Type one diabetes and Scuba diving

[ejcaswell]

Hi all,
I just wanted to see if anyone on here is a Type one diabetic who regularly scuba dives?
Do you have any hints and tips?

I have been signed off by the Dive Dr to do a PADI Open water course, and the centre knows all about my diabetes. I did a trial dive in their pool a few weeks ago, was in the water for over an hour. I am on an insulin pump, so reduced by basal rate 90 mins before we dived and made sure i was above 9mmol/l before i went for a dive. I managed to cheekily keep my continual monitor on for the dive (went to 3.5m) t.o see what my blood sugar did during the dive, and it just slowly went down and i was about 5 by the end of the session. So i will try and do things different next time (reduce basal rate more and maybe eat a snack or boost gel which I’ve used for running and hiking at times) to keep it higher for longer.

I am still quite anxious about the whole thing, obviously concerned about having a hypo in the water etc, but i have done a fair bit of snorkling with little issues, but have always be able to check my glucose while snorkling so just anxious about the whole thing.

Any advice or experiences would be much appreciated!
Thanks in advance.

 

[Scott-C]

Hi, @ejcaswell , I'm not a diver, but thought I'd post this link to Dana Lewis' experiences of diving with a libre.

https://diyps.org/2018/07/30/scuba-diving-with-a-flash-glucose-monitor-libre/

Dana is a T1 at the forefront of inventing artificial pancreases and seems to like diving too, there's lots of useful tips in there about how to dive with cgm and pumps!

Who says T1s can't do this stuff!?!

 

[Antje77]

I read somewhere of a diver using glucogel under water. Can't remember where I read it but it seems sensible to practice in the pool or shallow water before diving deep enough that it isn't safe to surface quickly.

So i will try and do things different next time (reduce basal rate more and maybe eat a snack or boost gel which I’ve used for running and hiking at times) to keep it higher for longer.

For me, quick acting glucose works to get me up quick when swimming (I'm no diver) but I drop pretty quick afterwards too. Eating something like bread without bolus before swimming works better for me, as it takes longer to digest so it keeps my bg up after some time, whereas glucose taken right before swimming makes me spike before I need it and seems to be used up by the time it's useful.
Might be different for you or with diving of course.

 

[kitedoc]

I personally would not ever do snorkelling or scuba diving as a sport, whether with insulin pump or not.
It is a matter of weighing up benefits vs risks. And also that the risk is not only to one's self but that someone may have to rescue me and put themselves at risk in the process. I think it will always be a controversial matter.
And I seriously question the medical assessment process of allowing such risk!!
Civil liberty you might argue? Your right to do what you like, go where you like?
Yes, it is great to think so but it is sensible for me as a TID, no matter how well controlled a pump/monitoring might seem to make things?
And the matter is complicated by the environment, whether underwater or at altitude part-way up Everest!
I recall a story of a person with T1D lapsing into unconsciousness with a hypo on a scuba dive with orcas and being brought to the surface and thus saved by 2 orcas - what luck !! - but also what lack of wisdom and judgement.
Why not do things with less risk? Being T1D and on insulin carry certain liabilities, we all need to understand this.
-not only for ourselves but for others also. Support climbers on Everest have died or others in need been left to die because persons with various known pre-determined disabilities /liabilities have demanded attention and help.
That is why as a diabetic I have to ensure that I am safe, BSL-wise, to drive a motor vehicle - for my own safety as well as others.
Just my view of commonsense over personal ambition or glory.
Harsh I know, but I contend, realistic.

 

[DCUKMod]

@ejcaswell - I'm not T1, so have no specific wisdom to offer you, but I'll make a couple of comments from an experienced diver perspective, and my experiences post-diagnosis of the wholly different T2.

When it comes to my adventures and "stuff" I'm willing to try, I know I was quite nervy for my first couple dives, post-diagnosis. In order to ensure Ikept my confidence I just built up my depths steadily, over a number of days. I have very narrow canals in my ears, so I always have to be a bit mindful of the changing pressures any way.

We were fortunate to have all our own gear, plus a compressor aboard, meaning we could refill our own tanks, so within the usual bounds, I could do as many dives, as I wanted without too many constaints.

I guess in your shoes, I'd want to be reassured my metabolism ran at the same rates and my insulin absorption was neither hindered nor hastened by the changing pressures on my body. Your Libre, with the reader in a dry pouch should help out with your monitoring.

Personally, I found diving very good for my blood sugars, but that of course suggests the exercise and conditions were effective in keeping my bloods nicely low. Not necessarily so desirable for you!

I don't know where you are doing yourr open water, but the majority of my diving, and certainly that around my diagnosis was in the tropics, so only in a shorty wetsuit and a bit like diving in a warm bath. Obviously at depth in this country (or the environs), the temperaturere could drop quite a bit.

