Diabetes mellitus

A diver with diabetes mellitus may have a hypoglycaemic attack while in the water, which may be fatal to himself or to his diving partner. The hypoglycaemic attack may be brought on by poor control of the diabetic condition or by an increase in physiological stress due to exercise, cold, etc.

The UKSDMC has decided that diabetics may be allowed to dive provided that they are able to pass the standard medical examination and in addition, satisfy the following criteria and those in the attached article “Diving with Diabetes”:

1. The diabetic has not experienced any hypoglycaemic attack within the last year.

2. The diabetic has not been hospitalised for any reason connected with diabetes in the last year.

3. The physician in charge of the diabetic at the diabetic clinic must consider the level of control to be satisfactory. This implies that the long-term control of the diabetic condition must be good. A guide to this may be obtained from the HbA or fructosamine level. The physician must also be able to state that he/she considers the potential diabetic diver to be mentally and physically fit to undertake the sport of diving.

4. There must be no microalbuminuria present. Any degree of retinopathy beyond background retinopathy is not allowed. There must be no evidence of neuropathy (sensory, motor or automatic), nor of vascular or microvascular disease beyond the background retinopathy in the eye.

No would-be diver under the age of 18 with diabetes is allowed to dive in open water, and may only dive in the pool with close supervision. The reason for this is that during adolescence, insulin requirements may vary within short periods of time due to the glucose demands of the body. Such changes are difficult to take into account when diving and the risks of hypoglycaemia in the water are high. By the age of 18, most growth has occurred and the doses of insulin required are more stable.

The potential diabetic diver should obtain forms A and B, together with a leaflet which should be given to the Branch Diving Officer on successful completion of the medical. Form A must be filled in by the diver on an annual basis. Form B should be filled in by the physician in charge of the diabetic diver and this too, must be done annually. A copy of both forms should be made and returned to Dr C.J. Edge, The Stone Barn, Gravel Lane, Drayton, Abingdon, Oxon OX14 4HY. The physician performing the medical examination should be satisfied that the diver has a good knowledge of the risks being undertaken when diving, which are due to the diver’s diabetic condition.