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Diving In And Diabetes

By Julia Sherman-Talley
Sept. 4, 2006

I do apologize for a slight diversion from my normal column but in a way this is not a diversion.

I am by nature a freebie hound. I glean the net looking for things to do that are free or cost very little. As you have no doubt read in my Adventures in the South my family and I visit places that are interesting and donít cost much. Well I was gleaning the web one night and came across a freebie for SCUBA diving lessons. And below are a few things I learned.

I am sedentary by nature. Exercise bah.. I do hike when its cool and the bears begin to scavenge for food. I do bike, I do play in the water at the lake, I bowl etc.

But what I got crazy over and I mean crazy for was something I never thought I would, Snorkeling and freediving (not extreme just enough to see what's below).

My husband bless him has always wanted to learn to SCUBA. And me being a freebie hound discovered a free try lesson locally through DiveBuddy.com. It was hook line and weight belts for him and surprisingly our daughter got involved too.

I however was leery. I had so many experiences as kid with going underwater and horseplay that just the thought of my head underwater was scary.

So after the two of them came back and was talking about what a "gas" it was. And after much hemming and hawing I decided I would give it a try. So dear husband arranged for me to try breathing through his regulator at his regularly scheduled PADI lesson.

When we go there I got in the pool and had to wait for his lesson to be almost over before I could try. So I thought. Humnnnn what about snorkeling. I had never done it and the thought of something over my nose and face was probably the hardest part. I hate having my face covered at all. I have to tell you its very different than a Johns Bargain Store snorkel set that you get to play with in a pool. It's literally a whole new world and an awesome one at that.

I fell in love with it. I mean hard hit. Not as much as I love my husband but so totally blown away by it.

I did try breathing through a regulator after his class and though I was amazed I could breath, it would take longer than a few lessons to get used to it. But snorkeling, now thatís wonderful.

So there you have how I fell in love with it.

Another item to note is I am diabetic. And after reading much on diabetics and lack of research on diabetics and diving I can for your diabetic and non diabetic readers give a primer so many of you can understand a few things and help diabetic appreciate diving in any of its many forms.

Diabetes is sometimes a confusing condition. I cant say itís a disease because its chronic and you deal with it everyday. It's no different than having two different colored eyes, gray hair, or any chronic condition. You have your good days and bad days. The idea is to have more good days.

I suggest snorkeling for diabetic because of a number of factors. Diving and diabetes is great of you are conditioned for it and you are in great control. The chances of something happening are less by and far. But many of us have sidelines annoyances that preclude us from diving all the time. So thatís why I suggest snorkeling or freediving. If anything happens you are at the surface are able to surface relatively easily and get help of any kind.

Diabetic information

In all of us red blood cells are the main source of oxygen and nutrients to the muscles and organ systems. In all healthy people the RBC's allow these to enter the cell itself and become and the RBC becomes an effective delivery system. In diabetes this is not the case. Often the cells are covered with glucose instead of it being in the cell itself. Insulin is the key that allows the RBC to get the glucose into the cell instead of riding on top. If the RBC if covered in glucose, then this cell cannot allow for oxygen and needed nutrients to enter the cell, this causes two things. The first is a signal for the need for food. This happens because the muscles and organs are signaling that they are not getting the oxygen and nutrients to function and this in a round about manner causes a hypoxia or cell suffocation type condition. In addition this excessive glucose in the blood stream leads to ketones, a bodily created acetone building up in the blood.

This is why so many uncontrolled diabetics have complications. This is also why there is concern over diving of any type and diabetes. If oxygen is not getting to the tissue the question arises how much nitrogen is not being exchanged as well?

In order to prevent cellular suffocation on any level, one simple procedure can assure any diver and his/her buddy that the possibility of something going wrong is minimal, that is blood glucose test or what we refer to as a stick. Testing is simple. A glucose meter and a strip can tell a diabetic so much information in a simple little number.

There is a rule of thumb that exercising or activity should take place when blood sugars are between 120 and 140-160. At 180 you are producing ketones. And until that number comes down and is stable itís a good idea to hold off for a little while any exercise.

A good rule is let your dive partner know about your diabetes and get them involved. Teach them how to care for you in case of an emergency. An emergency in a diabetic can be multiple things. From passing out or excessive sleepiness from to high blood glucose to being shaky and cold in low glucose. Make sure that you as the diabetic teach them how to test your blood sugars, how to give a glucagon shot if too low and how to give an emergency shot of insulin if too high.

That is why it is so important to test before doing any exercise or energy expending activity.

If you do a deep dive and experience hypoglycemia cut the dive short and begin an ascent but keep tabs on how the diabetic looks and acts. That way you as a dive buddy can help if the diabetic diver is unable to care for him/herself.

All diabetics after years of being in control can often tell when something is going to happen. So keep in constant communication while diving using a write on board

There are two things diabetic newbie divers of all kinds should be aware.

Cold temperatures in the water have an effect on glucose metabolism.

The longer you stay in the water the more glucose your body needs to maintain its inner core warmth and muscle needs. In order to compensate for temperature or exercise energy expenditure your liver will excrete glycogen to keep you going. If you are type 2 on oral medications and on Metformin this could be a glitch. Since it prevents your liver from excreting glycogen for energy compensation.

It is highly advised that insulin dependency is more effective and safer for active diabetics than oral medications. However that is not the case with glitizones, which help the muscles use glucose more effectively.

