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Type 1 or Insulin Dependent Diabetes Mellitus (IDDM) has traditionally been identified as a contraindication to scuba diving. Along with Asthma, Diabetes continues to be an on-going controversy in diving medicine. Diabetes is characterized by hyperglycemia and a deranged metabolism. Diabetics may present acutely with dehydration, ketoacidosis and hyperventilation or chronically with lethargy and general ill health. Diabetics may be at risk of decompression illness (DCI) due to their hyperosmolarity, dehydration, increase in blood viscosity and increased thrombotic tendency.
The main risk to the diabetic receiving treatment is the problem of hypoglycemia which is more likely to occur with insulin use rather than hypoglycemic oral medications and highly unlikely to occur with diabetes controlled by diet alone.
The symptoms of hypoglycemia include confusion, sweating, tachycardia, altered consciousness and convulsions (a bad thing to happen underwater). These warning symptoms may be perceived differently in the underwater scuba diving environment, especially under the influence of nitrogen narcosis. Long standing insulin dependant diabetics can even have a phenomenon known as "hypoglycemia unawareness" thought to be due to hypothalamic desensitization to falling serum glucose.
Hypoglycemia may be aggravated whilst scuba diving because of the variable conditions which can affect even the most well planned dive. A planned quiet dive may result in prolonged maximal exertion due to unexpected current conditions or a rescue scenario. Hypoglycemia may also be aggravated by the hyperbaric conditions themselves which may increase the rate of glucose metabolism, although it is thought to be the partial pressure of oxygen and not the ambient pressure that is responsible. Hypoglycemic symptoms may be confused with the symptoms of Decompression Illness.
In the past few years the equipment for testing and recording blood sugar levels have become simpler, more accurate and more mobile, hence suitable for use in a scuba diving environment. Over the past 10 years medical and scuba diving research has been conducted in countries such as the USA, Australia and the United Kingdom, and has resulted in guidelines for physicians and dive medicine doctors enabling them to assess and guide diabetics with regard to the special issues and risks which they face with regard to scuba diving.
Since the Dive Shops in Utila all operate under the PADI certification system, all scuba divers undertaking a scuba diving course are required to complete a PADI Medical Statement. (Click here to download a copy. 276KB PDF format). Answering Yes to any of the questions including diabetes, does not necessarily disqualify you from diving, but since your medical condition may affect your safety while diving you must obtain the approval of a physician prior to engaging in scuba diving activities.
The Utila Community Clinic undertakes Scuba Diving physical examinations for a fee of 200.00 Lempira (as at March 2005).
If you are diabetic you will be required to complete an additional Utila Community Clinic Diabetic Scuba Diver Medical Questionnaire (Click here to download a copy. 64KB Microsoft Word format). If in completing this Questionnaire the Doctor considers you are a suitable candidate for scuba diving, you will be asked to provide a report from the physician or organization who normally undertakes your medical diabetic care (Click here to download a copy of the Physicians Report 71KB Microsoft Word format) before the Doctor can approve you to dive.
Should the Doctor at the Utila Community Clinic approve you to dive, you will be provided with a copy of the Utila Community Clinic - Diabetic Scuba Diver Protocol, essentially a short document providing advice to Diabetic Scuba Divers. (Click here to download a copy 69KB Microsoft Word format).
Enjoy your diving!