Scuba Diving and Diabetes: Practical guidelines

We have been asked to sign medical release forms for diabetic patients who wish to scuba dive. With minimal personal experience and ambivalent literature (1-4), we developed a questionnaire to gather information about individuals with diabetes who dive that has been completed by 18 active divers with insulin-dependent diabetes mellitus (IDDM). This information has helped us develop safety tips for such people. Nine women and nine men responded to our questionnaire. Their ages ranged from 14 to 46 years, with a mean of 33 years. Duration of diabetes was 2-27 years, with a mean of 12 years. Seventeen individuals took two to four insulin injections daily, and one patient used an insulin pump. All patients monitored their blood glucose; 17 monitored more frequently the day of and the day after scuba diving. Of the 18 patients, 16 increased their carbohydrate intake the day of a dive and ate within 60 min of their dive. All patients avoided alcohol use for 24 h before diving and carried a liquid form of glucose to treat hypoglycemia on the day of the dive. Thirteen of the patients carried glucose with them when diving. No patients reported hypoglycemia during the dive. Three individuals reported a successful trial of ingesting liquid glucose during the dive. Of the 18 patients, 17 were certified divers with from 1 month to 19 years of diving experience. Three of these individuals were certified before the onset of diabetes. Five had received a medical release stating that they had diabetes. Seventeen of the 18 patients always dive with a buddy. The adverse experiences reported by these individuals included one episode of indigestion, one episode of ear congestion, and one report of being lost under water, unrelated to hypoglycemia. The remaining 15 individuals have had no adverse experiences while diving. We believe that individuals should be accountable for their own personal safety. In accentuating the safety of a person with diabetes who chooses to scuba dive, consider the following guidelines.