The Risks of Diabetes & Diving

I've been diagnosed with diabetes. What are this issues with diving?
Condition: Diabetes mellitus (DM) is a disorder of the endocrine system, manifested by one of two things: an insufficient production of insulin or the resistance of the body's cells to the actions of insulin despite normal or high levels. People with DM often have excessively high blood glucose (BG), called hyperglycemia, or an excessively low BG, better known as hypoglycemia.
Diabetes mellitus itself has two major forms: Insulin-requiring diabetes (IDDM, Type 1),* for which insulin must be given by injection to control blood sugar levels; and non-insulin-dependent diabetes (NIDDM, Type 2), which may be controlled by diet or by oral medications (oral hypoglycemic medications).
The main risk to the diver is the occurrence of hypoglycemia, that can manifest itself as confusion, sweating, rapid heartbeat, unconsciousness and even death. High blood sugar levels, or hyperglycemia, may also cause unconsciousness, although this usually develops much more slowly than hypoglycemia. Impaired consciousness underwater leads to almost certain death. Although hypoglycemia occurs most commonly in Type 1, it can also occur in individuals taking oral hypoglycemic medications. Hypoglycemia experienced during a deep dive may be wrongly perceived as nitrogen narcosis.
Although hypo- or hyperglycemia can occur daily, other problems can develop over the long term, in persons with diabetes. These maladies include: retinopathy (alterations in visual acuity); disorders of the kidneys; coronary artery disease; and changes in the nervous system, including abnormal nervous conduction and atherosclerosis, that can cause poor circulation in the limbs.
Fitness and Diving: Divers with diabetes are at risk of sudden loss of consciousness. This carries the ultimate risk of drowning and implies additional risks for their dive buddies. Individuals with diabetes, however well the diabetes is controlled, should not be deemed as fit to dive without restriction. Those who meet certain criteria can dive provided they dive in accordance with detailed, specific procedures (See Diabetes & Diving: Current practices demonstrate that many with diabetes do take the plunge; By Guy de Lisle Dear, M.B., FRCA, Alert Diver, January / February 1997). Divers with diabetes should be examined periodically for complications of their disorder that may disqualify them on the grounds of additional risk.
Medication Used in Treatment: Sulphonylureas (drugs that possess hypoglycemic action) such as glipizide, glibenclamide, chlorpropamide and tolbutamide may interact with numerous other drugs used to lower BG.
There is a small risk of lactic acidosis which is markedly increased by any condition that reduces metformin clearance (acute or chronic renal impairment) or compromises oxygen delivery and predisposes to tissue hypoxia (acute or chronic respiratory or cardiovascular insufficiency) in persons with renal, liver or heart diseases.
Additional Information:
Diabetes mellitus itself has two major forms: Insulin-requiring diabetes (IDDM, Type 1),* for which insulin must be given by injection to control blood sugar levels; and non-insulin-dependent diabetes (NIDDM, Type 2), which may be controlled by diet or by oral medications (oral hypoglycemic medications).
The main risk to the diver is the occurrence of hypoglycemia, that can manifest itself as confusion, sweating, rapid heartbeat, unconsciousness and even death. High blood sugar levels, or hyperglycemia, may also cause unconsciousness, although this usually develops much more slowly than hypoglycemia. Impaired consciousness underwater leads to almost certain death. Although hypoglycemia occurs most commonly in Type 1, it can also occur in individuals taking oral hypoglycemic medications. Hypoglycemia experienced during a deep dive may be wrongly perceived as nitrogen narcosis.
Although hypo- or hyperglycemia can occur daily, other problems can develop over the long term, in persons with diabetes. These maladies include: retinopathy (alterations in visual acuity); disorders of the kidneys; coronary artery disease; and changes in the nervous system, including abnormal nervous conduction and atherosclerosis, that can cause poor circulation in the limbs.
