SCUBA Diving with Diabetes
Back when T1WT founder Savannah wanted to go SCUBA diving for the first time, her doctors essentially said, “we don’t know anyone who has done this before, so we recommend against it, but if you decide to do it, good luck.” No one told her what to do or gave her any tips or resources, and there wasn’t much information online. She was determined to “figure it out.”
Savannah quickly learned that safe blood sugars did not inherently equate to safe experiences, yet when people checked in on her, their first question was always “how were your blood sugars?” and she intentioned to learn how to have both physically and mentally safe diving experiences thereafter. Fast forward 18 dives and two advanced diving certifications, and she can confidently say she has mastered underwater diabetes management. But learning curve was big, and, with Type 1 Way Ticket, yours doesn’t have to be.
At Type 1 Way Ticket, we promote holistic safety by equipping our travelers with the skills and support to thrive physically and emotionally during adventure activities like SCUBA diving. Prior to departure and on-program, we hold in-depth pre-activity orientations, so that T1D teens can approach new experiences with the confidence it might otherwise take years and a whole lot of trial and error to develop.
Below are some recommendations to prepare for–and thrive on–a diveabetes adventure:
PREPARING TO SCUBA DIVE WITH DIABETES
If you are a pump and/or CGM wearer:
- Pack enough diabetes supplies (pump sites, CGMs, adhesive wipes, etc.) to change your devices 2x per day while diving.
- Omnipods have an IP28 rating for up to 25 feet for 60 minutes. Because dives go to deeper depths and are submerged for longer periods of time, pods often error and alarm while diving. In addition to scaring away all the fish, this could mean you are not receiving basal insulin for an hour.
- Insulin pumps with tubing, including waterproof insulin pumps, must be taken off while underwater due to the depth and duration of the dives.
- Consider opting for MDI (multiple daily injections of both long-acting and fast-acting insulin) while diving.
- Apple Watches (Series 2 and newer) are water resistant for all depths you will be diving to. Though water can interfere with Bluetooth signal, you may be able to receive CGM readings underwater.
- CGMs (sensors and transmitters) are guaranteed to function as normal underwater at depths up to 8 feet. Many divers have experienced CGM functionality while diving up to 80 feet.
- Be sure to pack a backup blood glucometer and supplies in the event of CGM errors. Also pack ample low treatments, rapid acting glucose, and glucagon.
- Plan to consult with your endocrinologist to create a personalized healthcare management plan and ensure you have the proper supplies and paperwork prior to departure.
- Most diving schools require a medical clearance form to be completed by your endocrinologist.
SCUBA DIVING WITH DIABETES
- Alert your instructor and group about your diabetes and discuss the diving school’s protocols for handling medical emergencies underwater.
- Agree upon a special “I’m low” signal underwater to let dive buddies and instructors know you need to return to the boat.
- Wear a medical alert bracelet underwater in the event of emergency.
- Carry some type of fast-acting glucose with you during the dive. We recommend glucose gel packs as they are easy to tucked into dive vests and easy to tear open and consume on the surface of the water if needed.
- Set temp basals as you would for any swimming-related exercise.
- Do not dive deeper than 100 feet/30 meters. Hypoglycemia can be confused with nitrogen narcosis, which has an increased likelihood of developing at depths greater than 100 feet/30 meters. (This is a non-issue for Open Water Diver certifications, but may become a possibility as you advance your diving credentials).
- Blood glucose level should be ≥150 mg/dL or 8.3 mmol/L and stable or rising before entering the water.
- Blood glucose level should not be >300 mg/dL or 16.7 mmol/L before entering water.
- If blood glucose level is below or above range, delay the dive.
- Test blood glucose once you return to the boat.
AFTER YOU DIVE WITH DIABETES
- Log your blood glucose levels and trends so that you can refine future planning for SCUBA diving.
- Test your blood glucose using a finger stick + glucometer to ensure your CGM remains calibrated and functioning properly.
- Test your blood glucose/view your CGM often throughout the 12-15 hours following the dive due to the lag effect of swimming/diving.
- Remind yourself that you are a diabadass who just did something awesome.
A note from T1WT Founder, Savannah Johnson
“There are only three things in life you can’t do,” I vividly recall my endocrinologist saying to me when I was 10 years old, “be a pilot, join the army, and SCUBA dive.”
Those words rang loudly in my mind as I embarked on my Open Water SCUBA Diving certification over a decade later in southern Thailand. I had a doctor’s note, a management plan, and (admittedly unlike my discovery diving experience several years prior), both my instructor and my group knew about my diabetes. There was even another Type 1 diabetic and a nurse who wrote her dissertation on T1D technology in my small international group of 8! I was doing everything right–but a part of me still felt like I was doing something wrong. Was I recklessly defying legitimate limitations? Or was I embodying healthy determination? I’ve never responded well to limits imposed upon me externally, and I’ve always been fascinated by marine life. I was so excited to see octopi, my favorite marine creature, and maybe even whale sharks if I was lucky, up close and in the wild. And I knew I could prove to myself–and that doctor–that I could do it.
As many things travel and diabetes go, my course, and the fun dives afterwards, weren’t without hurdles to jump. I had anticipated wearing my Apple Watch to hopefully receive Dexcom readings while diving, but its face fell off and rendered it useless the day before, and the Apple store in Bangkok, the only one in Thailand, told me it’d take two weeks to fix. My Dexcom sensor fell out on the first day though, so I wouldn’t have received readings as intended any way. My Omnipods also either errored or fell out often, and I kept my blood sugars a bit higher than normal for the dives which made for some underwater thirstiness. But as I grew more comfortable underwater, so too grew my ability to plan for any situation thrown my way, and I gained a unique sense of confidence that enabled me to better manage my health and overcome diabetes challenges both underwater and on land.
Earning the certification represented so much more to me than just a license to SCUBA dive: it represented my ability and my determination to live beyond Type 1 Diabetes. It represented how the only person who gets to determine my limits pertaining to diabetes and otherwise is me. And, with the right amount of support and perseverance, even the limits I think I have can be stretched and my potential expanded.
In the months that followed my Open Water course, I went on to Indonesia where I dove through a sunken U.S. cargo ship covered in coral reef and wildlife and saw my first octopus and to the Philippines where I completed my Advanced Open Water Diver certification alongside sardine runs and whale sharks. To date, I’ve experienced underwater wonder on 18 dives with diabetes–and, from one T1D diver to an aspiring one, let me tell you: diving is nothing short of magical.
Each year, I look forward to exploring new dive sites around the world, and I look forward to continued opportunities to prove to myself and others that diabetes can’t and won’t stop me. This year, I have the tremendous privilege of guiding you on the adventure of a lifetime. Whether you’re discovery diving or about to join me as a certified diver, I can’t wait to show you just how much you can do and that diabetes can’t and won’t stop you.
See you underwater,
T1WT Founder, Savannah Johnson