Before suiting up for any type of diving, test. Make sure your glucose meter is temperature tolerant so that it doesnít err if you are out on a boat or beach. If you are unsure keep it in a duffel bag where it's dark and a little cooler. If you have to get a new one just for activity make sure that it matches as close to your lab tests as possible. After testing if you fall within your normal exercise range, suit up and go.

When you get out of the water after your water adventure test again. This is important to see if you are high or low. If you are low your body has used glucose well. If you are high that means you used more energy and you needed to excrete. This is still ok. Depending on how high you are after an hour you may need a shot of R insulin to bring your levels down. This is based on the Sliding scale. The sliding scale begins with 2 units at 180 mg/dl and goes up 1-2 units every 5-10 points wit a maximum of 20 units at 280.

In opposition if the glucose readings are below 80 then the need for food or glucose is needed. This can be a shot of glucagon to be used only for severe hypoglycemia, which is classified as below 60mg/dl. In most cases food or candy will suffice to bring your glucose level back up so you can dive again. Food, soda are your best bets for quick increase in blood sugar. Gatorade takes a bit to metabolize but works in a pinch but has no staying power. So keep a good medium size candy bar, soda, or glucose tabs in your ditty bag for quick recovery if needed.

A little confusing not really. After a while it will be as routine as prepping your mask. Safe diving with diabetes means making sure that those around you know and can help.

In snorkeling and freediving diabetes has the same consequences as diving. The body's reaction to cold and temperature drain. Only sunburn from being on top can be a new complication. Sunblock is fine but if you are a considerate diver you know that any chemical can harm where you are diving by washing off. Choosing a nice BC snorkel vest, snorkel skin or wearing a white T-shirt can be a lifesaver. Investing in a protective snorkel skin if you take to this seriously is worth its weight in gold. It keeps your temperature up and prevents sunburn. Sunburn can elevate glucose because itís an injury. And the body's reaction to an injury is to bring needed nutrients to the damaged area. In a diabetics situation it can bring suffocated RBC's and that means glucose, which easily turns to ketones. So a third degree sunburn can lead to later on severe complications and longer healing time.

As to the mask, irritation on the face from an ill-fitting mask regardless is something a diabetic should be concerned with. Just like we donít want shoes to rub we donít want our masks to rub either. If it feels bad choose another style.

The same goes for the snorkel. A mouthpiece that you have to constantly adjust or rubs against the gums doesn't fit right, can cause a complication and limit your fun. Make sure the snorkel mouthpiece fits where it doesn't rub, you donít have to twist your face to find it and you can breath easy in it.

Another consideration is fins. While most people can slap on a set of fins and adjust diabetics often have to deal with neuropathy. Neuropathy pain can affect many body parts. Most common are hands and feet. It can be akin to a constant tingling heat like your burning to total numbness and to any combination of symptoms. Affecting the feet can be the worst because you simply cant walk.

In choosing fins, you have to consider as a diabetic which type of foot is going to be most comfortable when you have neuropathy. And how easy for your dive buddy to remove if something happens.

For the diabetic fins can be worn with a simple little white sock to provide a buffer or cushioning and keep toes warm. Cold toes in a diabetic is dangerous, eventually leading to compromised circulation and possible amputation. So if you try on fins try on with a little sock to keep your toes cushioned and warm. Dive socks work well. Rubbing of the shoe part or the back strap is also dangerous. So make sure that your fins fit just right with no rubbing or irritation. Again try and swim with dive socks. Neuropathy is something that can be controlled by lowering blood glucose and can lessen as activity increases. As long as the neuropathy is not that bad and your still able to do things try. But is always something to be wary of. it can affect hands as well. So if your buddy or you is having trouble suiting up and cant feel anything, make sure your buddy knows and you take controlling actions. If it doesn't resolve itself in a few hours try again another day.

As to dive gear, when you are fit at a dive shop they know how to fit properly and adjust in relation to what you are doing or going to do. So follow their advice. Remember you are only a diabetic and you are in control of that.

The good news is that DAN has released information that diving with diabetes is no more dangerous than diving without diabetes. And those on Insulin are more pat to have better control. Visiting the DAN site you can get the scoop on what they found

So all in all being a diabetic and a free diver, snorkeler or SCUBA diver you just have to make sure you are:

Teach your dive buddies how to care for you if you can't do it yourself

Have a glucose meter and strips in your gear bag

Exercise within blood glucose limits

Have glucagon shot available

Have R insulin available with syringe

Take a snack with you

Maintain in your divers log your glucose levels in predive, after dive and two hours post dive.

Sure itís a few extra things to do but all in all it makes for safe diving for both your and your dive buddy.

Bibliography :

Retrieved September 1, 2006

Diving Medicine Articles Diabetes and Diving -- An article on current practices

Current practices demonstrate that many with diabetes do take the plunge

The question DAN wants to explore is: How safe is it?

By Guy de Lisle Dear, M.B., FRCA, DAN Assistant Medical Director

Diabetes and Diving Get New Scrutiny

http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=21

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About the author: Currently Julia is working on creating new books of Folk Crafts from History and getting entries ready for competitions and state fairs. LULU.com is her pereferred publisher and will have all of her volumes available for print this summer.

She is still at DePaul University plugging away at her BA in ethnography and stays at home in the East Tenneseee area with her hubby, daughter, nine babies and acre's of wild fruit.

Email: jimmysdevoted2@bellsouth.net


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