Historically, DAN has advised divers with insulin-dependent diabetes against diving because of the threat of a hypoglycemic episode underwater. However, in a 1996 survey, DAN discovered that approximately 177 of its members were diabetic and scuba diving. Of these, approximately 74 percent were insulin-dependent.
As a result of these findings, DAN Medical Research launched an observational study in 1997 to analyze current guidelines for divers with diabetes.
The objectives of the study were:To measure blood glucose levels during scuba diving while following study guidelinesTo develop a workable protocol for blood glucose analysisTo access compliance and study guidelines.
For this study, all participants:visited a personal doctor and had medical verification form signedhad a Hemoglobin A1c (glycosylated hemoglobin) test before dive trip (within two weeks of the study date)kept a daily log of diet, exercise, insulin doses, and blood glucose levels as describedadministered a minimum of three blood glucose tests within one hour of each dive activity and one post-dive test (DAN supplied diabetic equipment and supplies.)had a Hemoglobin A1c test after study within two weeks of completion of study (DAN covered both test costs.)
To participate, the diver must have:insulin-dependent diabetesa scuba diver certificationbeen between the ages of 18 and 65not been pregnantbeen a DAN Member with DAN Master or Preferred Plan dive insurancebeen willing to follow the protocols for DAN's studyhad a medical release form signed by a diabetologist or personal primary care physician
To participate, the diver must have had:a pretrip HbA1c test in range of < 9 percentno history of any episode of severe insulin reactions (loss of consciousness or seizure) in past 12 monthsno advanced secondary complications, coronary artery disease, cardiovascular diseaseno advanced peripheral vascular disease, proliferative retinopathy, neuropathy or renal diseaseno hospitalization within the previous 12 months for insulin shock or diabetic ketoacidosishypoglycemic awareness as well as a good understanding of the relationship between exercise and blood glucose levelsgood control of his or her diabetesthe ability to accurately check blood glucose without supervisionthe ability to detect and treat hypoglycemia without assistanceno hospitalization or surgery in past 12 months for other conditionsBlood Glucose Monitoring
Blood glucose monitoring occurred one hour, 30 minutes and 10 minutes prior to the dive and again immediately after the dive.What Are Hypoglycemic or Hyperglycemic Episodes?
Researchers assumed a hypoglycemic episode if the diver's blood glucose level was 70 mg/dl or less, or the diver experienced symptomatic hypoglycemia before, during or after diving.Signs and Symptoms of Hypoglycemiasweatingnervousnessfaintnesspalpitationsconfusionvisual disturbancesstuporseizuresloss of consciousness Prior to the Dive
Blood glucose levels below 100 mg/dl on predive measurements or falling levels during subsequent tests were treated with an oral glucose gel and a fourth measurement obtained one hour later. The subject was not allowed to dive and was kept under medical supervision until blood glucose level was rising or stable and above 100 mg/dl.During the Dive
Volunteers who experienced hypoglycemic events (symptoms of hypoglycemia) during the dive signaled their buddies with a pre-established hand signal — an L-shape with their thumb and index finger — and the buddies ascended to the surface. On the surface, the buddy helped the diabetic diver become positively buoyant and ingest a tube of glucose gel (each diabetic diver carried a tube). The buddy team then terminated the dive, returned to the boat and rechecked the diabetic's blood glucose level. An event occurring after the dive required a diabetic diver to eat a carbohydrate snack and recheck his or her blood glucose level until it rose above 80 mg/dl. The diabetic remained under medical supervision during this time.
From 1997 through 1999, DAN collected data on nine trips, 561 dives by 41 insulin-requiring divers and 504 control dives by 43 divers without diabetes. Diving created no adverse effects on the diver with diabetes. There were 18 hypoglycemic episodes outside of the diving.ResourcesList of publications related to this study"DAN and UHMS Publish Guidelines for Recreational Diving with Diabetes"Table of Contents for Diabetes and Recreational Diving with Diabetes
This project was supported by DAN Members, DAN donors and the following businesses and organizations:Aggressor Fleet Inc.Nekton Cruises Inc.Peter Hughes Diving Inc.Underwater Explorers Society (UNEXSO), BahamasBayer CorporationCan Am CareBuceo Medico Mexicano Hyperbaric Chamber, CozumelCasa del Mar, CozumelDel-Mar Aquatics, CozumelAquaWorld, CozumelAlbatros Charters, CozumelBlue Bubble Divers, CozumelCaribbean Divers, CozumelCozumel Equalizer SA, CozumelDive Paradise, CozumelMako Tours, CozumelScuba Club Cozumel, CozumelSand Dollar, CozumelCha Cha Cha Divers, CozumelScuba Du, CozumelDive Palancar, CozumelAldora Divers, Cozumel