Diving with Diabetes in the Philippines
When I signed up to dive in the Philippines, I hemmed and hawed about whether or not to reveal that I had diabetes. Even though I was already certified, whether or not I could dive here would be up to the discretion of the local dive shops. So I made a decision: I lied about having diabetes. Well to be fair, I didn’t exactly lie. I didn’t say that I didn’t have diabetes. I just didn’t say that I did.
I took comfort in the fact that I knew other people with diabetes who regularly dive and regularly don’t reveal that they have the disease. People with diabetes are generally not allowed to SCUBA dive—from what I’ve learned, it’s because it poses too much of a risk. There are too many unknowns: what happens if your blood sugar goes low on a dive? What if it goes too high? If you take almost any kind of prescription medication, you need a doctor to okay your dive. So I traveled to St. Thomas to get certified by Steve Prosterman, a certified SCUBA diver with type 1 diabetes (T1D) and also certifies others with T1D, in 2007.
When we arrived at the first dive spot, my blood sugar was a little high, in the 200s mg/dL. I tested with my hands inside my bag, so no one could see the blood drip from my finger. I didn’t correct because I still had insulin on board and we were about to swim for a bit. I disconnected my pump and stored it in my watertight bag, as if I was hiding contraband.
We explored a shallow Japanese gunner ship that had sunk in the early 1900s. It was cool to see how it received a second life and now housed an underwater ecosystem. The second dive was INCREDIBLE!!! My favorite part was looking through the portholes, which were still intact. Barnacles and other marine life had made the ship their home. After around 40 minutes, we made our way up, doing a safety stop so as not to come up too quickly and poison our bodies with nitrogen. When we reached the surface, I couldn’t get my mask off fast enough so I could exclaim to the whole world how AMAZING that was! The third dive was a little anticlimactic, no ships or boats, just regular old sea life.
Back on the boat, my blood sugar was 8.0 mmol/L145 mg/dL. Score! I didn’t let the celebration last for longer than a moment, though—because if I gave myself credit for this, it would mean that every time my blood sugar doesn’t end up where I want it to, it’s my fault and I have to take the blame. I try to remain even-keeled, not beating myself up or congratulating myself too much. Still, when I get it right, it feels damn good. It’s the only time I feel, just for a moment, worry-free.
I went back to the hotel, excited to eat alone and not have to make conversation with strangers. During dinner, deep into Malcolm Gladwell’s Blink, I got so dizzy that I kept reading the same sentence over and over again. While my blood sugar was sitting pretty in the 90s, my stomach hurt. I wasn’t sure if it was the kind of stomachache that would feel better after eating, or if I should try not eating. I chose to eat (I will always choose to eat, actually, if given a choice). It didn’t help.
In the hotel lobby, the only location with Wi-Fi, I Googled: “Not feeling well after scuba diving.” The Internet was so ssssslllllllloooooowwwwww. My head started to swim. I skimmed the results, which listed decompression sickness, or “the bends,” as possible ailments if you come up from diving too quickly, or stay down too long. It can be life-threatening, resulting in death or spinal and/or brain injury. The most important thing to do, I read, was to get oxygen. I had the wherewithal to stand up and walk over to the girl at the front desk. “Is there a doctor you could call?” I asked. “I’m not feeling that well. I think I’m going to pass out …” Bonk. I fainted.
When I came to, there were around 10 people from the hotel hovering around me. I felt weak. I checked my continuous glucose monitor (CGM) and my blood sugar was hovering in the 80s/90s, so for once, that was perfect, but I was convinced I was dying from the bends and I needed oxygen! I asked to see a doctor. Off to the hospital we went!
The taxis in the Philippines are called tricycles—they’re two-wheeled scooters with sidecars attached to them. Not built for the faint of heart, or those suffering from nausea and diarrhea. I felt so weak I didn’t know if I could hold on so as not to fall out of the sidecar.
The hospital was just past the dive shop, maybe a mile away from the hotel. It was hot and there was no air conditioning, so the windows were open. I was so thirsty and dehydrated, but the nurse informed me that they didn’t have potable water. No drinking water in a hospital?! They sent someone to the pharmacy across the street to buy some bottled water.
