A day in the life of a diabetic diver: the Undersea and Hyperbaric Medical Society/Divers Alert Network protocol for diving with diabetes in action.

Some people with well-managed insulin-dependent diabetes can dive safely. Those cleared to participate should control tightly the variables that impact blood glucose levels, including activity, timing, food and insulin. Honest self-assessment is critical. A diabetic diver should cancel a dive if seasick, unusually anxious, or following significant high or low blood glucose levels in the preceding 24 hours. The diver should enter the water with a blood glucose level above 8.3 mmol·L⁻¹ and below 14 mmol·L⁻¹ with a stable or rising trend in blood glucose established with glucose tests at 90, 60, and 30 minutes prior to a dive. The diver should carry emergency glucose at all times and brief dive buddies about hypoglycaemia procedures. This is a personal account of the author's experience diving with type 1 diabetes and details how the UHMS/DAN recommendations are put into practice on dive days. Key elements of the self-assessment process, long- and rapid-acting insulin adjustments, meal timing, responses to blood glucose trends, handling hypoglycaemia and approaching multi-dive days are described. Some considerations for people using insulin pumps are also briefly discussed.