Fitness and Diving: Divers with diabetes are at risk of sudden loss of consciousness. This carries the ultimate risk of drowning and implies additional risks for their dive buddies. Individuals with diabetes, however well the diabetes is controlled, should not be deemed as fit to dive without restriction. Those who meet certain criteria can dive provided they dive in accordance with detailed, specific procedures (See Diabetes & Diving: Current practices demonstrate that many with diabetes do take the plunge; By Guy de Lisle Dear, M.B., FRCA, Alert Diver, January / February 1997). Divers with diabetes should be examined periodically for complications of their disorder that may disqualify them on the grounds of additional risk.
Medication Used in Treatment: Sulphonylureas (drugs that possess hypoglycemic action) such as glipizide, glibenclamide, chlorpropamide and tolbutamide may interact with numerous other drugs used to lower BG.
- Biguanides (metformin) may cause self-limited (gastrointestinal side effects and may cause problems* in individuals with renal, liver or heart diseases.
- Acarbose (an alpha-glucosidase inhibitor) is also used in conjunction with other agents when the more simple sulphonureas do not work adequately to control blood glucose. Insulin acts to lower BG. In general, diving with diabetes is not recommended. An additional consideration: insulin requirements may change substantially with demands of exercise and diving.
There is a small risk of lactic acidosis which is markedly increased by any condition that reduces metformin clearance (acute or chronic renal impairment) or compromises oxygen delivery and predisposes to tissue hypoxia (acute or chronic respiratory or cardiovascular insufficiency) in persons with renal, liver or heart diseases.
Additional Information:
- Diabetes.com -- www.diabetes.com/
- The National Institute of Diabetes and Digestive and Kidney Diseases or (NIDDK) -- www.niddk.nih.gov/
- Diabetes & Diving: Current practices demonstrate that many with diabetes do take the plunge -- How safe is it? by Guy de Lisle Dear, M.B., FRCA, DAN Assistant Medical Director, Alert Diver, January/February 1997.
Posted in Dive Safety FAQ
Categories
2020
January
February
Group Fitness at the PoolHow to Rescue a Distressed diver at the SurfaceHow to manage Near-DrowningNo Sit-ups no problem How to manage MalariaHow to manage Oxygen Deficiency (Hypoxia)What to do when confronted by a sharkHow to manage Scombroid PoisoningHow to perform a Deep Diver RescueHow to perform One-rescuer CPRHow to perform a Neurological Assessment
March
DAN’s Quick Guide to Properly Disinfecting Dive GearCOVID-19 : Prevention Recommendations for our Diving CommunityGermophobia? - Just give it a reasonable thoughtScuba Equipment care – Rinsing and cleaning diving equipmentCOVID-19 and DAN MembershipFurther limitations imposed on travels and considerations on diving activitiesDAN Membership COVID-19 FAQsLancet COVID-19 South African Testing SitesCOVID-19 No Panic Help GuideGetting Decompression Sickness while FreedivingDown in the DumpsCardiovascular Disease and DivingDelayed Off-GassingDiving after Dental surgeryDiving with Multiple MedicationsPygmy Seahorses: Life AquaticAfrica DustCOVID-19 Myth BustersScuba Units Are Not Suitable Substitutes for VentilatorsDisinfection of Scuba Equipment and COVID-19Physioball Stability Exercises
April
COVID-19 AdvisoryScuba Equipment Care - Drying & Storing Your GearTransporting Diving Lights & BatteriesHow to Pivot Your Message During a CrisisTourism Relief FundCOVID-19 Business Support ReviewDiving After COVID-19: What We Know TodayEUBS-ECHM Position Statement on Diving ActivitiesPart 2: COVID-19 Business Support ReviewPress Release
May
