Below Ground Level: Diabetes and Scuba Diving

Guidelines for Recreational Diving with Diabetes

What makes this topic so important?

Since Scuba Diving has been a great hobby and an amazing outdoor activity that spread a lot among people in the last few years, healthy and non-healthy people wanted to participate. Among the people who wanted to try Scuba Diving were the Diabetic people. In order to keep everybody safe, Divers Alert Network "DAN" issued a report few years back with some guideline to dive safely for the diabetic people.

Table 1:

Guidelines for Recreational Diving with Diabetes - Summary Form 1 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 > or = 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 mgdL-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

If hypoglycemia noticed underwater, the diver should surface (with buddy), establish positive

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)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:

This is the source of the article.

Do you know how to behave with a diabetic diver?

Whether if we are diabetic people or not, diabetes has spread a lot during the past years. We must know how to interact with such people. The following is a survey that will ask you about scuba diving and diabetes. The result of the survey will be used to conduct an awareness campaign about scuba diving and diabetes. Thank in advance for participating and making people aware of this issue.