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Thread: Scuba Diving

  1. #1

    Default Scuba Diving

    My son is taking the Jr. Open Water Scuba Certification Coarse.It starts Monday. Just wanted to see if anyone else had diabetic kids that scuba dive and how it works out for them? I'm very nervous and he's very excited. It's the 1st thing he's really been passionate about since being diagnosed.

  2. #2
    Join Date
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    oh sounds like fun. There IS another mom here (though she hasn't posted in a while) and her son was doing scuba diving. I hope she pops in and see this.

  3. #3

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    Does he wear a pump or CGMS? There might be some restrictions due to the pressure changes that I would just be aware of that might mean he needs to take them off.

    I've always wanted to try but seriously think I'd be really susceptible to the bens!
    ~Nancy
    Mother to:
    Samantha - 17
    Michael - 14
    Emma - 9 (2/16/05 dx 3/07, dx Celiac 1/10) - Pumping with a Pink Animas Ping! as of 9/07, with t:slim as of 8/14!

    CGMSing as of 3/26/09 with Navigator, 9/14/12 with Dex 7, 12/5/12 with dex G4

  4. #4

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    No pump yet. We just ordered the Omni Pod so he will be soon. As a jr diver they are limited to how deep they can go but I will keep that in mind. No CGMS either. Thanks!

  5. #5

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    I have no personal experience but we went to Sea World San Antonio through an event set up by OmniPod. We listened to a dolphin and beluga whale trainer by the name of Robyn Cox. She was diagnosed at about the age of 13. She had some bumps in the road of some people telling her that her diabetes made it impossible for her to work as she now does (being that she must be scuba certified and she spends much of the day in the water, sometimes at significant depths). She refused to accept the answer of "no" (including from people who would not clear her for being hired), she found someone who had developed a protocol that mixed diabetes and scuba, she made it clear that she was capable of working in her desired capacity if she followed the protocol, and she eventually ended up able to work in her dream job.

    So, I have no real suggestions. I just figured you might want to share a success story with your son. I hope he enjoys scuba.

  6. #6

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    I've been a diver for 25 years, and a rescue diver for nearly 20. Diving with diabetes is not at all unheard of, but there are some very strict criteria that your son should adhere to. I would check out diversalertnetwork.org and type in 'diabetes' into the search engine. It will give you information about current industry standards. The greatest concern of course, is him going low while diving.

    That being said, most private instructors will not train divers with diabetes, due to liability issues, and even more individual divers will not dive with someone with diabetes, and rightly so. (Don't flame me yet..) It's more an issue of putting your son more at risk with a diver that will more than likely cause more harm than good than it is an issue of defending a diver that wouldn't want to dive with your son.

    Typically when diving you will dive with a 'dive buddy'... taking on the responsibility of not only your own safety, but that of your dive partner. Recreational divers, which make up the majority of divers worldwide, generally only have a basic understanding of safety protocols and physiological education, and have generally never had to perform any type of 'rescue' outside of demonstrating the skill at the time of certification under a controlled teaching environment.

    Diving is also a very strenuous sport. Both physically, physiologically, and psychologically. Effects of any substance or physical limitation are compounded dramatically when the body is introduced to multiple atmospheres of pressure, and when inhaling compressed gases.

    It's also important to realize that all dive instructors are not created equal. lol Scuba Diving is somewhat of a 'high adventure' sport, and seems to attract those of a similar mentality. Meaning... there are a LOT of YAHOO instructors out there that routinely put students in situations of extreme risk.

    As an example... my wife wasn't too excited about me certifying her, so we found a 10 year instructor for her. During the course of 4 open water certification dives, that instructor popped 1 student up from 30 feet, because he couldn't control the situation (luckily, she was screaming all the way to the surface and only experienced a mild case of the bends), and then, knowing he was severely allergic to shaggy mane jellyfish, did nothing to protect himself and ended up in anapeleptic shock. I had to hit him with adrenaline as HE was the groups rescue certified diver (not to be confused with a rescue diver )

    I'm not saying that your son shouldn't dive. I would encourage him! It's a fantastic sport and if he's excited about it, will probably help him improve his D care and outlook on life in general. BUT... he should be in top physical condition with no D related complications (particularly vascular), carefully question your instructor about his qualifications, shop around, realize that his D care will need to be approached as the most strenuous physical activity he has ever done (lowering basals, running himself high the 12 hours before any dive, carbing up). He also needs to realize that the risk is not just increased for himself, but also for his dive buddy. You also need to consider 'where' he will be diving. Cold water diving is MUCH more strenuous than warm water diving.

