Most of the recommendations seem to be fairly common sense but I have to question if having a BG level of above 150 either stable or rising makes sense. I get the conservative approach to not go hypoglycemic. But diabetes management has come a long way in the last 20 years. This seems to be more geared to therapy of using a long acting insulin like NPH which would still be working while diving. Not sure this would be at all applicable for me as I’m on a Medtronic 780G with CGM. I’m more concerned with going hyper since I would have to disconnect from the pump in order to dive.
Any divers out there with with a pump? How do you manage while diving?
I don’t dive now but I did back when I was young. I was able to keep my pump on under my wet suit in a ziplock bag that I notched for the tubing and used silicone gel to seal it. This was done the day before. Now I have a Omni pod so I think I might skip the water proofing.
You can’t get a signal underwater so cgm is not going to get out, but if you keep your pump next to your cgm it might work in auto mode, because you can’t take it out to look at it etc.
But it might alarm if it’s getting a signal, but you won’t be able to cancel the alarm which will be extra irritating will ruin your dive .
Cgm didn’t exist back when I was diving. Luckily my pump kept me very stable even when I was exerting myself. But first sign of low and I would start my resurface.
I don’t think a high would really be a danger unless it was so high you were in DKA.
I don’t know what kind of diving you do, but when I was doing it, we really weren’t down that long. You can check your sugar after you surface. I was into exploring old wrecks and looking at fish hoping for gold coins which I never found.
If you don’t want to wear your pump you could use lantus, but it will take a few days to work out the dosing. So I’m going to suggest that you keep your pump on and put it right next to your cgm and see if the looping works, I assume it will.
If you look long term you can consider the eversense because it has an alarm built in and will alert you under your wetsuit both high and low alarms no other cgm will do that.
It can’t talk to your pump yet though.
Thirdly, you can go for the expense of a dry suit, but many of the issues will still be present.
Most importantly you dive with someone who knows you and who understands blood sugars and develop some hand signs for low sugar and high sugar. And work out what could happen if you got disoriented. So that person can help you.
I never went cave diving and I never would because I think it’s just too dangerous even without diabetes, but with it, adds more complexity and time to get out of the cave. Correcting it is impossible underwater.
You are looking at open water anyway, but people tend to get overly bold after a couple of years.
Personally I wouldn’t attempt it even with modern tech.
I think diving is a lot of fun but is probably the most dangerous sport I can think of with Type 1. But you can manage it if you don’t get complacent
I don’t scuba, but I do snorkel and quite a distance from shore. We swim way out there. I don’t know the technicalities of scuba diving. But take something like GU gels with you, I slide mine in my swimsuit for if/when I need it. I would also rather be higher than drop to much when you are in the middle of the ocean. You might have a boat near, but you have to be able to get to the boat.
The other problem I have is I don’t feel the low signs when I am in the ocean. To me it feels the same as getting a little cold from the water. Luckily in my case I can still scan with a Libre while I swim.
Too many things can influence our BG level. I have had to down a GU gel out in the middle of the ocean a few times because I decided to drop for some reason. Maybe a stronger current, maybe my sleep was better or worse or??? There is no getting anywhere fast which reminds me of being down deep and still having to get to the surface?
Go in higher, it’s just not worth what the alternative is. You are in the water and you have to be able to swim to get where you need too. If you do it continually, you’ll get used to what you need to do. But I am used to snorkeling and I still drop sometimes and have needed to down a packet of the gel. Play it safe!
Thanks for the feedback. I don’t think it’s practical to try keeping the pump on because I’m not sure I could do it effectively. I also won’t be doing any exotic dives like in caves or shipwrecks, just open water dives of 45 minutes max and probably no more than 50 or 60 feet. Coral reef type stuff. I’ll be diving with my wife who’s not diabetic and knows how to respond if needed. She probably could tell I was going low before I could.
I was just thinking that with the pump removed I’d be getting no basal insulin so there wouldn’t be much chance of going low, but I guess you never really know so maybe the 150 number is a reasonable precaution. I’ll also bring the glucose gel.
