Diabetes as a contraindication to diving: Should old dogma give way to new evidence?

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Diabetes as a contraindication to diving: Should old dogma give way to new evidence?

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Title: Diabetes as a contraindication to diving: Should old dogma give way to new evidence?
Author: Taylor, L; Mitchell, SJ
Abstract: Background: Diabetics, particularly those who require insulin, are usually considered unfit to undertake compressed gas diving. This judgement has been based on concerns over hypoglycaemic events, hypoglycaemia unawareness, increased risk of DCI and ambiguity between diabetic symptoms and those of DCI. A SPUMS “Statement” released in 1992 proscribed diving by diabetics. Since this time there has been a progressive shift from prescriptive toward discretionary diving fitness evaluations, and this has been paralleled by increasing pressure from diabetics to be “allowed” to dive. We undertook a contemporaneous review of the issue. Methods: A review was undertaken to locate relevant material. This included a Medline search, and contact with authorities known to have an interest in the issue such as Divers Alert Network (DAN) and the British Sub-Aqua Club (BSAC). Results: Few papers published in the indexed literature address this issue. In contrast, textbooks and popular press diving publications contain numerous references. Few articles of any type contain relevant original data. The proscription against diving by diabetics is based largely on theoretical concerns, opinion and some case reports of diving accidents involving diabetics. In contrast, several data sets describing diving activity by diabetics suggest that some can dive at an acceptable level of risk. A voluntary DAN survey reported 48,663 dives by 110 diabetic respondents with only 1 case of DCI. Hypoglycaemia had been experienced by 15% of respondents at some time during diving, but no case had ended adversely. The BSAC has prospectively followed more than 230 diabetic divers who had completed 5,348 dives to November 1999. There have been no deaths, no episodes of DCI and 4 hypoglycaemic events, all of which were corrected with glucose paste. While these data must be interpreted with caution since they describe the activity of selected populations, they do suggest that focused diabetics can dive safely. There are also prospective studies addressing specific training of diabetic divers, and the occurrence of hypoglycaemia in chamber and open water dives. Conclusions: If issues of selection and training can be addressed, it may be appropriate for SPUMS to modify its 8 year old recommendation that currently prohibits all medicated diabetics from diving.
Description: Journal of the South Pacific Underwater Medicine Society.
URI: http://archive.rubicon-foundation.org/7710
Date: 2001

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