So, my buddy is a diabetic...

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Pinkpadigal
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So, my buddy is a diabetic...

Post by Pinkpadigal »

A question was raised a few days ago in the store and I wanted to throw it out to you all to see what you think.

If you were diving with someone who was a diabetic, do you think it is important that he/she tell you? If you are a diabetic, should you (or do you) let your dive buddy know?

If you were taking a class, the instructor would know (it is one of the questions on the medical form) but if you are just out diving, it isn't something that isn't necessarily asked about. Many diabetics dive without complications but something would to happen underwater, should a dive buddy know what to look for? Is it the diabetic diver's responsibility to make sure they check sugars before a dive dive and not bother his/her buddy about it because it is no big deal? Or, does it all come down to the importance of diving with someone you know very well?
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Re: So, my buddy is a diabetic...

Post by dwashbur »

I knew a few diabetics in the dive club back in Boise. They usually checked their sugars before gearing up to be sure everything was okay, and took their insulin if necessary before diving. As far as letting their buddies know, in that group it wasn't a problem because most everybody knew everything about everybody else. One person in particular was a fairly non-compliant diabetic (and a PADI instructor - shudder), and I only found out she was diabetic when I had a diabetes scare of my own. Then again, I hadn't done any diving specifically with her, so there wasn't a real reason for her to bring it up. I would think it would be a good idea to know if your primary buddy has a condition like that, but that's just me.
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Re: So, my buddy is a diabetic...

Post by Cold_H2O »

I would like to know. Always good to know your buddies limits.

Dove with a buddy who didn't explain he gets nosebleeds easily.
I called the dive when I noticed his mask filling with blood.
Once we surfaced he explained that it happens all the time.. no biggie
Wasn't a diving issue.
Next time we dove I looked over and just gestured that his mask was filling, waited for him to clear it continued our dive.

Wouldn't let it keep me from diving with a good skilled buddy but would be comforting to know that his/her sugar levels might be important to keep an eye on.
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Re: So, my buddy is a diabetic...

Post by CaptnJack »

One of my instructors had to haul a near comatose buddy 1500+ft out of a cave. A buddy who hadn't disclosed his medical condition because he was afraid it would disqualify him. Fortunately the unconcious diver's wife was waiting at the car and was able to quickly interpret what was wrong and save his life.

As a buddy, I would be royally pissed if you didn't confide in me relevant medical conditions. Diabetes, asthma, and PFOs if deco diving are biggies. I leave it up to buddies to decide what's relevant, but anything potentially incapacitating is certainly very high on the list of my expectations for discussion.
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Re: So, my buddy is a diabetic...

Post by Sounder »

CaptnJack wrote:As a buddy, I would be royally pissed if you didn't confide in me relevant medical conditions. Diabetes, asthma, and PFOs if deco diving are biggies. I leave it up to buddies to decide what's relevant, but anything potentially incapacitating is certainly very high on the list of my expectations for discussion.
:goodpost:

Anything like this needs to be disclosed. Hell, if I have a sore back or knee or whatever, I disclose that before we go. Buddy/team needs to know the big picture. We suspect Jake may have had an underlying health issue that he may have a) not known about, or b) didn't disclose. I would be extremely pissed off if something came up and I didn't know about it.

If they're diabetic, I would want them to check sugar, and eat-to-prepare for the dive, and probably bring something like sport-gel or glucose gel underwater with us that they would/could eat if they started to feel low during the dive. I'd probably carry one too, just in case.
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Re: So, my buddy is a diabetic...

Post by Norris »

I would like to know. I do dive with a buddy and he actually brings pills with him. He has shown me where they are in case there is a problem and I need to administer. He has some waterproof deal that is in his right BC pocket.
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Re: So, my buddy is a diabetic...

Post by Penopolypants »

Both of my parents are diabetic and my dad is a former diver, so I've spent some time thinking about this particular subject. It's very easy for a non-diabetic to say that the diabetic person must absolutely inform their buddy. However, there is a lot of misinformation out there about diabetes, which is why I think a lot of people wouldn't confide in their buddies. Ignorant people treat them like they're on the verge of a coma all the time, or super fragile, and that sucks. 99% of the time well-managed diabetics are no different than a non-diabetics. Most important is the form of management for their diabetes - not all diabetics are shooting themselves up with insulin!

If they are an insulin-dependent diabetic, or if they take other medications that artificially lower their blood sugar, then yes, they should let their buddy know, even if they are well managed. It shouldn't stop them from diving! But there is a small chance that there could be an incident. Why not give your buddy a heads up? Keep in mind, though, that there are medications for type 2 diabetes that don't artificially lower blood sugar, they simply help your body work the way it's supposed to work. In other words, they make a diabetic little different than you.

