148
VOLUME 10 NUMBER 4 • NOVEMBER 2013
REPORT
SA JOURNAL OF DIABETES & VASCULAR DISEASE
occurred, there is regular monitoring, with
an understanding of the risks of hypogly-
caemia, and that there are no other dan-
gerous co-morbidities. It is recommended
that drivers test their blood glucose levels
prior to departure and not drive if it is
< 4.0 mmol/l. Driving is not recommended
for 45–60 minutes following non-severe
hypoglycaemia.
Flying may affect blood sugar levels due
to changes in time zones. Flying east short-
ens the day and may require less insulin,
with a possible risk of hypoglycaemia. The
patient flying west has a longer day that may
require more insulin, with a possible risk of
hyperglycaemia. Insulin pump function may
be affected by changes in altitude; a pres-
surised cabin may slightly increase insulin
delivery, with a slight decrease in delivery
upon descent. The South African Civil Avia-
tion Authority has an extensive diabetes
mellitus protocol for pilots. See
caa.co.za/resource%20center/ASO/Avmed/
Docs/Diabetes%20protocol.pdf.
Diving poses unique challenges to the
diabetic patient. The diving environment
implies an inability to rest, eat or drink in
cold conditions. There are also the dangers
of decompression and diagnostic confusion.
However, there are no data to suggest that
diving is more hazardous in the patient with
diabetes. Guidelines from various diving
organisations (e.g. DAN, PADI) recommend
waiting three months after initiation of or
changes to medication and waiting one year
after a severe hyper/hypoglycaemic incident
that required assistance. The scope of diving
should be to a depth of less than 30 m with
a duration of less than one hour. Patients
should avoid long, hard, cold dives and
wrecks and caves. The dive buddy should
be educated about diabetes, but not have
diabetes him/herself.
G Hardy
Sponsored by Novo Nordisk
