve mandatory decompression stops. Diabetic divers must be accompanied by a buddy who is aware of their condition and knows how to respond in case of hypoglycemia. It's recommended that the buddy is not diabetic as well.

The L-signal

Managing Glucose on Dive Day

Diabetic divers taking medications that may increase the risk of hypoglycemia should follow a protocol to manage their diving experience effectively.

• Always have oral glucose in an easily accessible and consumable form, both at the surface and during all dives. Your dive buddy or someone on the surface should be trained in the use of glucagon (don’t assume that the dive operator, dive master, or instructor has this knowledge). If signs or symptoms of hypoglycemia are detected underwater, the diver must ascend, ensure positive buoyancy, consume glucose, and exit the water. An informed buddy should be ready to assist during this process. It's advisable to use an "L" signal with your thumb and index finger to indicate a suspicion of hypoglycemia.

  
  

• Check your blood glucose after each dive. Determine the appropriate response based on the day's schedule. It's crucial to note that blood glucose needs remain the same for all subsequent dives. Given the risk of delayed drops in blood glucose after a dive, it's strongly recommended to check your levels regularly for 12 to 15 hours afterward.

  
  

• Staying hydrated on dive days is highly recommended for diabetic divers (and applicable to all divers, really). High blood glucose can lead to increased urination. While data is limited, information gathered from diabetic divers suggests that an increase in hematocrit observed after diving (a sign of dehydration) can be avoided with intentional hydration. In short, drink more water!

  
  

For Those Who Want to Go Further

Informative list from DAN (reference at the end)

Requirements for Diving with Diabetes

• Age ≥ 18 years (≥ 16 years if in a special training program)

• Delay diving after starting/changing medication:

- Three months with oral hypoglycemic agents (OHA)

- One year after starting insulin therapy

• No episodes of hypoglycemia or hyperglycemia requiring third-party intervention for at least one year

• No history of hypoglycemia unawareness

• HbA1c ≤ 9% no later than one month before the initial evaluation and at each annual exam

- Values > 9% indicate the need for further evaluation and possible treatment modification

• No significant secondary complications from diabetes

• The doctor/diabetologist must conduct an annual exam and determine that the diver has a good understanding of the disease and the effects of exercise.

- In consultation with a diving medicine expert, as needed

• Silent ischemia evaluation for candidates over 40 years old

- After an initial assessment, periodic monitoring for silent ischemia may comply with accepted local/national guidelines for evaluating diabetics

• Candidate documents expressing their intention to follow the diabetic diver protocol and to cease diving and seek medical evaluation for any adverse events during diving potentially related to diabetes

  
  

Diving Scope

• Diving must be planned to avoid:

- Depths > 100 fsw (30 msw)

- Durations > 60 minutes

- Mandatory decompression stops

- Enclosed environments (e.g., cave, wreck penetration)

- Situations that could exacerbate hypoglycemia (e.g., prolonged cold and strenuous dives)

• The buddy/divemaster is informed of the diver's condition and the measures to take in case of problems.

• The dive buddy should not be diabetic.

  
  

Glucose Management on Dive Day

• General self-assessment of diving fitness

• Blood glucose (BG) ≥ 150 mg·dL-1 (8.3 mmol·L-1), stable or rising, before entering the water

- Perform at least three blood glucose tests before diving to assess trends

• Sixty minutes, 30 minutes, and immediately before diving

- Adjustments to OHA or insulin dosing the day before or on dive day may help

• Delay diving if blood glucose is:

- <150 mg·dL-1 (8.3 mmol·L-1)

- > 300 mg·dL-1 (16.7 mmol·L-1)

• Emergency medications:

- Carry easily accessible oral glucose during all dives

- Have injectable glucagon available at the surface

• If hypoglycemia is detected underwater, the diver must ascend (with a buddy), establish positive buoyancy, ingest glucose, and exit the water.

• Frequently check your blood glucose for 12 to 15 hours after diving.

• Ensure adequate hydration on dive days.

• Record all dives (include blood glucose test results and any relevant information for diabetes management).

  
  

Reference: DAN Guidelines for Diabetes and Recreational Diving

Happy diving!

Sincerely yours,

The Diving Bear