title: A day in the life of a diabetic diver: the Undersea and Hyperbaric Medical Society/Divers Alert Network protocol for diving with diabetes in action.
abstract: Some people with well-managed insulin-dependent diabetes can dive safely. Those cleared to participate should control tightly the variables that impact blood glucose levels, including activity, timing, food and insulin. Honest self-assessment is critical. A diabetic diver should cancel a dive if seasick, unusually anxious, or following significant high or low blood glucose levels in the preceding 24 hours. The diver should enter the water with a blood glucose level above 8.3 mmol·L⁻¹ and below 14 mmol·L⁻¹ with a stable or rising trend in blood glucose established with glucose tests at 90, 60, and 30 minutes prior to a dive. The diver should carry emergency glucose at all times and brief dive buddies about hypoglycaemia procedures. This is a personal account of the author's experience diving with type 1 diabetes and details how the UHMS/DAN recommendations are put into practice on dive days. Key elements of the self-assessment process, long- and rapid-acting insulin adjustments, meal timing, responses to blood glucose trends, handling hypoglycaemia and approaching multi-dive days are described. Some considerations for people using insulin pumps are also briefly discussed.
authors.affiliation: Chief Executive Officer, Telethon Type 1 Diabetes Family Centre, 11 Limosa Close, Stirling, WA 6021, Australia. rebecca@telethontype1.org.au.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Johnson
mesh_terms: D001315:Australia; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods / Q000592:standards; D002568:Certification / Q000592:standards; D002985:Clinical Protocols; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000628:therapy*; D059026:Diagnostic Self Evaluation; D004242:Diving; D005247:Feeding Behavior; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D017408:Guidelines as Topic; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D007328:Insulin / Q000008:administration & dosage / Q000493:pharmacokinetics; D007332:Insulin Infusion Systems; D012016:Reference Values; D013549:Sweetening Agents / Q000008:administration & dosage; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D013549:Sweetening Agents; D005947:Glucose
keywords: Scuba diving; blood glucose level; endocrinology; exercise; health status; safety