October 4, 2013
Exercise and Sports, Other
Question from Auckland, New Zealand:
I have two sons, ages 23 and 16, both of whom have type 1 diabetes. They both have good control and are quite sporty. They would like to do their open water diving training. After reading up about this and taking into account all the precautions/limitations involved, we thought this would be okay. However, when I mentioned it to my younger son's endocrinologist, he advised against it and, in his clinic letter, cited the current NHMRC (National Health and Medical Research Council) guidelines for diving for people with type 1. We also have a great general practitioner and after taking advice, he has agreed to sign my older son's medical clearance for diving but won't sign my younger one's form because of the comments in the clinic letter. I fully understand that my sons would need to be extra careful and follow strict guidelines but, at the same time, I want them to live their lives and not feel that they are "disabled" by their diabetes. My younger son is quite upset by all of this and we would really appreciate your advice.
This is a difficult issue and you have received both sides of the advice spectrum. Most of us as diabetologists, whether dealing with kids, teens or adults, want to minimize potential complications while, at the same time, allowing everyone to participate fully in life’s activities. Diving poses special dangers should extremes of hypoglycemia or hyperglycemia that may occur. Assuming no already existing eye, blood pressure, kidney, nerve or circulatory problems, then such risks should be able to identified and minimized or avoided with some more detailed monitoring pre-, mid- and post-diving. Making sure instructors and diving partners are aware of how to recognize and treat emergency hypoglycemia would also be important but also easy to set up. Not all instructors will agree to participate with these extra risks, however. You did not mention levels of A1c, whether they are treated with insulin pumps, continuous glucose monitors, multiple injections and all that would have to be taken into consideration, as well as how they actually participate in their own diabetes care. Certainly, there are easy ways to go diving that would minimize any such risks and most of us would “sign” permission if overall A1c control was in the good to excellent control. We wouldn’t accept a blanket refusal for such participation, but would make such decisions on an individualized basis reviewing current health, risks for heart and circulation problems, so the best advice that I might provide long-distance would be to continue to have open and honest discussions with your diabetes care team so that you might come to a mutually acceptable and agreed-upon evaluation, set up some ways to minimize or avoid risks associated with diving and then proceed to document that the diving can actually occur safely. We do have people with typical type 1 diabetes mellitus who dive successfully following such “rules” so it is possible to set up!