Diving in the Era of COVID-19Dive Operations and COVID-19: Prepping for ReturnCOVID-19 & Diving Activities: 10 Safety RecommendationsCOVID-19: Surface Survival TimesThe Philippines at its FinestThe Logistics of ExplorationThe Art of the Underwater SelfieShooter: Douglas SeifertFAQs Answered: Disinfecting Scuba EquipmentStock your First-Aid KitResearch and OutreachCovid-19 ResearchOut of the BlueEffects of Aspirin on DivingThe New Pointy end of DivingDiving and Hepatitis CCaissons, Compressed-Air work and Deep TunnellingPreparing to Dive in the New NormalNew Health Declaration Form Sample Addressing C-19 IssuesDiving After COVID 19: What Divers Need to Know
June
Travel Smarter: PRE-TRIP VACCINATIONSAttention-Deficit/Hyperactivity Disorder and DivingCOVID-19: Updated First Aid Training Recommendations From DANDiving with a Purpose in National Marine SanctuariesStay Positive Through the PandemicFor the Dive Operator: How to Protect Your Staff & ClientsStudying Deep reefs and Deep diversAsking the Right QuestionsLung squeeze under cold diving conditions
July
Dive DeprivationVolunteer Fish Surveys: Engage DiversDAN Member Profile: Mehgan Heaney-GrierTravel Smarter: Don’t Cancel, Reschedule InsteadDive Boat Fire SafetyRay of HopePartner ExercisesDiving at AltitudeAluminium ExposureHip FracturesAcoustic NeuromaGuidelines for Lifelong Medical Fitness to DiveNew Dive Medical Forms
August
Women in Diving: Lauren Arthur, Conservationist & Natural History Story TellerWomen in Diving: Dr Sara Andreotti White Shark ResearcherTiming ExerciseWomen in Diving: The Salty Wanderer, Charlie WarlandWomen in Diving: Beth Neale, Aqua soul of freedivingWomen in Diving: Diving and spearfishing Diva, Jean HattinghWomen in Diving: Zandile Ndhlovu, The Black Mermaid
September
October
Freediving For ScienceStep Exercises with CardioFluorescence Imaging help Identify Coral BleachingChildren and DivingThe Watchman device and divingScuba Diving and Factor V Leiden gene mutationNitrogen Narcosis at shallow depthsOil and Particulates: Safe levels in Breathing Air at depthDive Principles for Coping with COVID-19The Importance of a Predive Safety CheckTalya Davidoff: the 'Plattelandse Meisie' Freediver
2019
February
April
May
DAN Press ReleaseYour Dive Computer: Tips and tricks - PART 1Your Dive Computer: Tips and tricks - PART 2Aural HygieneDCS AheadHow Divers Can Help with coral conservationRed Tide and shellfish poisoningDiving after Kidney DonationDiving with hypertrophic cardiomyopathyEmergency Underwater Oxygen Recompression
June
July
September
October
November
Exercise drills with DowelsHeart-rate TrainingCultivating ConservationTRavel Smarter : Evaluating an unfamiliar Dive operatorChallenging the Frontiers of Decompression ResearchTravel Smarter: Plan for Medical EmergenciesWhen should I call my Doctor?DAN Student Medical Expense CoverageAdvice, Support and a LifelineWetsuits and heat stressDiving after Chiropractic adjustments
2018
April
Flying after pool diving FAQLung squeeze while freediving FAQDiving after Bariatric surgery FAQMarine injuries FAQVasovagal Syncope unpredictable FAQIncident report procedure FAQDiving after knee surgery FAQDiving when in RemissionDive with orbital Implant FAQInert gas washout FAQOxygen ears FAQPost Decompression sicknessChildren and diving. The real concerns.Diving after SurgeryPhysiology of Decompresssion sickness FAQDiving and regular exerciseGordon Hiles - I am an Underwater Cameraman and Film MakerScuba Air QualityBreath-hold diving. Part 3: The Science Bit!Compensation Legislation and the Recreational DiverCape Town DivingFive pro tips for capturing better images in cold waterThe Boat Left Without You: Now What?
May
When things go wrongEmergency Planning: Why Do We Need It?Breath-hold diving: Running on reserve -Part 5 Learning to RebreatheSweet Dreams: When Can I Resume Diving Post Anaesthesia?Investing in the future of reefsTo lie or not to lie?THE STORY OF A RASH AFTER A DIVEFirst Aid KitsTaravana: Fact or Falacy?