    He should NOT be partnered with a dive buddy with anything less than a current Dive Master or Master Diver certification. One on One instruction and open water certification would be ideal, but that might be cost prohibitive. If so, try and get him into the smallest class as possible... 4-6 people with 2 Dive Masters on hand. 1 instructor with 1 dive master for 8-10 is not uncommon, but it's really easy to get an extra Dive Master on hand. They typically are closely affiliated with the particular dive school/shop and are on hand for classes for the price of a free tank fill from the shop. They just want an excuse to get wet

    His pool work shouldn't be that demanding, but his open water qualifications will be a true test to see whether or not he will be able to manage his D safely. My understand is that D Divers go MDI. Pumps and cgms's are not practical. Again, 1 hour of pool work during his class is no big deal. His open water dives will be 2 dives a day over 2 days. It depends on the certifying organization what those dives will be. I would check to see what requirements he'll need to fulfill in order to certify. Many require the last dive to be a "deep dive" (relatively speaking) of 70 feet. If so, try to get him to certify under a different organization. At 33 feet, he'll be subject to 2 atmospheres of pressure. That is where all the physiological changes, tissue retention, times tables, nitrogen narcosis issues start coming into play. Until he feels completely comfortable with everything Diving related, I would highly recommend he does not exceed 33 feet.

    Speaking to my father... (25 year instructor, technical diver, dive shop owner, master equipment technician) he said he's seen a lot of D divers that will remove any air from a gel tube before going down and have no problem whatsoever taking it if they feel low. Like astronauts in space.
    Last edited by Mikker; 08-07-2009 at 03:14 PM.

  7. #7

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    Consult PADI's website. I have seen advice on there.

    I am not a diver, though. There is a diving school for diabetics in the virgin islands, though, fyi.

    Also, treating a low underwater is difficult, but it has been recommended to us Insta-Glucose gel to treat lows, since the tube is contained, and you can just twist off the cap and squeeze it in to your mouth.

    I have also heard a horror story of an insulin pump (paradigm pump) literally breaking apart at 20 meters below the surface. This is not surprising, actually.

    The omnipod WILL have to come off every single time he dives, and same with any other pump. Depth is not really the qualifying factor here, because the pressure exerted on persons and objects at seemingly insignificant depths--is actually significantly more than one would actually think. This could possibly even lead to accidental overdeliveries of insulin, and most likely, it WILL cause the pump to break.

    FYI, the atmospheric pressure (pounds of pressure exerted on your body and other objects) DOUBLES for every 10 meters you go below the surface of water.

    So, at 0 meters, you are at standard atmospheric pressure normally exerted on you on earth

    at 10 meters you are twice the standard atmospheric pressure

    at 20 meters you are triple the standard atmospheric pressure

    at 30 meters you are quadruple the standard atmospheric pressure


    So, it is not surprising that the pump literally broke up in the water, when you hear of this information.

    Since he will have to disconnect from a pump every single time, you may want to factor in how much he will be diving. If it is going to be a very common occurence, and not just something that happens on vacations or special occasions, you may want to reconsider going with the Pod. It will require changes for every single dive he takes.

    I hate saying that, honestly, but it's true. Also, there is absolute risk with him wearing a pump while diving.

    If you plan on putting him on a pump with his diving activities, I would recommend looking at the new medingo patch pump (that does not require a new site insertion for disconnection) or the tubed pumps.

    If a non-tubed pump is your absolute preference, I would go with the medingo pump since you can absolutely avoid wasting site changes and a pod, and wait to hear news and reports on it from users. Otherwise a tubed pump would be your next best choice.

