Diving and Scuba Diving

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Diving and Scuba Diving

A group for people with diabetes that are interested in diving, scuba diving, snorkeling, and the likes.

Members: 68
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Diabetes Forum

Kids w/ T1D and scuba diving

Started by Janette. Last reply by Janette Apr 19, 2013. 13 Replies

Scuba and the OmniPod

Started by mmom. Last reply by jbowler Dec 16, 2012. 7 Replies

Its Official

Started by diadiver. Last reply by Joan Nov 5, 2012. 2 Replies

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Comment by jbowler on July 30, 2014 at 5:22pm

Davis: I didn't know about Woahink lake, in fact I didn't know Oregon had a dive park! Sounds like a nice shore entry, the dive park at Avalon in Catalina has an entry which can be challenging in a swell for new divers, enough to scare my recently qualified wife off after a couple of minutes in the water. Woahink is definitely on my "to visit" list.

I like Brookings but I think mainly for the abundance of fishable wildlife - scallops, abalone, ling cod. You need a good guide; I remember one wonderful shallow dive twisting round rocks, finding fish and scallops (I didn't have the scallop/abalone card so I didn't take anything.)

Comment by jbowler on July 30, 2014 at 4:53pm

The current PADI guidelines are here (this is a link to the DAN website). Summary table:

http://www.diversalertnetwork.org/training/courses/online/uploads/1...

(I carry a laminated version of that with me in my dive log book, just in case I forget something.) The more detailed explanation (still only four pages):

http://www.danasiapacific.org/main/diving_safety/DAN_Doc/pdfs/diabe...

IRC some of the participants in the conference advised checking for ketones, but the summary above allows diving with a blood sugar in the range 250-300 and I *know* I invariably show ketones at 250mg/dl. Since I also start to feel bad above 200 and irritable above 250 I personally target 150, even though it might mean micro-adjustment immediately before the dive (a couple of glucose tablets work wonders.)

My personal rule of thumb is to start the dive at 150-250 with a distinct preference. I might start a dive above 250, but I would have to know why; failing to unsuspend my pump would be an adequate explanation for example.

The issues of divers with pumps were discussed in the conference but there are no conclusions in the guidelines. The workshop was conducted in 2005 and that is the first year the Omnipod was available, as a result people at the workshop had never heard of an insulin pump that works under water. The full workshop proceedings are here:

http://www.diversalertnetwork.org/files/UHMS_DAN_Diabetes_Diving_20...

See the comment at the bottom of page 29 about water resistant insulin pumps. (Bear in mind that this document is a collection of papers - each paper presents a different viewpoint and that is reflected in differences of opinion of the relevance of things like ketones.)

The YMCA treatment, documented in the paper that starts at page 58, covers a protocol for pumps. There's quite a lot in the YMCA stuff that I don't do - for example I don't limit myself to 2 dives a day or to 30 minutes of bottom time - and clearly a lot of that stuff didn't make it into the guidelines.

You can see the full range of different approaches in Table 3 on page 95.

Comment by Fabio Esteban on July 30, 2014 at 1:51pm

One of my favorite caverns in Q.Roo, Mexico.

Comment by Fabio Esteban on July 30, 2014 at 1:51pm

Comment by Fabio Esteban on July 30, 2014 at 1:49pm

Comment by Rock on July 30, 2014 at 12:22pm

I must be a grandfather... I know what Octonauts are...

As for "Bad juju", well, that is an old diving instructor catch all for "Don't do that". It applies to staying out of recompression chambers and such things. A subcutaneous infusion of seawater through the open end of an insulin pump catheter or the pass through site, while unlikely, can lead to peritonitis, which can be difficult to treat, especially in diabetics. (Is that a run on sentence or what?) The point is to minimize the possibility of infection. As in the kind where the helicopter comes over and picks you up in a litter basket and flies you to the hospital kind of infection.

I had plans last summer to go diving for lobster off of Cape Cod, but then the momma fur seals showed up to have babies and the great white sharks showed up to keep the fur seals company. I love lobster, but confess to being a devout coward when it comes to great whites. There is a charter outfit that takes you out to the Farallons and lets you take picture of them from a shark cage. Not far away are a bunch of guys windsurfing. Is there something wrong with this picture?

I am a bit more cautious than most folks about my glucose levels because I am one of those crazy tech divers and do quite a bit of trimix decompression diving. So getting a low glucose during a deco dive is seriously bad ju-ju. I carry the liquid sugar goop in a pocket of my bc and my buddy knows where to find it. On long dives, I take a CamelBak with sugared Kool-Aid.

If you want to get into a good read, find a copy of "The Girl of the Sea of Cortez", by Peter Benchley. Buy a copy so your little one can read it when she is a teenager.

And maybe we will see the three of you in the Sea of Cortez some day.

Take care,

Dive safe,

Rock

Comment by J. Davis Harte on July 29, 2014 at 6:41pm

Thanks Rock - she is very keen to take up diving - she asks every trip if her daddy has seen "Dashi" who is one of 8 cartoon characters from the Octonauts who live under the ocean! Very unrealistic diving-wise, but very spot on for the rest of the details (she knew what the midnight zone was before I did!)...she loves to dive down in the pool, so that's a start. To be honest - we did dive in the cold water, but for only one of the 4 dives we did - Woahink Lake was up to 68! Great tip about the thermos of hot water...also, better gear. My buddy will be my husband, so he will be understanding. My 300+ number came down pretty easily. What happens if you get seawater infused?