When I told the nurses about my dive experience, they started to check the oxygen levels in my blood with a little meter that clips onto your finger. This would determine if my oxygen levels were low and if I was suffering from decompression sickness. They clipped the meter to my finger and we anxiously waited. It turned out that the meter was broken. The only one in the whole hospital. I asked if they had any oxygen just in case—all I remember from Googling is that if I’m suffering from the bends I need oxygen, stat!! But no, on an island known for scuba diving, there was no oxygen in the hospital. They told me to wait for the doctor.
While waiting, I decided I should get in touch with my mother: “Oh, by the way, I passed out in my hotel lobby. NBD. In the hospital. Will probably get an IV.” Just in case this was the last time she ever heard from me, I explicitly laid out for her where I had left some of my luggage in the main city of Cebu so she could recover it if necessary. I felt so bad for doing this to my mom. Her responses seemed rational and calm. I could tell she was Googling the name of the island and the hospital. She asked me to send her the phone number of the hospital. I asked the nurses for the phone number—but the hospital didn’t have a phone. I was sure this was a conspiracy. How do people get in touch with you I ask? Response: they just call the doctor on his cell phone.
When the doctor finally arrived, he walked into my room and didn’t bother to introduce himself. “What dive shop did you go to?” he asked.
This question took me by surprise. I didn’t want to tell him the dive shop I went to because I didn’t want the hospital to tell the dive shop that I have diabetes. I told the nurses and doctor that I have T1D, because this is serious, this is my health, but I don’t want people to think that this poor little girl with diabetes doesn’t take care of herself and she shouldn’t be traveling the world alone and she didn’t prepare or think this through! That couldn’t be farther from the truth!
The amount of diabetes-related thought and planning that went into every detail of this trip was astronomical: from how I should pack all of my medical supplies to how I would keep my insulin cold, from how I can surf with my pump to making sure I have enough food on me in case my blood sugar goes low. I didn’t want all of the maddening preparation and worry and consideration that went into this whole trip to be boiled down to one trip to the hospital which (I felt) had nothing to do with diabetes. After so much time and so many years explaining T1D, I didn’t want to further the misunderstanding of this disease and have this entire situation be reduced to: That person with diabetes didn’t take care of herself and she should have never gone SCUBA diving in the first place.
I told the doctor, “I don’t remember.” Later, however, I pieced together that the dive shops are responsible for the people they take diving. So if I were in need of oxygen, the dive shop would have had to provide an oxygen tank for me. Oops.
The doctor said something to the nurses and then left. No examination, no questions about how I feel. He prescribed an IV (“No sugar!” I reminded them, “Just saline.”) and some anti-nausea medicine. Finally, some relief! They were also on a mad hunt for oxygen tanks across the island and were able to find one guy who was still open and had a tank available. Whew.
When they set up the oxygen tank, one nurse told me they were giving me the oxygen because I was hysterical, not because I needed it. The nerve! How could she know I didn’t need oxygen if they couldn’t even measure the oxygen in my blood! The nurse started my IV, which would last for eight hours, after which, the doctor would come back and check on me.
The next day, Vince, my dive master, walked into my hospital room like a ray of sunshine. He quickly reassured me that based on how deep we dove and how long we were down for, it was very unlikely that I had the bends. He showed me the dive computer on his wrist and re-explained how he had calculated our diving times, reminding me that we had made a safety stop on the way up. Vince was not only a dive master—he was an EMT. He had seen many people with the bends, and they did not look like me. I felt better just hearing his voice. He bought me some Gatorade, told me to rest and left. He still didn’t know I had diabetes, but from what they could tell, it was simply dehydration. By this point, my IV was almost done. I had no interest in waiting for the doctor. I bolted out of there.
After a shower, a nap and some Pedialyte, I decided to go to the dive shop. I had bought a gift for Vince’s daughter, to say thank you, as well as a big jar of cookies for everyone else at the shop. I just wanted to officially get rid of any remaining negative vibes. I didn’t want to take them off the island with me. I left the shop and waited to fly standby to get the heck off that island as soon as possible.
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