If they are controlling their diabetes with diet and exercise, they are again no different than you. Why would they need to inform you of anything?
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Re: So, my buddy is a diabetic...

Post by LCF »

I had this experience -- I had someone write and ask me if he could join one of our cave diving trips, and it wasn't until he got down to Mexico that I found out he was diabetic. I found it problematic, both because he didn't give me the information to let me decide if I WANTED to dive with a diabetic buddy in a cave, and because I had implicitly committed my friends in the group to being willing to dive with the guy when none of us knew this about him.

We had a nice discussion about his disease, and I found out his control was good, he had had no hypoglycemic episodes, he didn't get ketoacidosis, and he was on pretty benign meds. At that point, I was okay with diving with him, even knowing that his diabetes raises his risk for stroke and heart attack, as well as blood sugar woes.

I think if you have a medical condition that could incapacitate you during a dive, you owe it to your buddy and to yourself to disclose it. To your buddy, so that they can make the risk assessment as to whether they want responsibility for you or not (and whether they do that fairly or not, it is still their privilege to do it), and to you, because your buddy really ought to know what the highest likelihood problem is if you start behaving strangely.

I would exclude diabetics who are diet-controlled from this; that is really pretty borderline diabetes. People who are on hypoglycemic meds are diabetics. Some of the oral meds are worse than insulin for getting people into low blood sugar trouble.
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Re: So, my buddy is a diabetic...

Post by CaptnJack »

LCF wrote:I think if you have a medical condition that could incapacitate you during a dive, you owe it to your buddy and to yourself to disclose it. To your buddy, so that they can make the risk assessment as to whether they want responsibility for you or not (and whether they do that fairly or not, it is still their privilege to do it), and to you, because your buddy really ought to know what the highest likelihood problem is if you start behaving strangely.
Ding ding. I may very well put my life on the line here, I deserve the chance to talk about your risk factors as well as disclose mine so we can decide if we should dive together in as well informed a manner as possible. Also giving me a better than guesswork chance of saving you too. And yes if you have something I have little knowledge about my decisions are likely to be based on Medline.
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Re: So, my buddy is a diabetic...

Post by spatman »

Sounder wrote:Anything like this needs to be disclosed. Hell, if I have a sore back or knee or whatever, I disclose that before we go. Buddy/team needs to know the big picture.
i probably should have mentioned this earlier, sounder, but it seems that whenever we dive together, i have a pain in my ass.
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Re: So, my buddy is a diabetic...

Post by ljjames »

it was mentioned in the hyperbaric tech program that diabetics are more suceptable to seizures when exposed to high ppo2, and that a person (any persons) metabolism is increased whilst under pressure (more oxygen to fuel the fire?) Anyhow, blood sugar and response to high O2 (pre seizure behavior), were on the list of 'monitor closely' whilst being treated (often for wound healing issues brought about by diabetes). Sometimes I am not sure if the general population (even medical practitioners) really fully comprehend some of the issues surrounding the effects of hyperbaric exposure on the body. "but my doctor cleared me!"

IF we apply what is known in the chamber community to the diving community, maybe the borderline diabetics (ones who did not even know they were?) are the ones who have had more issues with high PPO2 in situations that it should have been fine... and these incidents have continued to drive the 'safe' PPO2 lower and lower? Who knows... 20 years ago if someone was diabetic or asthmatic, it was much more rare that they were 'cleared' for diving. Now it's one a case by case basis. I'm not saying this is better or worse, it just changes the population of divers. the whole "diving is as safe as gardening" mentality. 20 years ago Nitrox wasn't as prevalent so there are lots of variables.

Medical conditions that could effect the 'team' need to be disclosed.
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Re: So, my buddy is a diabetic...

Post by pensacoladiver »

Norris wrote:I would like to know. I do dive with a buddy and he actually brings pills with him.
Qualudes don't count in this discussion.
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Re: So, my buddy is a diabetic...

Post by Norris »

:roll: :roll: :roll:
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Re: So, my buddy is a diabetic...

Post by ktb »

My thinking is, if you should be wearing a medical ID bracelet, then I should know about it. But then again, I also hope my buddies disclose *anything* that might hinder the dive, such as me telling my buddy last week, "It's my first night dive with this camera set-up." But--as a new diver--that's why I'm still wary of diving with people I don't know. I'm just now slowly starting to branch out from my "usual" buddies.
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Re: So, my buddy is a diabetic...