For BG management, all of the work is done in the hours leading up to your dive.
Don’t eat a meal for 4 hours before your dive. You don’t want any IOB floating around in your body. If you need a correction snack, of course that’s fine, you should do that. But don’t eat a meal that you will need to bolus for. Zero IOB is important.
Manage the 2 hours before the dive meticulously. Test often. Don’t just look at your CGM, test your BG with a good meter. Many times.
Diving is a lot of exercise! So turn off your basal a short while before the dive, and don’t dive with a pump.
How long before you dive should you turn off basal will depend on your BG and which way it is heading, and how quickly. There is no set number of minutes, it just depends on the circumstances. Practice it.
For myself, I would be okay with a flat 120 before a dive, as long as I had no IOB and zero basal. But for each person, it depends. Find a range you are comfortable with.
During your certification training, test it all out! Treat every training session like it is a dive. An actual dive will require more energy than a class or pool session, but use the classes and pool sessions to practice not only your Scuba skills, but your BG management as well.
I have been certified for 38 years. And I have been a T1D for 52 years.
Although the DAN guidelines do consider pumps the basic guidelines are, I believe, for people on long acting (i.e. MDI).
The problem, and it is a serious problem, for us pump users is that when we drop into the water we lose our basal. When I was river diving and even when I did sea dives off the Oregon coast I didn’t consider that an issue and since you are only starting open water training you should not either. Just do the 150 or there abouts.
If you get further and enjoy it you may start doing dive trips - a week or more of diving. I’ve done a few and, eventually, I ended up swapping back to MDI. If you get that far you will understand why; it’s nothing to do with diabetes it’s because of the odd, first hand, stories you will hear of people who ended up spending hours in the water waiting for the boat…
So far as you are concerned you will, I hope, be around lots of competent divers. You won’t be diving for more than 45 minutes and, initially, you’ll only be under water for a few minutes at a time. Use the CGM; it should work, but also be ready to do fingersticks as soon as you surface. It’s a PITA but most of the time I was diving that’s what I did and once I had to abort when I got an unexpected reading.
The 150 is a mantra, the magic is to flatline; going up or going down too fast doesn’t work. DAN doesn’t say this because that would make things way too complicated.
You need the sign off from your doctor. Take the form, get it signed. It has to be a real doctor; a surgeon. No “PAs” etc.
I’m advanced open water (in PADI terms) but I’ve stopped these last few years because of the nightmare of re-upping the medical approval. I don’t find that enjoyable so I just stick to skiing.
For recreational SCUBA a dive can’t last significantly more than 60 minutes. If we go beyond this our time between dives starts to become prohibitive. The way dive masters run this stuff and the way the regulatory authorities encourage it diving for more than 60 minutes is really difficult.
Insulet say that after a 'pod expires it should be replaced (with a new pod) within 60 minutes; I was surprised when I read that but after experiences with broken 'pods and delayed replacements it does seem fine. This is with fast acting insulin.
So for well regulated SCUBA diving, including the courses, we don’t need no Insulin
My concern is when something goes wrong. But, realistically, that has very little to do with diabetes and rather a lot more to do with water.
I’ve lost my pump river rafting; I didn’t know it had lobbed off until I started to feel the effects maybe about an hour later… I was getting a lot of exercise so the effects are not so obvious.
I’ve lost my pump skiing. Same deal but I noticed faster because I had xDrip+ speaking my CGM readings every 5 minutes (this is very useful while skiing.)
The risk is to be stuck without a pump and with the backup out of reach. I have Lantus pens but any NPH is fine. A single pen will last me more days in the wilderness than I will live, though I might use the needle more than once.
Pens are “equalised”, a diving term for something that survives submersion by simply taking in and letting out water. So a diver can take a pen on the dive. If I felt the need to do that I would attach a needle, possibly a very long one; I require an 8mm semi-dry wet suit when diving off the Oregon coast There’s no problem doing an injection under water.