    Again, I hate trying to say that a certain pump may not be suitable for his circumstances, but honestly, it needs to be mentioned before you make the pumping decision, especially if he's going to dive.
    Young adult with type 1 diabetes, autoimmune autonomic neuropathy, and chronic inflammatory demyelinating polyneuropathy (CIDP)

  8. #8

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    Have to agree with Monica, pumps, pods, cgms's are not compatible with diving. "Waterproof" values in equipment not specifically intended for submerged usage is typically measured in static values. In layman's terms... an unmoving object in unmoving water. If the water is moving, or the object is moving through the water... I'm sure you get the idea.

    Detaching is fine for a single daily dive, but anything more than that and he'll probably want to go MDI.

  9. #9

    Default

    Interesting thread - always exciting to learn more about what our children CAN do :-)

    There used to be an adult scuba diving camp for persons with diabetes
    http://www.childrenwithdiabetes.com/camps/d_07_2hb.htm

    If anyone here has full journal access through a university - these may help the OP

    http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

    Diabetes Metab. 2009 Jun 16. [Epub ahead of print] Links
    Safety of recreational scuba diving in type 1 diabetic patients: The Deep Monitoring programme.

    Bonomo M, Cairoli R, Verde G, Morelli L, Moreo A, Delle Grottaglie M, Brambilla MC, Meneghini E, Aghemo P, Corigliano G, Marroni A.
    Department of Diabetology and Metabolic Diseases, Niguarda Ca' Granda Hospital, 3, Piazza Ospedale Maggiore, 20162 Milan, Italy.

    http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

    Diabetes Metab. 2009 May 25. [Epub ahead of print] Links
    Safety of recreational scuba diving in type 1 diabetic patients: The deep monitoring programme.

    Pollock NW.
    Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC 27710, USA; Divers Alert Network, Research, 6, West Colony Place, Durham, NC 27705, USA.
    PMID: 19473866 [PubMed - as supplied by publisher]


    http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

    Diabetes Metab. 2009 Apr;35(2):101-7. Epub 2009 Feb 28. Links
    Safety of recreational scuba diving in type 1 diabetic patients: the Deep Monitoring programme.

    Bonomo M, Cairoli R, Verde G, Morelli L, Moreo A, Grottaglie MD, Brambilla MC, Meneghini E, Aghemo P, Corigliano G, Marroni A.
    Department of Diabetology and Metabolic Diseases, Niguarda Ca' Granda Hospital, Milan, Italy. matteo.bonomo@ospedaleniguarda.it
    AIM: To verify whether, with thorough practical and theoretical training, well-controlled, non-complicated diabetic patients can safely go diving underwater with no additional medical or metabolic risks. METHODS: Twelve diabetic patients participated in the study after undergoing training focused on their diabetic status. Two dives per day were scheduled during two five-day stays on the island of Ventotene (Italy). Capillary blood glucose (BG) was checked at 60, 30 and 10 minutes before diving, and corrective measures adopted if necessary, based on BG absolute levels and dynamics. A device for continuous subcutaneous glucose monitoring (CGM), expressly modified for the purpose, was worn during dives. RESULTS: Data were gathered from 90 dives; mean BG at 60, 30 and 10 minutes before diving was 205.8+/-69.6 mg/dL, 200.0+/-66.4 mg/dL and 200.5+/-61.0mg/dL, respectively. In 56 of the 90 dives, supplementary carbohydrates or insulin were necessary, but only one dive was interrupted on account of hypoglycaemic symptoms. Mean post-dive BG was 158.9+/-80.8 mg/dL. CGM recordings showed that glucose levels gradually decreased during the dives (nadir: -19.9%). CONCLUSION: Experienced, well-controlled, complication-free young diabetic patients can safely go scuba diving, provided that they apply a rigorous protocol based on serial pre-dive BG measurements. The specific variables of underwater diving do not appear to involve significant additional risks of hypoglycaemia.
    PMID: 19251448 [PubMed - indexed for MEDLINE]



    Full text of article referenced below: http://www.em-consulte.com/article/80366

    Diabetes & Metabolism
    Vol 31, N 2 - avril 2005
    pp. 144-151
    Doi : DM-04-2005-31-2-1262-3636-101019-200513251

    Blood glucose changes and adjustments of diet and insulin doses in type 1 diabetic patients during scuba diving (for a change in French regulations)

    http://www.ncbi.nlm.nih.gov/pubmed/16716063?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.P ubmed_Discovery_RA&linkpos=1&log$=relatedarticles& logdbfrom=pubmed
    Undersea Hyperb Med. 2006 Mar-Apr;33(2):125-33.Links

    Plasma glucose response to recreational diving in novice teenage divers with insulin-requiring diabetes mellitus.