Post by LCF »

Yeah, as Peter pointed out, I always tell my buddies that I'm likely to need a little help out of the water and up hills in my gear. It always seems reasonable to let your buddy know what your possible failure points are . . .
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Re: So, my buddy is a diabetic...

Post by ArcticDiver »

From the perspective of a traveling diver who seldom gets to dive with the same person more than a couple times I have to day: It Depends.

To me controlled diabetes is no different than any other physical limitation. For example, on my last trip I had a buddy who wore a mask with prescription lenses. He let me know because he didn't have a spare mask and if he lost that one I'd have to be his guide to get him home. If he had been able to recover on his own I would not have expected any special information.

Most people I know have some kind of problem that could, or could not, become a problem under certain circumstances. I don't think it is incumbent upon anyone to tell others of all the human frailties that could impact a dive as long as we are in the realm of usual recreational or tech dives.

On the other hand, if we are doing what I would call Project Dives where we are exploring, or prodding the edge of the envelope all members of the team need to be intimately familiar with each other to the most detailed extent. That includes every detail of health, physical and mental capability and performance parameters.

This is all based on the idea that buddies usually have no legal responsibilty to each other. What they do have is an agreement to do what they can without undue hazard to themselves to help out the other person.
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Re: So, my buddy is a diabetic...

Post by loanwolf »

I have several deep CCR dive buddies who are diabetic. We have never had any major problems . But just as with climbing if you know you can watch for it. They check themselves several times before the dive and carry Gue packs with just in case things get a little low. I have only 1 time had to flag one of them and tell them to take a pack.

I have no problem with as long as I know so I can watch out for a problem. I do not feel someone should be singled out of something just because of something like that if their doctor has stated to them the risks and they understand the risks they are taking. We just make changes to the dive plan and plan for contingency's.

That and they understand that Mountain Rules are in effect. :uh:
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Re: So, my buddy is a diabetic...

Post by LCF »

Yes, loanwolf, but they TOLD you. The point is, you ought to know.
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Re: So, my buddy is a diabetic...

Post by loanwolf »

LCF wrote:Yes, loanwolf, but they TOLD you. The point is, you ought to know.
Yes they should. It is not right to hold anything back about any problem as I stated. I have seen people refuse to dive with people who are diabetic. I watched a boat captain in CA not allow a diver to dive after he saw him checking his blood sugar. So I kind of take this topic personal, sorry if I diverged. If someone does not divulge that to me I will never dive with them again.
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Re: So, my buddy is a diabetic...

Post by ljjames »

loanwolf wrote:
LCF wrote:Yes, loanwolf, but they TOLD you. The point is, you ought to know.
Yes they should. It is not right to hold anything back about any problem as I stated. I have seen people refuse to dive with people who are diabetic. I watched a boat captain in CA not allow a diver to dive after he saw him checking his blood sugar. So I kind of take this topic personal, sorry if I diverged. If someone does not divulge that to me I will never dive with them again.
*momentary thread hijack*

The one thought that crossed my mind when i read that last statement... OH MY GAWD! Greg has limits!!! LOL

*grin*

hijack over.
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Re: So, my buddy is a diabetic...

Post by loanwolf »

ljjames wrote:
loanwolf wrote:
LCF wrote:Yes, loanwolf, but they TOLD you. The point is, you ought to know.
Yes they should. It is not right to hold anything back about any problem as I stated. I have seen people refuse to dive with people who are diabetic. I watched a boat captain in CA not allow a diver to dive after he saw him checking his blood sugar. So I kind of take this topic personal, sorry if I diverged. If someone does not divulge that to me I will never dive with them again.
*momentary thread hijack*

The one thought that crossed my mind when i read that last statement... OH MY GAWD! Greg has limits!!! LOL

*grin*

hijack over.

:rawlings: :rawlings: :rawlings: :arsespank: :neener:
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Re: So, my buddy is a diabetic...

Post by CaptnJack »

ljjames wrote: *momentary thread hijack*

The one thought that crossed my mind when i read that last statement... OH MY GAWD! Greg has limits!!! LOL

*grin*

hijack over.
:rofl: :geek:
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Re: So, my buddy is a diabetic...

Post by airsix »

I think both parties have a responsibility.

1) I believe each of us is obligated to inform our diving partners of any non-optimal risks we bring to the team. Failure to do so is omission of material fact (same as a lie) and could be tricking another person into taking risks they would not otherwise accept. None of us have the right to do that to others, even if we assume they will overreact. An overreaction would be unfortunate, but two wrongs don't make a right.

