Diabetes

Question:
One of my student want to dive (he is a diver for a long time), but he just discover that he is diabetic.
Is it possible for him to continue to dive (is there any danger, and if yes what kind of?).
Is it generally considered necessary to take any sugar containing food or drink while diving?

Answer:
Diving with diabets used to be considered absolutely contraindicated until some years ago, when extensive research has been started, which produced interesting and - at least partially - relieving results. Currently the contraindication is considered relative, and you will find some information here below.
Regarding your second question, it is not generally considered necessary to take any sugar containing food or drink while diving ( in the case of recreational diving ), if the blood glucose level and the diabetic condition in general is kept under good control and well understood by the diver, as indicated below. However, there are certain special gadgtes on the markeplace that, when fitted to the regulator's mouthpiece, would allow you to drink while diving. These gadgtes, however, are not without risk, as they may, in certain cases, stimulate cough and irritation and potential.

From the DAN Europe Medical Division
Diabetes Mellitus - Insulin Dependent or not - can, under certain circumstances, be compatible with recreational diving. The main problem with Diabetes and Diving is the risk of hypoglycemia while underwater, with the inherent risk of loss of control or consciousness and eventual drowning.
A strict control of one's dietary habits, of the insulin injection timings, as well as a full awareness of the relationship between exercise and blood-glucose levels is essential. All these variables may already be difficult to control in normal circumstances, and, actually, IDDM is considered a relative contraindication to diving, which may be considered only in well controlled cases.

Consider the following tips:
1. See the family and diving doctor to define if the student's diabetes is compatible with diving according to the following:
2. There should not be any diabetic complication
3. The student should be able to perceive any sign of oncoming hypoglicemia
4. The student should be able to control his diabetes, respecting the requirements regarding nutrition, antidiabetic medication and theri timing, and understanding completely the relationship between physical exercise, nutrition, time of medication and the risk of hypoglicemia
5. The student should be aware of the potential risks and very self-disciplined.
Many diabetics dive with no significant problems. Field studies have shown that hypoglicemia, although occuring, has not been a significant problem among the diabetic diver populations studied.

From Alert Diver IV / 1999
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 body¹s 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) for which insulin must be given by injection to control blood sugar levels; and non-insulin-dependent diabetes (NIDDM) which may be controlled by diet or by oral 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. 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; 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. 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. Divers with diabetes should be examined periodically for complications of their disorder that may disqualify them on the grounds of additional risk. Sulphonylureas may interact with numerous other drugs used to lower BG. Biguanides may cause self-limited gastrointestinal side effects and may cause problems in individuals with renal, liver or heart diseases. Insulin acts to lower BG.

Question:
Would you be able to tell me whether an insulin dependant diabetic (clear medical history) be able to become a fully qualified PADI instructor?

Answer:

 

Whereas Insulin Dependent Diabetes Mellitus, under certain circumstances, can be compatible with recreational diving, the additional requirements and responsibility involved in instructional underwater activity make diving not advisable in such a capacity.

 

The main problem with Insulin Dipendent Diabetes and Diving is the risk of hypoglycemia while underwater, with the inherent risk of loss of control or consciousness and eventual drowning.

 

A strict control of one's dietary habits, of the insulin injection timings, as well as a full awareness of the relationship between exercise and blood-glucose levels is essential. All these variables may already be difficult to control in normal circumstances, and, actually, IDDM is considered a relative contraindication to diving, which may be considered only in well controlled cases.

 

The additional burden of the responsibility for a third person, the possibility that the strict required nutritional and drug administration timings, imposed by the diabetic conditions, are overlooked and put on a secondary priority scale, with respect to the needs and expectations of the student-customer, the possibility that the diabetic instructor goes beyond the exercise limits imposed by the diabetic condition and the delicate exercise / blood glucose balance, thus risking hypoglycemia in the attempt to help a student / customer with possible further aggravation of the emergency situation, are all factors that should be carefully considered.