June
Oxygen Unit MaintenanceKnow Your Oxygen-Delivery Masks 1Know Your Oxygen-Delivery Masks 2Emergency Oxygen unitsInjuries due to exposure - HypothermiaInjuries due to exposure - Altitude sicknessInjuries due to Exposure - Dehydration and other concernsHow to plan for your dive tripThe Future of Dive MedicinePlastic is Killing our ocean
September
Return to DivingDiagnoses: Pulmonary blebSide effects of Rectogesic ointmentDiving with ChemotherapyReplacing dive computers and BCDsCustomize Your First-Aid KitPlan for medical emergenciesHow the dive Reflex protects the brain and heartDry suits and skin BendsAltitude sickness and DCSScuba Diving and Life Expectancy
2017
March
April
Incident Insight: TriageA Field Guide to Minor MishapsSnorkels: Pros & ConsTime & RecoveryMedication & Drug UseDiving with CancerNitrox FAQCOPD FAQHyperbaric Chamber FAQJet Lag FAQHydration FAQAnticoagulant Medication FAQFluid in the Ear FAQEye Surgery FAQElderly Divers FAQNitrogen FAQHealth Concerns FAQMotion Sickness FAQMicronuclei FAQ
June
August
2016
February
March
Breath-Hold Diving & ScubaReturn to Diving After DCITiming Exercise & DivingHot Tubs After DivingSubcutaneous EmphysemaIn-Water RecompressionDiving at AltitudeFlying After DivingDiving After FlyingThe Risks of Diabetes & DivingFlu-like Symptoms Following a DiveHand & Foot EdemaFrontal HeadachesBladder DiscomfortLatex AllergiesRemember to BreatheProper Position for Emergency CareAches & PainsCell Phones While DrivingSurfers Ear Ear Ventilation TubesDealing with Ear ProblemsDiving with Existing Ear InjuriesPerforated Ear DrumENT SurgeryUnpluggedCochlear ImplantsPortuguese Man-of-WarJellyfish StingsLionfish, Scorpionfish & Stonefish EnvenomationsStingray Envenomation Coral Cuts, Scrapes and RashesSpeeding & Driving Behaviour
June
Newsflash! Low Pressure Hose DeteriorationItching & rash go away & come back!7 Things we did not know about the oceanMigraine HeadacheAttention Deficit Disorder Cerebral Vascular AccidentEpilepsyCerebral PalsyHistory of SeizuresMultiple Sclerosis Head TraumaBreast Cancer & Fitness to Dive IssuesLocal Allergic ReactionsSea LiceHow ocean pollution affects humans Dive Fatality & Lobster Mini-Season StatisticsPregnancy & DivingReturn to Diving After Giving BirthBreast Implants & DivingMenstruation During Diving ActivitiesOral Birth ControlBreast FeedingPremenstrual SyndromeOsteoporosisThe Aftermath of Diving IncidentsCompensation Legislation & the Recreational DiverNoise-Induced Hearing LossLegal MattersThe Nature of Liability & DivingDAN Legal NetworkWaivers, Children & Solo DivingHealthy, but overweight!Taking Medication while Scuba DivingGetting Fit for the Dive SeasonBone Considerations in Young DiversAsthma and Scuba DivingHepatitisDiving with HyperglycemiaShoulder PainDiving After Spinal Back Surgery
August
Hazard Identification & Risk AssessmentCaring For Your People Caring For Your FacilitiesCaring For Your BusinessScuba Air Quality Part 1Scuba Air Quality Part 2Chamber Maintenance Part 1Chamber Maintenance Part 2The Aging Diver Propeller SafetyRelease The PressureDon't Get LostMore Water, Less Bubbles13 Ways to Run Out of Air & How Not To7 Mistakes Divers Make & How To Avoid ThemSafety Is In The AirHow Good Is Your Emergency Plan
2015
January
March
No Comments