Ask D’Mine: Getting Tattooed, Insulin in the Hospital

Got questions?  Not sure if something is ‘kosher’ or ‘PC’ or even particularly healthy if you’re living with diabetes? You came to the right place.  Check out today’s edition of our new diabetes advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

This week, Wil shows off both his ‘Tats’ and his prejudices vis-a-vis hospital care. Take it away, Wil:

Joe from Florida, type 1, asks: Should I get a medic alert tattoo?

Wil @Ask D’Mine answers: Yes.

Next question?

What? Really? OK. So Amy says I have to give a wee bit more detail than that (and she’s the one always complaining that I use up too much space)!

Yes, if you use insulin.

Still more? Alright…

So first the standard disclaimer. I have a medic alert tattoo myself. My mother, who hates tattoos, and my wife teamed up on this project because I’m on the sloppy side about wearing medic alert jewelry, and I’m on the road a lot. It gives them a measure of security knowing I have an alert that I can’t accidentally leave behind.

Wi's Diabetes Tat

Not that there’s anything wrong with hanging out in a tattoo parlor.

I’m just saying, you need to free your mind from tattoo stereotypes when we’re talking about medical tattoos.

But I do have some tattoo rules: First and foremost is actually advice my mother gave me when I was 16: never get a tattoo that you can’t cover up if you need to get a bank loan.

This is good advice. Not everyone loves tattoos. Sometimes you need to look more “mainstream” than you might actually be. Bank loans, testifying before Congress, or trying to talk your way out of a traffic ticket — in all of these cases, if you have a big blue tattoo on your forehead that says “F— Diabetes” it’s going to cause you trouble.

So if not on your forehead, where should an alert tattoo go? The consensus seems to be on the right wrist. The reason for this is most folks wear a watch on their left, so medics are more likely to check for a pulse on the right. Another option is on your neck above the carotid artery, but that can be harder to cover, depending on your wardrobe, when the summons to testify before the US Senate arrives.

Working in medicine, I do have a few health and safety tips for you. Plenty of people got hepatitis in the old days getting tattoos. This really isn’t a problem anymore, but make sure the shop you choose uses a brand new needle just for you, make sure they autoclave their guns between customers, and ensure that they either use disposable ink “pots” or that the pots are autoclaved too. That’ll keep the viruses at bay. (For many years the whole needle thing was being taken care of but people were still getting sick. It turns out the viruses were living in the ink pots, the little supply wells used to fill the needle with ink.)

The second medical consideration: no tattoos if your A1C is over 9.0, and to really be safe, it should probably be sub-8. If your blood sugar is high, you won’t heal well, which opens up a whole range of risks from scarring on the bottom end to sepsis and amputation on the top end. ‘Nuff said about that.

And speaking of tattoo parlors, pick someone talented. Tattoos are pretty much permanent, so you want a skilled artist putting it on you. Oh, and I’d avoid going to a tattoo parlor that has a huge banner saying “Grand Opening.”

As to design, there is no one universal medical alert design. In general I’d look towards a design that either has the caduceus or the Rod of Hermes on it. These are the two designs most commonly used on medic alert jewelry. The caduceus is the “doctor’s symbol,” the winged staff with two snakes. Here in the US it has become pretty much the universal symbol for all things medical. The Rod of Hermes is a single staff with a single snake and no wings. It’s more common in Europe, I’m told. But we use both here, and I think it just comes down to which appeals more to your eye.

Of course you can “tattoo it up a bit” to quote Orlando Sedillo, the guy who did mine. Just don’t tattoo it up too much. If you get so fancy that the symbol can’t be recognized, it does you no good when you are lying on the pavement drooling.

It should say, “diabetes,” “diabetic,” or “insulin” on it somewhere. You don’t want to be mistaken for an epileptic.

Not that there’s anything wrong with that.

Which pretty much covers everything but age. Yikes. I can see the comment storm on the horizon already. What about teenagers? Well….

So teenagers, in general, are the most reckless about wearing their medic alerts…

And teenagers, in general, are the most susceptible to blood sugar problems…

And teenagers, in general, are the most likely to undertaking other risky behavior…

And teenagers, in general, are the most likely not be to in responsible company…

But is it even legal for a teenager to get a tattoo? Generally, yes, it is, but of course state laws vary a great deal on this subject. Here in New Mexico, if you are 16 you can get one all by your lonesome, and you can get one at 14 if a parent or guardian is with you. I did a quick Google and was surprised to find most states are even more liberal, with generally no bottom age by law so long as a parent or parent equivalent is present. (Of course there are a handful of states that lock tattoo artists up for life if they even look sideways at anyone under the age of 18.) You can check out your state’s tattoo laws hereif you like.

Law aside, how young is too young? Hmm, I really can’t pick an age number. It depends on the kid, the family, the community.

I’ve got one 14-year-old T1 boy who comes to see me at the clinic who wants a tattoo. His parents asked me what I thought. As my conversations with the kid generally start out like this…

Where’s your medic alert? I forgot it.

Where’s your glucagon? In my nightstand.

Where’re your spare pods? I left them at a friend’s house.

Got any sugar on your body? Nope.

…I said that I thought it was probably a pretty good idea. That coupled with the fact that this kid really wants one. I think the family’s made some sort of deal where the parents sign off on it and even pay for the tattoo so long as he gets his blood sugar low enough to make it safe.

So yes. I think you should get a medic alert tattoo.

And readers who already have: send us pictures of your medic alert tattoos!

Carmen from New Mexico, type 2, writes: My 81-year-old mother was recently hospitalized for several days for pneumonia. The hospital diabetes people basically tore up the diabetes treatment plan her primary care doctor and her educator have been using. The hospital gave her a complex sliding scale for insulin and said she has to attend carb-counting classes. She’s a type 2 with an A1C of 8.2, takes Lantus, and has a host of other medical problems…?

Wil @Ask D’Mine answers: OK. I need to be careful not to let my personal prejudices cloud my advice today.

Oh screw that! I am soooooooooo going to let my prejudices into the picture.

Hospitals have no right messing with established treatment plans. Hospitals don’t know patients well enough, and you aren’t under their care long enough for them to make those calls. Plus, if you are in the hospital at all, you’re sick, so they aren’t seeing you at your best.

The primary care team, on the other hand, has a relationship with their patients. They ostensibly know the character, personality, quirks, family, religion, culture, and economic realities of their patients. They get the “Big Picture.”

Hospitals don’t know any of that.

So, that’s my general overview. But even if I didn’t feel that way, I think they gave your mom bad advice. If your mom is 81, that tells me she was born in 1930. The life expectancy for a woman born in 1930 is supposedly to age 61.4. So she’s already beat the odds by almost twenty years. Her A1C in the low 8’s isn’t great, but it’s low enough to keep her kidneys safe. As she has a “host” of other medical issues, I’d put money on the fact that her diabetes isn’t going to be her demise at this point.

My feeling is that we need to balance quality of life with quantity of life. You can live forever on tofu and cottage cheese alone on some mountain top, but why would you want to? To me, it sounds like her diabetes control is good enough for her age and health. I see no value in trying to make it perfect.

On Lantus she’s taking either one or two shots per day. A sliding scale means multiple daily injections, more fingersticks, plus learning to count carbs is tedious and stressful — and completely unnecessary for her.

My take? Stick with the plan the primary doc and his educator came up with.

The hospital should butt out.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.