• Introduction
• Some History
• History in the Making - the DAN Plan
• The Details

Introduction

Insulin-dependent diabetes mellitus (IDDM) has traditionally been identified as a contraindication to scuba diving. DAN surveys have revealed, however, that some divers with insulin-dependent diabetes are currently diving - without adverse complications. And they're vocal about their ability- and rights - to do so.

During 1997, DAN launched a two-year research project under the supervision of Dr. Richard Moon, Medical Director of DAN, and DAN Assistant Medical Director Dr. Guy Dear, into the viability of diving with IDDM.

Some History

People with insulin-dependent diabetes have successfully competed in athletic activities other than scuba diving despite the risk of hypoglycemia. Many already participate in scuba diving against traditional recommendations.

The major risk of diving with diabetes, say physicians, involves the inherent dangers of a hypoglycemic episode underwater, in which a diver could lose consciousness and drown and perhaps even affect the safety of his or her dive buddies.

Support for the proposed liberalization on diving with insulin-dependent diabetes has come from surveys DAN conducted in 1991 and 1995. These surveys reveal that a total of 129 persons with insulin-dependent diabetes reported participating in over 27,000 scuba dives with no major complications. Some divers with IDDM reported symptoms of hypoglycemia, but none reported loss of consciousness.

Because divers with insulin-dependent diabetes want to continue to dive, several established medical groups have developed empirical guidelines to diving with IDDM.

One example is a set of guidelines developed by Dr. George Burghen, Chief of Endocrinology and Metabolism at the University of Tennessee, and Stephen Prosterman, Dive Supervisor for the University of Virgin Islands, St. Thomas, for use at a special camp for divers with diabetes in the U.S. Virgin Islands, Camp DAVI (see The Diabetes Question, p. 21, January/February Alert Diver). In the Camp DAVI guidelines, researchers measured blood glucose (BG) levels four times: one hour pre-dive, 30 minutes pre-dive and immediately pre-dive. Then they measured post-dive BG.

Recently, Dr. Burghen reported on BG in 32 IDDM divers during 146 dive exposures - with no incidents of symptomatic hypoglycemia. Dr. UlikeThurm and Dr. Michael Lerch, diabetes researchers in Germany, used these same guidelines to study seven divers with IDDM in Palau in 1995. They reported no incidence of hypoglycemia during their study.

History in the Making -the DAN Plan

A good start, it seems, for divers with IDDM. What's up next?

The DAN Medical Research Department begans its own project in 1997 to study the issue of diving with IDDM successfully, following Burghen and Prosterman's established guidelines. Titled Research into the Reliability of Current Guidelines for Recreational Scuba Diving with Insulin-Dependent Diabetes project, its goals are:

• to evaluate the prevalence of hypoglycemic episodes associated with scuba diving when following strict guidelines; and
• to determine the compliance of divers with diabetes following guidelines for monitoring their blood glucose levels while on a recreational dive trip.

At the same time, DAN researchers will collect information on dive profiles and decompression illness (DCI) for Project Dive Safety, a joint project of DAN and International DAN to collect 1 million dive profiles worldwide in order to study the incidence of DCI.

This project will benefit all persons with diabetes who wish to scuba dive. Currently, because it is a contraindication, many persons with diabetes are unable to get certified - or they do so without admitting that they have diabetes.

This is an unsafe practice. The data collected in this project may change the current policies in the recreational dive field, which would allow a specific group of persons with diabetes to participate in scuba diving.

The results of this study may offer persons with insulin-dependent diabetes the same opportunity to participate in recreational diving available to the non-insulin-dependent population.

The first DAN diving with diabetes project was held at the Underwater Explorers Society (UNEXSO) in Freeport, Grand Bahamas, Feb. 19-Mar. 5, 1997.

For more information about this project or to receive the necessary paperwork, contact Donna Uguccioni at DAN Research, Suite 1300, 3100 Tower Blvd., Durham, NC 27707; or call (919) 684-2948 ext. 627 Monday through Friday 9 a.m. - 5 p.m. Eastern Time.

The Details

DAN's study on diving with insulin-dependent diabetes is an observational research project - divers involved will volunteer their time. DAN plans to collect data over a two-year period.

The plan is to assemble approximately 15-20 divers with IDDM for a two-week research trip, with each diver agreeing to collect and provide data for a minimum of four days during the trip. A total of four two-week research trips have been planned so far.

Participants may plan the trip as a diving vacation, and bring spouses or friends. Each participant is responsible for expenses including a doctor's visit to sign a release form prior to the trip, airline fare, food and lodging, dive packages and dive equipment (as applicable). DAN will cover the cost of the two HbAlc tests and supply diabetes monitoring equipment.

For eligibility requirements, click here.