    Pollock NW, Uguccioni DM, Dear G, Bates S, Albushies TM, Prosterman SA.
    Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
    A growing number of individuals with insulin-requiring diabetes mellitus (IRDM) dive, but data on plasma glucose (PG) response to diving are limited, particularly for adolescents. We report on seven 16-17 year old novice divers with IRDM participating in a tropical diving camp who had recent at least moderate PG control (HbA1c 7.3 +/- 1.1%) (mean +/- SD). PG was measured at 60, 30 and 10 min pre-dive and immediately following 42 dives. Maximum depth (17 +/- 6 msw) and total underwater times (44 +/- 14 min) were not extreme. Pre-dive PG exceeded 16.7 mmol x L(-1) (300 mg x dL(-1)) in 22% of dives. Males had significantly higher pre-dive levels (15.4 +/- 5.6 mmol x L(-1) [277 +/- 100 mg x dL(-1)] vs. 12.8 +/- 2.9 mmol x L(-1) [230 +/- 52 mg x dL(-1)], respectively) and greater pre-post-dive changes (-4.3 +/- 4.4 mmol x L(-1) [-78 +/- 79 mg x dL(-1)] vs. -0.5 +/- 4.3 mmol x L(-1) [-9 +/- 77 mg x dL(-1)], respectively). Post-dive PG was < 4.4 mmol x L(-1) [< 80 mg x dL(-1)] in two dives by two different males (3.4 and 3.9 mmol x L(-1) [61 and 70 mg x dL(-1)]). No symptoms or complications of hypoglycemia were reported. These data show that in a closely monitored situation, and with benign diving conditions, some diabetic adolescents with good control and no secondary complications may be able to dive safely. The impact of purposeful elevation of PG to protect against hypoglycemia during diving remains to be determined.
    PMID: 16716063 [PubMed - indexed for MEDLINE]
    Last edited by Ellen; 08-08-2009 at 07:52 AM.

  10. #10

    Default

    My father mentioned he would do a little follow-up with regards to this (he and I both would really like to see my son dive as well since... well... pretty much everyone in our family are certified divers of one sort or another, so it's germaine ) and spoke with him a bit more tonight.

    He stressed that D care will vary greatly depending on the type of diving your son will be doing. Warm water, cold water, open ocean, lake diving, etc, but the theory seems to remain constant. It seems most D divers will run themselves high the 12 hours prior to diving.... even halting basals... and will try to 'fat' up 2-3 hours before diving. They try to maintain slow burning carbs throughout the course of their dives. The two fellow instructors that he spoke to that run boat dives like he did all mentioned that they never saw anyone with a pump or cgms. To their collective recollection, everyone always took shots, but that was generally at the end of the day.. not between dives. They seems to be more concerned about carb'ing up.

    One of the fellows has a BIL that is T1 and, talking to him (he also does technical diving), he said he generally likes to be between 200-300 before he dives (depending on the duration, depth, and type of dive). He also mentioned gel tubes. He usually carries 3-4 during each dive, but has never had to take more than 2. Again, he technical dives which is way beyond anything your son will be doing for quite a long time. He commented though that you really have to plan ahead. You never know when the current might take you out a bit further than you though, or when you might have a bit of a surface wait for a boat pickup.

    He reminded me too about how we're always eating oysters and clams, or popping a hard candy to keep our mouths hydrated, so it really is no big deal at all for your son to treat a low at depth once he is comfortable with the mechanics of diving.

    He suggested he might talk to his instructor and include consuming a partial gel tube underwater as one of his pool skills.

    They all seemed to agree that he should stay under 30 feet until he's fluent with his basic skills, and has complete control over his neutral buoyancy.

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