Diabetes and recreational diving: guidelines for the future.

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Diabetes and recreational diving: guidelines for the future.

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Title: Diabetes and recreational diving: guidelines for the future.
Author: Pollock, NW; Uguccioni, DM; Dear, GdeL
Abstract: Table 1: Guidelines for Recreational Diving with Diabetes. --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 ≤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 mg·dL-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 the surface • If hypoglycemia noticed underwater, the diver should surface (with buddy), establish positive buoyancy, ingest glucose and leave the water • 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)
Description: Divers Alert Network (DAN) http://www.diversalertnetwork.org/.
URI: http://archive.rubicon-foundation.org/5538
Date: 2005

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