Scuba diving, Doctor, and T1

So for my birthday this year I would really like to get my first open water certification in diving. It’s just a 3 day course, but it will require a lot of physical activity. I have not really talked to anyone much about it, but I am sure that IF they say they are willing to allow me to dive I will need a note from my doctor, which I know will not be granted. The reason I know my dr. won’t give me one is that he refused to allow me to participate in a class required clinical rotation with the fire department, and stated he was concerned with my hyperthyroidism not D, saying I was there “for observation only”. Since he refused to let me do that much for one 12 hour shift then there is NO WAY I see him giving the OK to swimming for 3 days.
Personally I know I will be fine with the management of my D and this should be no problem. I am a very active person and do a lot of “extreme” sports that he would not approve of, and so he does not get told I participate in them. I have just never needed a note before…and during that clinical rotation, his “written order” was completely ignored.
So my question is if anyone, especially type 1’s have experience with diving and getting certified post dx.

just my .02 get another doc and enjoy scuba diving

Hi Jessica,

I got my certification long before being diagnosed, but I doubt it will be a problem for you. One thing you might consider is just going to your regular doctor instead of your endo for the note. PADI won’t care which doctor you got the note from, an M.D., endo, P.A., or maybe even an L.P.N. would work. I believe the note is more of a liability issue than a concern over your ability to participate.

When you get started with your training, be sure to tell your dive instructor that you’re diabetic. You don’t have to make a bid deal out of it, but make sure he or she knows that you will need to check your BG before and after diving. You might also give a little heads up on what they should do if you have a bad hypo.

Whenever you get ready to start diving (usually on day 2), you will want to check your BG often and have lots of high carb snacks available in your dive bag or with you on the boat. Diving is a lot of fun, but it’s also a lot of exercise, and it can be really hard to tell if your BG is low when you are under water. Be safe and test and eat before jumping in.

Diving is one of the coolest experiences that you can have. There is absoutely no way to describe it that won’t sell it short. I bet you’re going to be hooked for life once you try it!

Good luck!

The biggest issue with diving with D is hypoglycemia. The main concern being is that while you are underwater, you can not test, and symptoms of hypoglycemia often are the same as nitrogen narcosis. You can’t also treat a low while underwater, and depending on the depth you are diving at, you can’t immediately get to the surface in order to test/and or treat a hypo (there are safety stops required). The other issue is that the hypo can impair your judgement as what to do in an emergeny whilst underwater. As prior poster said, you should have lots of high carb snacks and foods available on the boat with you. Diving/swimming requires a lot of energey expenditure, and hypos can be common.

This is the Dan Statement on diving - Divers Alert Network

Fitness and Diving: Divers with diabetes are at risk of sudden loss of consciousness. This carries the ultimate risk of drowning and implies additional risks for their dive buddies. Individuals with diabetes, however well the diabetes is controlled, should not be deemed as fit to dive without restriction. Those who meet certain criteria can dive provided they dive in accordance with detailed, specific procedures (See Diabetes & Diving: Current practices demonstrate that many with diabetes do take the plunge; By Guy de Lisle Dear, M.B., FRCA, Alert Diver, January / February 1997). Divers with diabetes should be examined periodically for complications of their disorder that may disqualify them on the grounds of additional risk.

I would bring this information to your physician. There are a lot of references on the DAN website.

I unfortunately do not have any other doctor outside my endo, well I have a gyn and a eye dr. But those will not be of much use in this situation.
I know several divers and everyone agrees it is something worth doing, and I know my body and how much control I have so I do not foresee a major problem other than those to every diver.
But my endo said it had nothing to do with my diabetes as to his letter of restriction from before, it was my hyperthyroidism… which is just strange.
Thank You for the advice.

See I have had a bad experience with diving in the past. While in mexico there was this tour group that offered “scuba diving” along a reef at a resort I was at. granted this was not real diving since no one needed certification and it was in mexico but run by a company in the US … (if that makes sense)
Well when I went to sign up for this “excursion” I let them know I was a diabetic, to which a young blond american woman (who was the main dive instructor on the “trip”) told me that I absolutely could NOT dive and she did not know a dive school/instructor in the US that would ever allow a diabetic to dive. This was just 2 years ago.
I realize she was incredibly ignorant now, but it really put me off at the time and I used some rather foul language at her because I knew there was something just rude and not right about what she said.

I am aware of the risks of diving, with and without diabetes, and if it helps you could say I have a more extensive medical background than most. If I am allowed to dive, then I already have a plan set in place to allow my BS to run high prior to the dive and make sure I have a meal heavy in protein, fat and carbs a few hours before the dive and then a moderate carb snack immediately before.

And I would like to say all the information you gave me is very helpful to me. However, I doubt it will persuade my dr. if he wouldn’t even allow me to participate in a controlled environment. There are times I just want to switch endos, but he is very good at his job, just not with “extracurricular activities” haha

Hi Jessica. I had posted a similar discussion in August in the Type 1 forum. Here it is:
Someone had mentioned (and I know it’s been long-believed) that Type 1s cannot scuba dive. I decided to take a look at the guidelines and found that we CAN dive, but under very strict constraints:

Guidelines From DAN for Diabetics Who Want to Dive
DAN suggests that some diabetics may dive safely in controlled settings.

• 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)


a lot of the BG monitoring would probably be completely resolved if you happen to use a CGM.

Yeah, it is a blast.

You’re right, you know your body and diabetes better than anyone else. While hypoglycemia during diving is inherently more problematic than during other sports, it’s not like you don’t know how to prepare and be careful.

I was thinking, does your school have a student clinic. We have a place here on campus where you can get in and see a Dr. for almost no cost. You might be able to have this person give you a physical and write a note saying that you are fit for diving. I have no idea if this would work for you, but it’s an idea

I believe this - MANY dive instructors absolutely refuse to let people with certain medical conditions such as D and asthma to dive. I have asthma too - very well controlled - and I had to jump through hoops in order to get certified over 10 years ago- I had to find an instructor willing to let me dive with them, as well as obtaining clearance from my medical doctor.

While I have D, it is T2, however recently diagnosed about 6 months ago, and on insulin currently as well os OHA. I have yet to dive since my diagnosis of D. I am nervous about the reaction I will receive.

I do have that, but I am afraid a doctor that has no real idea about my medical history might be a little leery about giving me the go ahead and be responsible for anything that may happen.
I may give it a try though, if my endo really does say no