DAN Medics and Researchers Answer Your Dive Medicine Questions
Q: I was recently diagnosed with type 1 diabetes and will now require insulin. Will I be able to dive again?
A: A diagnosis of insulin-dependent diabetes poses many significant health issues to consider, but it does not necessarily mean the end of your dive journey. Each dive requires thoughtful planning and medical oversight.
A major immediate concern is hypoglycemia (low blood sugar), which can cause impaired judgment, confusion, seizure, or loss of consciousness underwater. In the long term, poorly controlled hyperglycemia (high blood sugar) can result in a range of organ system impairments that can affect visual, renal, and cardiovascular systems. These considerations could impact your safety and ability to assist a dive buddy in an emergency.
Before diving again, it’s important to establish stable glycemic control and become familiar with how your body responds to insulin, food, and physical exertion. You should be able to recognize the signs of a falling blood glucose level and act quickly.
An adjustment period of three months to one year after diagnosis will help you evaluate your glucose control to ensure you have a stable treatment regimen. Consult with your endocrinologist about the required procedures for your treatment plan before and after entering the water.
In general, insulin-dependent divers should do the following:
• Obtain medical clearance from their physician team that includes a dive medicine physician.
• Maintain excellent management of their diabetes without other organ system involvement.
• Avoid coldwater, deep, or technical diving, including overhead environments and decompression dives.
• Use proper thermal protection.
• Always carry a source of fast-acting glucose, and dive with an informed buddy.
Many divers with diabetes return to safe recreational diving with the proper precautions, training, and support from their care team.
— Diana Rodriguez, NREMT-P
Q: Can breast pain after diving be a symptom of decompression sickness (DCS)?
A: Yes, breast pain can be a symptom of cutaneous DCS or lymphatic DCS. It is important to make sure that the pain is confined to the breast’s soft tissues and is not chest pain.
Cutaneous DCS often manifests in the skin overlying adipose tissue. Adipose tissue, commonly known as body fat, is connective tissue that stores energy as fat. The most common areas for cutaneous DCS are the abdomen, back, thighs, and breasts.
Lymphatic DCS can manifest anywhere there is lymphatic tissue, a specialized tissue that plays a critical role in the immune system. The breast contains a network of lymphatic vessels and lymph nodes.
Type 1 or mild DCS is usually characterized by musculoskeletal pain, skin rash, lymph node swelling, and itching or raised skin. Obstruction of the lymphatic system is less common with Type 1 DCS but can result in swelling and localized pain in the tissues surrounding the lymph nodes.
Breast pain associated with DCS can often get overlooked when it is the only symptom. Divers have described their breast pain symptoms as itchiness, pain to the touch, and a feeling like the breasts are engorged. The feeling of engorgement is possibly the inflammatory process in the lymphatic tissue, which impedes fluid drainage from the associated tissues. These symptoms can be present with other, more common cutaneous and lymphatic DCS symptoms.
There are other nondiving causes of breast pain that a physician should consider, especially if a diver’s history and physical exam are not consistent with DCS. AD
— Jevon Monaghan, EMT-P
© Alert Diver – Q3 2025