How I Go Scuba Diving with Diabetes

I’m an adventure-seeker: skydiving, heli-skiing, night surfing, canyon swinging—you name it. Living with Type 1 diabetes for nearly 20 years hasn’t prevented me from doing any of these things, so while visiting Australia in early 2020, I was excited to add scuba diving to the list. I wanted to do an introductory Discover Scuba Diving experience before committing to getting my PADI certification, and since I was traveling to Queensland, what better place to do it than on a trip to the Great Barrier Reef?

Few feelings compare to the immersive solace and calm of scuba diving. For people with diabetes and other disabilities, underwater experiences can still be elusive, even as accessibility to diving has increased, with expanded awareness and safety guidelines, in the past few decades. Diabetes is a chronic condition that eliminates or reduces insulin, a critical hormone responsible for digesting glucose. This type of disease requires constant monitoring and managing of insulin doses while also maintaining self-awareness to detect and treat symptoms of high and low blood sugar levels. Thanks to reduced stigma, advances in technology and community support, more divers are opening up about their diabetes, and new divers are encouraged to see the world from an entirely different point of view.

Through blog accounts and personal stories shared with me I found that until recently, people with diabetes haven’t felt comfortable disclosing their condition for fear of being forbidden from diving. In order to dive in Australia, I needed to present a medical certificate from a local doctor, and even then, my participation was up to the discretion of the dive operator. I was lucky to have the help of an Australian friend who works in the healthcare field and also has diabetes. She helped me contact various medical offices to find a doctor who specialized in diving and was familiar with diabetes. Meanwhile, I asked my endocrinologist for a letter stating that it was safe for me to dive, which I presented for the medical evaluation.

The Australian physician told me that while he can evaluate my diabetes management and perform all kinds of physical tests, those things don’t show whether you have the most important quality for diving: common sense. I wasn’t quite sure how to prove that I possess common sense, but maybe my history as a strong swimmer (and former waterfront head lifeguard), my diligent diabetes management and my enthusiasm to do whatever it took to be able to experience diving were enough to issue a certificate that deemed me fit to dive in Australia for one year. I felt like I was holding my breath during the entire visit: I was anxious about over-explaining myself, nervous about the possibility of being denied, and annoyed that I had to go through this process in the first place.

When it came to booking my dive, I spoke with some hesitant operators who said they “strongly doubted” that I would be able to dive, even if I came prepared with my paperwork. The shop I settled on came recommended for their customer service, but I still experienced anticipatory anxiety over the devastating idea of being rejected after so much effort and travel. After I booked my day trip to the reef, my therapist helped me plan for that possibility, and I decided to take myself out for dinner at a restaurant near the marina so that I had something positive to look forward to, no matter how the day turned out.

To my surprise, when I presented my medical certificate, the dive instructor exclaimed, “Oh, you went to see Mark!” The evaluating physician was well-known, and this made a huge impression on the crew. My instructor wasn’t fazed by my diabetes, and in addition to permitting me to dive, he and I worked out a special hand signal: I’d make an “L” with my right hand if I felt any symptoms of hypoglycemia while submerged. Underwater pressure doesn’t affect people with diabetes any differently than it does people without diabetes, but it can be a dangerous distraction to feel light-headed or shaky in the event of a “hypo,” or low blood sugar, during a dive.

This proved to be a nonissue because I was so worried about my blood sugar dropping that I over-prepared and actually needed to take more insulin, resulting in higher-than-normal blood sugars (which aren’t ideal but are less urgent than low ones). I couldn’t bring my continuous glucose monitor, which records my blood sugar every five minutes, underwater with me, so I made sure to closely monitor myself before and after dives. Highlights of my initial dive included swimming above a reef shark, exploring a huge wall of coral and sea life, and enjoying the quietude beneath the surface. I made friends with other new divers in my group and chatted with veteran divers on the boat. The weather was perfect and the water clear, making for stellar conditions.

It turned out to be an amazing experience, but the process was expensive and emotionally draining. Enrolling in a PADI Open Water Diver course at home in New York proved much easier: No one blinked when I filed my medical form, and communication was always encouraged. I was reassured when a divemaster participating in my third and fourth dives at Dutch Springs, Pennsylvania, said if anyone needed to surface for any reason, it was more important to ascend safely and make sure everyone was OK than explain why they needed to surface. It made me feel like part of the group, and that kind of openness is very freeing because it helps reduce discrimination for everyone. I now hold a PADI Open Water Diver certification and am planning my next international dive in the Caribbean, where I hope having my C-card and several successful dives under my belt will make things go a bit smoother.

I feel so lucky to have the privilege of being able to experience diving. I have since discovered even more divers with diabetes. I have learned a lot from them and I look up to the adventurers who have done it before me. Demystifying the process inspires more people in the disability community to join us—by sharing our stories we can continue to overcome challenges and expand the diving world.

It’s important to research the medical evaluation expectations wherever you're planning to dive. During an evaluation, stand up for yourself and your diabetes management. People with diabetes are our own primary caregivers, and we work hard!

Your endocrinologist can be your advocate when it comes to filling out forms and communicating with other physicians. Taking the extra step to find a local doctor who has an established reputation in the diving community is another way to ensure that your medical evaluation is respected.

Avid underwater photographer Pei Yan Heng, of Singapore, has been living with diabetes for 25 years and believes that it is all about preparation: “When crossing time zones, it’s crucial to adjust your body clock and diabetes management routine to the local time zone,” she says. “It is all right to not participate in all dives, and you might want to consider a pay-as-you-dive package rather than a prepaid dive package.”

Make sure you’re comfortable in the water before you try diving, says certified diabetes educator Julie De Vos: “Go swimming and snorkeling and know how your body reacts in the water. Many of the things that you’ll be dealing with are similar to what you’ll manage while scuba diving. In those situations, you can just pop out your snorkel and check your blood sugar, so it’s a good way to get comfortable in the water.”

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