AD 2018 Q1

people with diabetes face a greater risk when it comes
to diving safely.
Even today some medical experts strongly disapprove
of diving by people who have diabetes. Divers with
diabetes, however, along with physicians and dive
researchers have demonstrated that by taking the right
precautions it is possible to pursue one’s passion for
diving without jeopardizing one’s health and safety.
Before diving, people with diabetes should know
their limits and always speak with professionals to
get an objective assessment of their health status. No
matter how well controlled one’s condition may be,
people with diabetes cannot dive without restrictions.
They must accept that the risks they face are higher
— even if their diving skills are equal to or greater
than those of nondiabetics. Having diabetes should
not prevent people who are sufficiently healthy and
capable from exploring the world, but they must
always take the right safety precautions.
DAN EUROPE DIABETES RESEARCH
Results from research by DAN Europe suggest that to
prevent worsening of hypoglycemia and to correctly
interpret hypoglycemia-like symptoms while diving,
divers with diabetes could benefit from real-time
blood glucose (BG) monitoring during their dives.
During one study of 26 dives in a hypberbaric chamber
by diabetic divers, researchers noted no statistical
differences among the BG measurements recorded
every five minutes before, during and after dives.
This study, featuring the use of a continuous
glucose monitoring (CGM) system in a waterproof
case, was a perfect example of how technology can
help people with diabetes increase their dive safety. A
subcutaneous sensor monitored interstitial glycemia,
and a display showed real-time blood glucose levels,
allowing the divers to continuously check their BG.
Another DAN Europe research study found similar
results, demonstrating through continuous monitoring
that although BG levels declined progressively, diving
did not impart a significant risk of hypoglycemia.
These DAN studies point to a potentially useful
conclusion: A real-time CGM system used by diabetic
divers while diving can provide immediate information
on BG values and trend. This could mean both a
significant increase in diving safety and enhanced
knowledge of and interest in this specific field. These
data could be valuable, considering that hypoglycemiarelated
problems during diving can be easily confused
with other symptoms such as those that result from
nitrogen narcosis or alternobaric vertigo (unequal
pressure in the middle ears).
Natasha, a young diver with diabetes who took part
in one study, had this comment about using the CGM
system while diving:
I’m used to regularly monitoring my blood
glucose during the day; I’ve being doing this
since I was a kid. However, being able to test it
every five minutes while below the surface was
just unbelievable. I finally felt safer while doing
what I love most along with people I love: being
underwater and enjoying marine life.
For divers who do not suffer from any long-term
complications, diving with diabetes is possible, provided
they have regular medical checkups and keep their
diabetes well controlled to minimize potential risks.
Recommendations for diving with diabetes
• Consult with a doctor who has expertise in diabetes
and/or dive medicine before attempting to dive.
• Always wear a diabetes medical alert bracelet so
fellow divers and rescuers are aware of your disease
in case of an emergency.
• Always carry oral glucose with you, both on the surface
and underwater. Make sure your buddy has some too
and knows how and when to provide it to you.
• Have a glucagon injection available on the surface in
case you lose consciousness.
• Eat food with slow-to-digest carbohydrates before
you dive to promote a stable glucose level.
• Measure your blood glucose immediately before and
after diving.
• Avoid depths greater than 100 feet. The risk of
nitrogen narcosis increases at depths greater
than 100 feet, and its symptoms can be confused
with hypoglycemia.
• Avoid diving for longer than 60 minutes.
• Log your dives, and take note of your blood sugar
levels for future reference.
• Do not dive in cold water, strong currents or
conditions that demand strenuous activity.
• If you have type 1 diabetes, ensure your blood sugar
is stable and no less than 150 mg/dL (8.3 mmol/L).
• Consider using a CGM system to check your BG in
real time.
• Stay hydrated and healthy before, during and
after diving.
• Remain relaxed, and enjoy the experience. AD
88 | WINTER 2018