2) Likewise I think each of us have a responsibility to be reasonable and open minded. Treat diving partners in such a manner that they will be forthcoming with this sort of information. Be logical and understanding. Ask if there are any conditions or physical limitations you should know about, but ask in a way that inspires confidence and trust. I would like to know if you have any type of health, physical condition, injury, or even emotional risk (i.e., fear of low-vis) and what you would like me to know about it so I can be the team-mate you need me to be. I also want to confirm that you are being realistic about it. If I feel you have made a reasonable decision I'm probably not going to take issue with it. If I think you are not being reasonable I reserve the right to abort, but I'm going to give you a fighting chance first.

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Re: So, my buddy is a diabetic...

Post by renoun »

I occasionally dive with one buddy I know is diabetic. She is well controlled and I have never known her to have a hypoglycemic episode on land or in the water. I would echo others comments about the need for disclosure although I am willing to keep it to the buddy group if doing an easy rec. dive, even if it is off a charter.

I haven't seen anybody mention DAN Medical Research; Diabetes & Diving.
Table 1: Guidelines for Recreational Diving with Diabetes - Summary Form1
Selection and Surveillance
• Age ≥18 years (≥16 years if in special training program)
• Delay diving after start/change in medication
- 3 months with oral hypoglycemic agents (OHA)
- 1 year after initiation of insulin therapy
• No episodes of hypoglycemia or hyperglycemia requiring intervention from a third party for at
least one year
• No history of hypoglycemia unawareness
• HbA1c ≤9% no more than one month prior to initial assessment and at each annual review
- values >9% indicate the need for further evaluation and possible modification of therapy
• No significant secondary complications from diabetes
• Physician/Diabetologist should carry out annual review and determine that diver has good
understanding of disease and effect of exercise
- in consultation with an expert in diving medicine, as required
• Evaluation for silent ischemia for candidates >40 years of age
- after initial evaluation, periodic surveillance for silent ischemia can be in accordance with
accepted local/national guidelines for the evaluation of diabetics
• Candidate documents intent to follow protocol for divers with diabetes and to cease diving and
seek medical review for any adverse events during diving possibly related to diabetes
Scope of Diving
• Diving should be planned to avoid
- depths >100 fsw (30 msw)
- durations >60 minutes
- compulsory decompression stops
- overhead environments (e.g., cave, wreck penetration)
- situations that may exacerbate hypoglycemia (e.g., prolonged cold and arduous dives)
• Dive buddy/leader informed of diver’s condition and steps to follow in case of problem
• Dive buddy should not have diabetes
Glucose Management on the Day of Diving
• General self-assessment of fitness to dive
• Blood glucose (BG) ≥150 mg·dL-1 (8.3 mmol·L-1), stable or rising, before entering the water
- complete a minimum of three pre-dive BG tests to evaluate trends
 60 minutes, 30 minutes and immediately prior to diving
- alterations in dosage of OHA or insulin on evening prior or day of diving may help
• Delay dive if BG
- <150 mg·dL-1 (8.3 mmol·L-1)
- >300 mg·dL-1 (16.7 mmol·L-1)
• Rescue medications
- carry readily accessible oral glucose during all dives
- have parenteral glucagon available at the surface
• If hypoglycemia noticed underwater, the diver should surface (with buddy), establish positive
buoyancy, ingest glucose and leave the water
• Check blood sugar frequently for 12-15 hours after diving
• Ensure adequate hydration on days of diving
• Log all dives (include BG test results and all information pertinent to diabetes management)
1 For full text see: Pollock NW, Uguccioni DM, Dear GdeL, eds. Diabetes and recreational diving:
guidelines for the future. Proceedings of the UHMS/DAN 2005 June 19 Workshop. Durham, NC:
Divers Alert Network; 2005.
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Re: So, my buddy is a diabetic...

Post by ArcticDiver »

I guess my concerns go along with the themes of my prior post and that of airsix. Why pick on just diabetes? There are many divers with a wide variety of mental and physical problems that could have an adverse impact on a particular dive. Some divers and dive operations consider things like age and weight as being debilitating problems in and of themselves. Others will take anyone who can pony up the money.

At the same time there is such a diversity of how disclosure of such things is treated that a person is well advised to be cautious how much they tell others. Sometimes, disclosure is received and treated in an appropriate manner. Other times it results in the diver being summarily banned from that boat or group. Yet, other times the information is not treated with consideration for the person's privacy. Did you know so and so has xxxxx?

Added to this is the wide variety of ideas as just what a buddy is responsible for; both legally and practically. ideas range from the Nanny (I'm responsible in toto for my buddy) to the Black Sheep (If my buddy can find me I'll help out).

Best just to have a quiet talk asking and answering the question: Is there anything I need to be aware of where you might need any particular help on this dive? And then answering the question for the other person.
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