DAN Medical Frequently Asked Questions

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Diabetes

Officially known as diabetes mellitus, the disease has two forms: type 1 (also known as insulin-dependent), in which the body fails to produce enough insulin, which helps regulate blood glucose (blood sugar) levels; and type 2, in which the body develops a resistance to insulin. But when traveling abroad, anyone with diabetes must take extra precautions, particularly those with type 1 diabetes.
About 387 million people worldwide (8 percent of the global population) — and over 29 million Americans (9 percent of the U.S. population) — are currently living with diabetes. Of the 29 million Americans with the disease, about 21 million cases are diagnosed and 8 million are undiagnosed. Officially known as diabetes mellitus, the disease has two forms: type 1 (also known as insulin-dependent), in which the body fails to produce enough insulin, which helps regulate blood glucose (blood sugar) levels; and type 2, in which the body develops a resistance to insulin. Of Americans with diabetes, the vast majority have type 2, with only about 1.25 million having type 1. The prevalence of diabetes increases with age; in Americans aged 65 and older, its prevalence is 26 percent. Every year, almost 2 million new diagnoses of diabetes are made in the U.S. In addition, 86 million Americans age 20 and older have a condition known as prediabetes, which is characterized by blood glucose levels higher than normal but not high enough for a diagnosis of diabetes. Learn more about the statistics on diabetes from the ADA.

Both types of diabetes are very treatable, with dietary measures and/or administration of insulin, either orally or by injection (or other medications, in the case of the type 2 form of the disease). Type 2 diabetes can be prevented with weight control or loss, a nutritious diet, and exercise. The symptoms of untreated diabetes include weight loss, excessive urination, excessive thirst, and increased hunger.

Many people with diabetes travel regularly without major problems. Some people with diabetes also participate in extreme sports, although often against medical advice. But when traveling abroad, anyone with diabetes must take extra precautions, particularly those with type 1 diabetes.

The two major concerns for those with insulin-dependent diabetes are the availability of insulin and their ability to control their diet while traveling. Insulin may not be readily available in some locations, and even if it is available, not all countries follow the same standards regarding quality; thus travelers must carry insulin with them in a more than sufficient quantity, in case they encounter travel delays.

The availability at your destination of healthy — and safe-to-eat — foods is a concern for those with both type 1 and type 2 diabetes, since following a consistently healthy diet is one of the key factors in managing diabetes. It is thus essential that those with diabetes research the available cuisine, and its safety, in any countries they expect to travel to or through, and plan ahead as to how they will meet their dietary needs.

In addition, traveling induces stress that can cause variations in individuals' daily need for insulin, so they must be more vigilant in monitoring their blood sugar levels. Those with recently diagnosed diabetes should not travel until they have mastered good control of their blood sugar levels.

There are also issues of particular concern to individuals with diabetes who plan to scuba dive. In years past, individuals with diabetes (especially type 1) who chose to dive typically did so against medical advice by hiding their condition. However, in recent years, there has been a shift away from a blanket prohibition on diving with diabetes, due partly to antidiscrimination laws and partly to the growing record of safe diving by individuals with diabetes. It is now possible in many countries for those with diabetes to receive dive training and to dive safely.

An international workshop in 2005, jointly sponsored by DAN and the Undersea and Hyperbaric Medical Society, reached agreement that prospective divers who are able to control their diabetes with either dietary measures or medication and who are otherwise qualified to dive may undertake recreational scuba diving, provided they meet certain criteria. This conclusion was ratified by the Recreational Scuba Training Council in the United States.

The criteria are detailed in the full consensus guidelines. These guidelines consist of 19 points that are divided into three sections:
* Selection and surveillance
* Scope of diving
* Glucose management on the day of diving
You can read a summary of the guidelines online. In addition, DAN offers a free online seminar on diving safely with diabetes.

The guidelines contain practical recommendations for medications and procedures in case a diver develops hypoglycemia (low blood sugar) underwater. Individuals with diabetes, as well as their buddies and dive leaders, should be aware of the status of any divers with diabetes and knowledgeable about the signs and symptoms of hypoglycemia and the procedures that may be required in case a problem arises.

Divers with diabetes can be very sensitive to manifestations of hypoglycemia. Many people will feel early warning signs, such as weakness, nausea, blurred vision, sweating, anxiety and/or trembling. As the diver's blood sugar continues to drop, fatigue will set in and changes in mental status can occur. Eventually, an affected diver may become combative or unaware his or her surroundings. In severe cases, loss of consciousness or seizures may occur. Episodes of hypoglycemia that lead to changes in mental status or seizures can result in drowning.


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