The biggest risk associated with scuba diving and diabetes is if a person who is taking blood sugar lowering medicine (ie insulin) has a severe low blood sugar event while underwater that could result in losing consciousness which in turn could lead to drowning. Diving is also a physical activity and can be strenuous depending on the conditions and like any other type of exercise, the physical activity itself can lower blood sugar in addition to the insulin.
Yeah, that sounds pretty damn scary, but my view is that if you can manage your blood sugar day to day and are comfortable in the way you manage it, your chances of becoming impaired while diving because of low blood sugar are pretty low. We have to manage our blood sugar for exercise so it doesn't drop to low during a workout, same thing for getting behind the wheel of a car. In my opinion, its the same thing for scuba diving.
In 2005, the Diver's Alert Network (DAN) along with the Undersea and Hyperbaric Medical Society (UHMS) established guidelines for recreational diving and diabetes. These guidelines have also been endorsed by the Recreational Scuba Training Council. In summary the guidelines recommend that a diver with diabetes be in overall good physical health (this is important for anyone who wants to dive, not just those with diabetes), an A1C under 9 and no significant complications from diabetes. The guidelines also recommend that your blood sugar be steady or rising before you enter the water and that you have a fast acting glucose source on hand, just in case.
With this info in mind, my husband and I headed to Belize for my first dive trip with diabetes and if I can toot my own horn a bit, I think my blood sugar control was perfect! My blood sugars were higher than I prefer them to be when I'm at home, but that was my lifestyle decision -- to be able to pursue an activity that I enjoy and to do it safely. I did not experience one low blood sugar episode during any of my dives and we did 16 of them, including a night dive. Here was my approach:
- I lowered my basal insulin doses both in the morning and before bedtime. I lowered my bed time dose by 1 unit and my morning dose by 2 units. I have to admit that these were kinda arbitrary values. Part of my thinking was that in doing 2-3 dives a day while there, I would be getting some exercise out of that activity which would help lower my blood sugar in and of itself.
- When there were dives scheduled right after meals, I opted to eat very low carb and not take any insulin with those meals. My thinking being that I didn't want my rapid acting insulin to be peaking while underwater, which coupled with the activity of the diving itself, could risk sending my blood sugar too low.
- I checked my blood sugar at least 3 times before each dive to be sure it wasn't going down. "Steady or rising" was my pre-dive BG mantra for the week.
- Both my husband and I carried glucose gels with us during our dives. I also had a water tight plastic box on the dive boat that held my meter and its accessories, another glucose gel, glucose tabs and a snack bar or two.
I found that my BG was in the 180 - 220 mg/dl range before each of my dives. I also checked my BG after each dive and found that the diving tended to lower my BG 50-80 pts, which most of the time put me right in the normal range. I kept my dive times were right around 60 minutes, but I have to admit that I did go beyond one of the DAN guidelines which recommends no dives greater than 100ft. One of the more famous dive sites in the world is the Belize Blue Hole. The main attraction of this site are some huge stalactites that start right around 100ft. I had to check them out so my maximum depth for that dive ended up being 123ft. Thats my deepest dive ever and I really can't get much deeper than that -- 130ft is the recreational limit. I also hit another milestone on this trip -- I completed my 100th dive!
One of the main challenges I encountered on the trip was checking my blood sugar after my dives. After spending 60 minutes in the water, my finger tips were so wrinkly it was hard getting a decent drop of blood that could be sucked up by the test strip -- when I pricked my finger the blood would disperse through the many little channels created by the wrinkles on my finger tips.
The staff at the resort took alot of interest in how I managed my diabetes for diving. I think part of their interest was because they hadn't encountered someone like me before and wanted to learn more in the event they had future divers with diabetes. One of the things they mentioned and that I was not aware of was that some dive operators won't let a person with diabetes dive unless they have a note from their doctor. This kinda bugs me because I believe that it is my decision to undertake the risks associated with diving and that by signing those liability forms you always have to sign before going on a dive, I believe I should be able to do what I damn well please. But, it is definitely something to keep in mind for my next trip and if a note from my doctor is necessary, so be it.
All in all it was great week of diving -- I was so happy to be able to do something I enjoy despite having diabetes.