Diabète et Plongée

Alexis · Inscrit le: 24 Mai 2003 Messages: 115 Localisation: Paris

Chers amis,
j'ai le plaisir de vous annoncer que notre projet "faisons plonger les diabétiques" fera l'objet d'une communication lors du congres de la societe européenne de médecine hyperbare (EUBS, plus d'informations sur http://www.eubs.org )à Ajaccio du 15 au 19 septembre 2004.

Ci dessous l'abstract de l'article qui sera présenté :

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DIABETES AND DIVING : CHANGE IN REGULATIONS ?
Tabah A1, Lormeau B2, Bresson R3, Dufaitre L4, Thurninger O5, Sola A6
1: SAMU95-SMUR Hôpital de PONTOISE, FRANCE, 2: Endocrinologie - Diabétologie Hôpital Jean Verdier BONDY, FRANCE , 3: Endocrinologie - diabétologie Hôpital de DOUAI, FRANCE, 4: endocrinologie – diabétologie, Hôpital la Timone MARSEILLE, FRANCE, 5: Endocrinologie - diabétologie Hôpital Forcilles FEROLLE ATTILY, FRANCE, : Endocrinologie – diabétologie, Hôpital Hôtel Dieu PARIS, FRANCE

In France, there is a total ban on diving for diabetics, due to the risk of hypoglycaemia underwater and consecutive drowning. It is well known that despite this ban, some diabetics dive. However data from DAN and BSAC let us think that under strict regulations there is a possibility for selected patients to dive safely. In order to propose specific guidelines, we analysed the behaviour of type 1 diabetic subjects when diving, with an immersion protocol based on capillary Blood Glucose (BG) levels. Fifteen type 1 well controlled (HbA1c 7,3%) diabetics, without any complications, undertook a total of 100 dives during 4 days at Golfe Juan, France, in October 2003. BG was tested 30, 15 and 5 minutes before immersion, then 5, 15 and 30 minutes after boarding. A minimum of 7.7 mM BG was required to start the dive. No hypoglycaemia symptoms or fainting were observed underwater or onboard. Four dives were postponed, due to a BG level below requirements in 3 cases, and for positive ketonemia (0.3g/l) in one case. We had to face rough sea and the only medical problems encountered were sea sickness and a middle ear barotrauma. Continuous Glucose monitoring (CGMS) showed some high variations during the day and mostly at night, but not during immersion. Insulin dose was reduced by an average of 19.3%, and a total for the 8 dives of 15 to 435 grams of Glucose were ingested to reach the required level of 7.7 mM before diving. Average daily calory intake was 3255 kcal. Therefore an alternative to French regulations may be proposed, allowing well controlled, educated and non complicated diabetics to dive, ensuring safety by checking BG 30, 15 and 5 minutes before diving, with 9 mM BG at least and no decreasing BG tendency before entering the water. Insulin dose reduction advice and fitness should be assessed yearly by a diabetologist on top of the usual fitness to dive examination.

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Alexis