It's not my place to influence your decisions, but proceed with caution, and err on the side of safety. Enjoy your course.

Diving is a magical sensation.

 

[KK123]

I personally would not ever do snorkelling or scuba diving as a sport, whether with insulin pump or not.
It is a matter of weighing up benefits vs risks. And also that the risk is not only to one's self but that someone may have to rescue me and put themselves at risk in the process. I think it will always be a controversial matter.
And I seriously question the medical assessment process of allowing such risk!!
Civil liberty you might argue? Your right to do what you like, go where you like?
Yes, it is great to think so but it is sensible for me as a TID, no matter how well controlled a pump/monitoring might seem to make things?
And the matter is complicated by the environment, whether underwater or at altitude part-way up Everest!
I recall a story of a person with T1D lapsing into unconsciousness with a hypo on a scuba dive with orcas and being brought to the surface and thus saved by 2 orcas - what luck !! - but also what lack of wisdom and judgement.
Why not do things with less risk? Being T1D and on insulin carry certain liabilities, we all need to understand this.
-not only for ourselves but for others also. Support climbers on Everest have died or others in need been left to die because persons with various known pre-determined disabilities /liabilities have demanded attention and help.
That is why as a diabetic I have to ensure that I am safe, BSL-wise, to drive a motor vehicle - for my own safety as well as others.
Just my view of commonsense over personal ambition or glory.
Harsh I know, but I contend, realistic.

This is YOUR opinion. By YOUR reckoning I may as well give up my job. Why should the poster do 'things with less risk'? As for 'realistic', says who?, in fact the poster is probably less at risk than a non diabetic because they are taking extra precautions. Honestly I know everybody is entitled to their opinion but this post is extremely judgemental, and yes, we do all have a right to do what we like and go where we like (within the law) diabetic or not.

 

[Jaylee]

I personally would not ever do snorkelling or scuba diving as a sport, whether with insulin pump or not.
It is a matter of weighing up benefits vs risks. And also that the risk is not only to one's self but that someone may have to rescue me and put themselves at risk in the process. I think it will always be a controversial matter.
And I seriously question the medical assessment process of allowing such risk!!
Civil liberty you might argue? Your right to do what you like, go where you like?
Yes, it is great to think so but it is sensible for me as a TID, no matter how well controlled a pump/monitoring might seem to make things?
And the matter is complicated by the environment, whether underwater or at altitude part-way up Everest!
I recall a story of a person with T1D lapsing into unconsciousness with a hypo on a scuba dive with orcas and being brought to the surface and thus saved by 2 orcas - what luck !! - but also what lack of wisdom and judgement.
Why not do things with less risk? Being T1D and on insulin carry certain liabilities, we all need to understand this.
-not only for ourselves but for others also. Support climbers on Everest have died or others in need been left to die because persons with various known pre-determined disabilities /liabilities have demanded attention and help.
That is why as a diabetic I have to ensure that I am safe, BSL-wise, to drive a motor vehicle - for my own safety as well as others.
Just my view of commonsense over personal ambition or glory.
Harsh I know, but I contend, realistic.

I'm good driver. BSL is a resposibillty in my part of the world. As an insulin dependant driver. That responsibility is mine regarding what I sighed upto regarding fitness to drive with DVLA.

I have done snorkelling on Greek islands but it's not a case of diabetes nearly dashing me on rocks in a mad swell...
Lack of experience & being a below average swimmer. The worst I actually got out of the experience was sun burn.
Lol, no I wouldn't try it again. But not because of diabetes. Cuz I just can't swim in strong currents....

The OP may just have mere than I got. I wish her well.
Life is too short. I'm still here. & learned from the experince. Especially when the marine biology students were changing nearby rather coyly into thier gear on a nudist beach....?

Seriously. @ejcaswell , do your research & be safe.. Have someone trained & experienced to "spot you." Until comfortable In the endevours & have fun...

I'm still here, but I wouldn't try it again. unless I developed the skills of Aquaman..
You know your own capabilities.