@John_Bowler Insulet says to replace it, but it still works for 8 hours after expiration. Then it sets off a high shrill sound and it’s a trick to try to get it to turn off. You have to take a needle or paperclip etc and insert it into a hole at the back to get it to stop. Trying to find that in the middle of the night and something to stab it with BTW is not fun. Same if you forget to deactivate it and throw it in the trashcan. There are videos you can watch that explain/show how. But wrapped in a towel several times in a microwave at the other end of the house works too.
I haven’t had it happen since I switched to the Dash system, but I assume the pods are probably the same set up.
I had one scream like that for no reason, I had already deactivated it and threw it in the trash and put a new one on. 15 min later it screamed and paperclip didn’t work.
I ended up putting it in a glass of water. I could still hear it but it was quiet enough. It kept going for probably 10 hours.
It can be tricky. It’s necessary to break the corner off the PCB; the corner that is directly under the hole.
The Eros pods were easy to pop open then we could remove the cells and that stopped them. The Dash pods need a Dremel with the plastic cutoff blade, then it’s possible to cut the entire side off and remove the batteries.
Easier, use the Dremel to cut through the corner with the paperclip hole.
Easier still, the Paul Bunyan approach. (Or you could try John Bunyan, but I lived in Bedford for a while and praying never worked.)
What I said was most confusing, I apologise (albeit in English). I meant that the advice I read, probably when I was using the Eros pods, was to replace the 'pod within 60 minutes of it stopping. Insulet uses “expire” ambiguously in the Dash manual, referring to three beeps, a notification, an alarm and a hazard. The latter; it’s expired and it plays that merry tune (if you listen long enough for the easter egg.)
The best I could find was Insulet’s page which is, in fact, generic pump advice (so more relevant for @ljaz perhaps):
Since Insulet for some unknow reason block out there pages for minutes until they can be read here is the relevant quote, under “Daily Maintenance” right at the top:
Do not suspend insulin delivery or disconnect pump for more than 90 minutes without replacing missed basal insulin on an hourly basis.
Note that this really is generic for all pumps and that it is authored, according to Insulet, by “Guest Blogger”, aka “Insulet Corporation, Guest Blogger”; i.e. a nameless employee.
It does reflect the information that I remember, perhaps presented with less lawyerly implausible deniability. They will probably take it down after this post.
The guidelines accord, in the limit, with the DAN guidelines which do not consider Omnipods or, indeed, any submersible pump (at the time there was one other!) The guidelines state that a pump user disconnect before the dive and reconnect afterward.
These guidelines are also in accord with my own practice. I don’t sweat a failed or, indeed expired, pump. (I run all my pumps to 80 hours unless they fail first). I don’t let a pump make me panic; I have plenty of time to replace it or, indeed, to start MDI if I care not to.
For background a dive boat vacation typically involves either 2 or 3 dives per day. It’s very difficult to go over that for recreational divers because the decompression requirements accumulate rapidly after the first dive. The 3 dive option is two regular dives starting at some unearthly hour in the morning then, at the end of the day, the dreaded “night dive”. Hey, it’s really cool not to be able to see a damn thing and be 60ft under water!
Me, I really enjoyed drift dives. If you are ever diving in Cozumel just do drift dives; you lob off the boat, swim down to 25ft or so and the current just takes you along. No effort, 60 or even more minutes watching sea life pass. Pure bliss.
The 'pod is IP68 to 25ft depth. Dropping it in a glass doesn’t cut it, not even after the rated 60 minutes. It just won’t stop.
I’ve dropped a 'pod at 100ft depth in very salty water (not your salt water pool salt, serious salt water) and it just started beeping and did not stop until I later deactivated it.
Well said! I think assuring you don’t have IOB while SCUBA diving is essential as you never know how much exertion you will have. I use Omnipod 5 for an hour of lap swimming or a long swim meet. The Dexcom must be as close as possible to the Omnipod location to connect with readings. And OmniPod 5 automode will not provide bolus until the BG is above 180 so that seems safe for SCUBA.
