Proceedings Summary | DAN/UHMS Diabetes and Recreational Diving Workshop
Diabetes is a major chronic disease that affects millions of people worldwide with an increasing trend. In the United States, more than 14% of adults are affected. Insulin-dependent diabetes mellitus (IDDM) affects up to half a million people of all ages, out of which 150,000 are younger than 19 years old. Many people continue to be productive members of the community and pursue various interests and careers despite having diabetes. However, when it comes to diving, the diving medicine community has long maintained the conservative position that IDDM is an absolute contraindication for diving. Recognizing that a substantial number of divers are diving successfully (either openly or surreptitiously) with diabetes in spite of the restriction has led many to believe that it is time to acknowledge this fact and re-examine the position concerning diabetes in diving.
A workshop addressing the issues of diabetes and recreational diving was jointly sponsored by the Undersea and Hyperbaric Medical Society (UHMS) and Divers Alert Network (DAN) on June 19, 2005 in Las Vegas, Nevada. They brought together experts and interested parties from within and beyond the international diving community. At the workshop, participants reviewed the existing data, discussed concerns, and finally developed consensus guidelines to address diabetes and recreational diving. The issues concerning professional diving require future, separate deliberations.
The consensus guidelines were released with the clear statement that it is a set of guidelines, not rules and with an understanding that various interest groups must have the flexibility to use the guidelines as they best serve their community’s needs.
This consensus reflects a more inclusive approach and provides guidelines on how to individually evaluate fitness to dive and how to keep it safe for those who qualify. Not everybody with diabetes who wishes to dive will be able to do so; there are various conditions and states of diabetes that would make diving with the condition too risky for divers and for those diving with them.
The guidelines are designed for individual divers who are primarily responsible for their own health and safety. They should adhere to these guidelines developed to improve their protection and that of their dive partners. The guidelines aim to also assist primary physicians and diving physicians evaluating and monitoring divers with diabetes. Other divers should be aware of the guidelines too, and be mindful of special considerations when buddied or leading dives with divers with diabetes.
Individuals with diabetes who wish to dive must undergo the same medical fitness evaluation as other candidates to ensure first, that no other exclusionary conditions (e.g., epilepsy, pulmonary disease, heart disease, etc.) exist; and second, that there are no complications of diabetes that may increase the risk of injury while diving.
They should be 18 years or older (≥16 years if in special training program), with a well-established treatment, well maintained plasma glucose level and the ability to sustain those levels efficiently in the course of changing demands of daily activities. Candidates and divers with diabetes have to undergo mandatory medical examination annually, and if over 40 years old, they should be regularly evaluated for silent cardiovascular disease.
Candidates who pass the fitness evaluation and master regular scuba training, must also learn and adhere to the diabetic diving protocol. They should dive only in comfortable environmental conditions, with no overhead. Their dive should not exceed the depth 30 meters of sea water (100 fsw), duration of one hour nor involve compulsory decompression stops.
Divers with diabetes should dive with a buddy who is informed of their condition and is aware of the appropriate response in the event of a hypoglycemic episode. It is recommended that the buddy does not have diabetes.
Divers with diabetes whose medication may put them at risk of hypoglycemia, should use a protocol to manage their health on the day of diving.
(Summary Form 1)
1 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: Divers Alert Network; 2005.
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