This quite old thread may help with regards to the "Aqua Libre" use.. https://www.diabetes.co.uk/forum/threads/freestyle-libre-sensor-and-scuba-diving.83004/

 

[Bon83]

I personally would not ever do snorkelling or scuba diving as a sport, whether with insulin pump or not.
It is a matter of weighing up benefits vs risks. And also that the risk is not only to one's self but that someone may have to rescue me and put themselves at risk in the process. I think it will always be a controversial matter.
And I seriously question the medical assessment process of allowing such risk!!
Civil liberty you might argue? Your right to do what you like, go where you like?
Yes, it is great to think so but it is sensible for me as a TID, no matter how well controlled a pump/monitoring might seem to make things?
And the matter is complicated by the environment, whether underwater or at altitude part-way up Everest!
I recall a story of a person with T1D lapsing into unconsciousness with a hypo on a scuba dive with orcas and being brought to the surface and thus saved by 2 orcas - what luck !! - but also what lack of wisdom and judgement.
Why not do things with less risk? Being T1D and on insulin carry certain liabilities, we all need to understand this.
-not only for ourselves but for others also. Support climbers on Everest have died or others in need been left to die because persons with various known pre-determined disabilities /liabilities have demanded attention and help.
That is why as a diabetic I have to ensure that I am safe, BSL-wise, to drive a motor vehicle - for my own safety as well as others.
Just my view of commonsense over personal ambition or glory.
Harsh I know, but I contend, realistic.

I'm not a diver but I know a few people who regularly dive. Diving is a risk - which requires calculation and careful judgement to avoid bad decision making. T 1 d folk I'm afraid are often very aware of making correct, considered decisions in daily life. I know I put a lot more thought into running than my none diabetic counterparts - I will always have emergency food/mandatory kit list at an event - I know plenty don't. Bad decisions and recklessness put people at risk- not being insulin dependant.

 

[kitedoc]

Yes. It is my opinion made after 52 years experience as a diabetic on insulin.

I put the obvious problems of how to recognise and treat a hypo underwater up front and centre
for you all to contemplate.

Technical support -
# if you were wearing a CGM (and assuming it was accurate) in a falling BSL state how well could you
consume glucose gel without swallowing/inhaling water? And without pulling off the mask in confusion?

# would you have to go to the trouble of wearing an intravenous line with a glucose infusion linked to a
CGM which sent a bolus dose of glucose if BSL trended down too much? (and how expensive and a hassle is this)?

As the Americans say - it is 'a whole other ball of wax' compared to adventures in ambient air.

Even with a diving buddy how 'safe' would you be? Can you imagine such a person trying to give someone
with a hypo some oral glucose underwater? Glucogen injection through the neoprene wet-suit?
Try to put in an intravenous line under water or if there is a line in situ to be able to administer glucose through it?
And what if the person with the hypo turns combative, pulls off the buddy's mask, puts them at risk too?

And one cannot expect a friendly orca or two to be conveniently there to rescue you.

 

[DCUKMod]

Yes. It is my opinion made after 52 years experience as a diabetic on insulin.

I put the obvious problems of how to recognise and treat a hypo underwater up front and centre
for you all to contemplate.

Technical support -
# if you were wearing a CGM (and assuming it was accurate) in a falling BSL state how well could you
consume glucose gel without swallowing/inhaling water? And without pulling off the mask in confusion?

# would you have to go to the trouble of wearing an intravenous line with a glucose infusion linked to a
CGM which sent a bolus dose of glucose if BSL trended down too much? (and how expensive and a hassle is this)?

As the Americans say - it is 'a whole other ball of wax' compared to adventures in ambient air.

Even with a diving buddy how 'safe' would you be? Can you imagine such a person trying to give someone
with a hypo some oral glucose underwater? Glucogen injection through the neoprene wet-suit?
Try to put in an intravenous line under water or if there is a line in situ to be able to administer glucose through it?
And what if the person with the hypo turns combative, pulls off the buddy's mask, puts them at risk too?

And one cannot expect a friendly orca or two to be conveniently there to rescue you.

Kitedoc - Do you have any personal experience of diving?

 

[Diakat]

I have a T1 colleague (not a member so cannot ask him to post) who has dived al over the world.i do not dive so have not asked for info - but I know hypo awareness would come into it.
If you are hypo aware and take reasonable precautions should be ok. Have you tried asking on a diving forum?

 

[KK123]

Yes. It is my opinion made after 52 years experience as a diabetic on insulin.

I put the obvious problems of how to recognise and treat a hypo underwater up front and centre
for you all to contemplate.

Technical support -
# if you were wearing a CGM (and assuming it was accurate) in a falling BSL state how well could you
consume glucose gel without swallowing/inhaling water? And without pulling off the mask in confusion?

# would you have to go to the trouble of wearing an intravenous line with a glucose infusion linked to a
CGM which sent a bolus dose of glucose if BSL trended down too much? (and how expensive and a hassle is this)?

As the Americans say - it is 'a whole other ball of wax' compared to adventures in ambient air.

Even with a diving buddy how 'safe' would you be? Can you imagine such a person trying to give someone
with a hypo some oral glucose underwater? Glucogen injection through the neoprene wet-suit?
Try to put in an intravenous line under water or if there is a line in situ to be able to administer glucose through it?
And what if the person with the hypo turns combative, pulls off the buddy's mask, puts them at risk too?

