Summary Form - Guidelines for Recreational Diving with Diabetes
Table 1: Guidelines for Recreational Diving with Diabetes - Summary Form1
Selection and Surveillance
Age 18 years (16 years if in special training program)
Delay diving after start/change in medication
- 3 months with oral hypoglycemic agents (OHA)
- 1 year after initiation of insulin therapy
No episodes of hypoglycemia or hyperglycemia requiring intervention from a third party for at
least one year
No history of hypoglycemia unawareness
HbA1c > or = 9% no more than one month prior to initial assessment and at each annual review
- values >9% indicate the need for further evaluation and possible modification of therapy
No significant secondary complications from diabetes
Physician/Diabetologist should carry out annual review and determine that diver has good
understanding of disease and effect of exercise
- in consultation with an expert in diving medicine, as required
Evaluation for silent ischemia for candidates >40 years of age
- after initial evaluation, periodic surveillance for silent ischemia can be in accordance with
accepted local/national guidelines for the evaluation of diabetics
Candidate documents intent to follow protocol for divers with diabetes and to cease diving and
seek medical review for any adverse events during diving possibly related to diabetes
Scope of Diving
Diving should be planned to avoid
- depths >100 fsw (30 msw)
- durations >60 minutes
- compulsory decompression stops
- overhead environments (e.g., cave, wreck penetration)
- situations that may exacerbate hypoglycemia (e.g., prolonged cold and arduous dives)
Dive buddy/leader informed of diver's condition and steps to follow in case of problem
Dive buddy should not have diabetes
Glucose Management on the Day of Diving
General self-assessment of fitness to dive
Blood glucose (BG) >,= 150 mgdL-1 (8.3 mmol.L-1), stable or rising, before entering the water
- complete a minimum of three pre-dive BG tests to evaluate trends
@ 60 minutes, 30 minutes and immediately prior to diving
- alterations in dosage of OHA or insulin on evening prior or day of diving may help
Delay dive if BG
- <150 mg.dL-1 (8.3 mmol.L-1)
- >300 mg.dL-1 (16.7 mmol.L-1)
Rescue medications
- carry readily accessible oral glucose during all dives
- have parenteral glucagon available at
If hypoglycemia noticed underwater, the diver should surface (with buddy), establish positive
Check blood sugar frequently for 12-15 hours after diving
Ensure adequate hydration on days of diving
Log all dives (include BG test results and all information pertinent to diabetes management)
For full text see: Pollock NW, Uguccioni DM, Dear GdeL, eds. Diabetes and recreational diving:
guidelines for the future.
Proceedings of the UHMS/DAN 2005 June 19 Workshop. Durham, NC:
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