Yes jbowler, I haven't been wearing my cgm for months now, for similar but different reasons - until this open water class, I was doing Bikram's yoga a few times a week and the humidity and sweat build up means it is virtually impossible to keep the dang thing on - never mind the actual pump site! I don't feel convinced by the Lantus swap - especially since the few times I've done it have only been for a day or two while a replacement pump was enroute. I don't have tight control by any means, but the subtle quick changes that we can make with the pump would be preferable - I just have to remember to un-suspend! and probably take a quick tiny bolus if I'm up very high before diving. I'm not sure I'll dive again before our trip, since little one and I will be joining daddy who is doing some 'extra' work down in the Falklands. Now that is cold water diving! He actually loves this sport enough to do it - 37* last weekend...me, no way - I think I'll be more like the 80/80/80 I've heard about. I like that. I also agree that, knowing myself, I really don't anticipate being able to, or wanting to dive 5 times a day...I'll probably cherish the alone time to just gaze at the horizon. Also - I have to factor in high-likelihood of motion sickness. Does the medicine do a number on your numbers - anyone?

Although we live in Corvallis, we dive with the Eugene Skin Divers Supply - and they plan regular trips up to the Channel Islands. People light up when they think about the lobster season (butter!? yum! haha). I suspect I'll go there one day. Does Brookings have nice dives? My brother and his family live near Grants Pass...maybe sometime I could combine the two outings.

Thanks for the great welcome :] - if/when I become scarce it's because I'm playing with the kid or writing for the work or traveling to far off lands...

Comment by jbowler on July 29, 2014 at 4:25pm

The Lantus swap is tricky and requires some care in my experience. I would advise avoiding it if at all possible.

Prior to starting on the Omnipod a couple of years ago I was on MDI and did 24IU Lantus as two injections of 12IU morning and evening.

After the switch to the Omnipod I ended up with a basal dose of 14IU, delivered as 0.5IU/hour except for two hours of 1.5IU in the morning (to combat the dawn phenomenon.)

The change is partly because of the increased effectiveness of the Humalog when delivered gradually; something I think most pump users experience. However it is also because on the pump I can under-dose basal and correct during the day with small boluses; on MDI we simply can't deliver a 0.5IU correction let alone a 0.05IU dose! This helps enormously with physical activity; when I was on MDI if I got a lot of exercise in the day I would be continually fighting low blood sugar for the next three days because of my increased insulin sensitivity.

All that is gone when I go on a dive vacation! I ended up using 16IU/day Lantus and, out of habit, I now test and inject much more frequently - often in 1 or 2 unit amounts (which are horribly inaccurate, but I'm used to much more control than is possible with MDI.)

I could avoid this if I used a tubed pump, but then I would be forever attaching and detaching it since, at this time of year, I swim between one and three times a day.

My advice would be to stick with a tubed pump if at all possible. Even on liveaboards, which can be really intense:

I dove numerous dives in two days last October in the Channel Islands; it was a three day liveaboard at the start of Lobster Season, the boat was running seven dives a day. I was 150 or close to it before every dive, I ate after every dive; this was on the Lantus regime, it worked perfectly. However by the third day I couldn't take any more; it's nothing to do with being a diabetic, I just need to relax and snorkel, I should have sat out more dives on the first two days.

Comment by Rock on July 29, 2014 at 3:51pm

Nice work on getting an open water checkout dive in 50 degree water. Glad to hear that you saw some cool stuff. We used to dive for Dungeness crabs and Geoduck clams and abalone and stuff. Talk about good eating. Although I have had a pesky sea otter swim up to me and take my abalone away. :-(

Next time you dive in that cold water, bring a thermos jug of hot tap water and pour it down the neck of your wetsuit before you get in the water. It helps that breathtaking sensation when you first get in.

Good to hear you were careful with the pump. The thing most folks don't know is that the water pressure from the dive can crush the insulin reservoir in the pump and force it into your body. Divers refer to this sort of thing as "Bad juju". There are some pumps available that can be worn while swimming, and are OK down to about 10 feet, but don't wear them scuba diving.

Covering the catheter with a waterproof bandage prevents getting a subcutaneous injection of seawater, which is also "Bad juju".

A liveaboard is the adventure of a lifetime for a diver. Eat, sleep and dive. Two dives in the morning, two dives after lunch and a night dive. Last time I went, my diving cut into my drinking. Using Lantus might be a good idea, but be ready to adjust the basal dose, as your level of physical activity will go way up, which should lower your body's demand for insulin.

Most of all, be aware that the two most important safety features are the mass between your ears and your buddy. Know yourself and call the dive if you feel low. Arrange a hand signal in advance with your buddy and do not let your ego get in the way. Call the dive, signal your buddy, and let them take control and get you out of the water.

Keep this up, and before you know it, you will find yourself chasing that cute little scuba diver hanging over your right shoulder in the picture.

Have fun, and take lots of pictures for us!

Rock

Comment by jbowler on July 29, 2014 at 3:50pm

The problem I see with current CGMs is that they are only waterproof to about 8ft yet they stay on for about a week. 8ft isn't enough even for snorkeling or free dives. The week between changes also means that a dive will add to the cost of the CGM and, indeed, given the way US health plans work, could easily mean not having enough sensors.

 

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