And one cannot expect a friendly orca or two to be conveniently there to rescue you.

You could apply the 'What if' scenario to all walks of life, you take steps to minimise them. Your 'advice' was fine up until the point you started berating the poster for what you think was a reckless decision.

 

[Robinredbreast]

Yes. It is my opinion made after 52 years experience as a diabetic on insulin.

I put the obvious problems of how to recognise and treat a hypo underwater up front and centre
for you all to contemplate.

Technical support -
# if you were wearing a CGM (and assuming it was accurate) in a falling BSL state how well could you
consume glucose gel without swallowing/inhaling water? And without pulling off the mask in confusion?

# would you have to go to the trouble of wearing an intravenous line with a glucose infusion linked to a
CGM which sent a bolus dose of glucose if BSL trended down too much? (and how expensive and a hassle is this)?

As the Americans say - it is 'a whole other ball of wax' compared to adventures in ambient air.

Even with a diving buddy how 'safe' would you be? Can you imagine such a person trying to give someone
with a hypo some oral glucose underwater? Glucogen injection through the neoprene wet-suit?
Try to put in an intravenous line under water or if there is a line in situ to be able to administer glucose through it?
And what if the person with the hypo turns combative, pulls off the buddy's mask, puts them at risk too?

And one cannot expect a friendly orca or two to be conveniently there to rescue you.

There must be certain procedures that are put into place when a diver, diabetic or not, becomes ill, or flips out, freaks out, under water, safety is paramount to both. It's like when Air Ambulance, Fire Crews, Paramedics, Police, Life Boats, Mountain rescue etc are sent out to vulnerable and scared people.
I don't see why we, as type 1 diabetics, or who have type 1 diabetes, cannot do the things we enjoy and live a normal life.
I am not sure I would do it now, maybe if I were younger, but I love to see people living their lives to the fullest.

 

[Deleted Account]

@kitedoc and @KK123 this discussion reminds me of an interview I heard with Andy Kirkpatrick, a British climber.
The interviewer was concerned about the danger of climbing. Many years later, I still remember the gist of Kirkpatrick's response - there is risk in climbing but much of that risk you can manage: you can make sure your equipment is safe, you can choose routes to your ability, you can climb with a partner you trust, you can train on an inside wall to improve your technique, you can decide not to climb if the weather forecast is wet, ...
I do not diving, but I believe, like climbing there are risks, and, like climbing you can mitigate many of them.
I certainly don't live my life avoiding risk - I live it mitigating as much risk as possible.

 

[kitedoc]

Kitedoc - Do you have any personal experience of diving?

Snorkeling in shallow areas, and some scuba diving before I was diagnosed.

 

[DCUKMod]

Every one of us makes hundreds, if not thousands of risk assessments a day, from whether we snooze the alarm once more, cross a road, eat that extra rasher of bacon, take more insulin, swim, drive, dive, skydive or zipline.

I feel positive each one of us has differing life risk tolerances, to different things. I'm quite bold in general terms, but some silly things I'd rather avoid. Our tolerances can even vary day to day.

@ejcaswell seems to be taking good steps to mitigate where he percieves his risks, which is including asking people to share their experiences.

If his instructor is PADI Instructor qualified, he too will have done risk assessments on his students, and contacted the relevant people to ensure he has done everything he should, before allowing them to enter the water. He will not want to increase the risks to his students, or in turn to himself, in terms of any potential rescue situation.

I'll be interested to hear how it all goes ejcaswell.

 

[kitedoc]

You could apply the 'What if' scenario to all walks of life, you take steps to minimise them. Your 'advice' was fine up until the point you started berating the poster for what you think was a reckless decision.

It is about real risks and inadequate solutions. The diver I mentioned in the first post being saved by 2 orca - now that is an interesting situation. Or is that not relevant??

 

[DCUKMod]

Snorkeling in shallow areas, and some scuba diving before I was diagnosed.

Bearing in mind the duration of your diagnosis, I think it would be fair to comment things have likely changed a bit.

 

[porl69]

I have zero hypo awareness BUT my bloods are pretty well controlled. I did a "try dive" in Turkey last year and loved it. I made the dive master aware I was type 1, he was happy as long as my bloods were fine before I went down and tested in front of him when I came up. He said he had taken numerous diabetics down and knew a few with their open water qualification

 

[LooperCat]

We could say that type ones shouldn’t dive, climb, run, get tattoos, do ziplines, persue careers in medicine... because “what if”? (I’m doing/have done the last three). But surely those also apply to anyone?

When we’re serious about doing a thing like this, we make **** sure our sugars are solidly under control.