| 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
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| Scope of diving |
- Diving should be planned to avoid
- Depths >100 fsw (30 msw)
- Durations >60 minutes
- Compulsory decompression stops
- Overhead environments (eg, cave, wreck penetration)
- Situations that may exacerbate hypoglycemia (eg, 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
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| Glucose management on the day of diving |
- General self-assessment of fitness to dive
- Blood glucose (BG) ≥150 mg/dL (8.3 mmol/L), 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 (8.3 mmol/L)
- >300 mg/dL (16.7 mmol/L)
- 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 to 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)
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