Wil’s all over the map today with our latest edition of Ask D’Mine, the “curiously strong” diabetes advice column. That is of course our host, veteran type 1, diabetes author and community educator Wil Dubois. 
{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}
Send us your queries related to life with diabetes — whether it’s how to get a tan, or what to do in case of dying.
Ross from Washington state, type 2, asks: Do you think it’s important to have a Living Will with this disease? If I ever pass out and go into a coma I’d like my family to know my wishes. But I don’t want to freak them out by handing them a ‘Will’ while I’m still running around and feeling healthy.
Wil@Ask D’Mine answers: I guess anyone could “pass out and go into a coma,” but as you’re a type 2, I gotta tell ya, it’s pretty unlikely that’ll happen to you. That said, I think you should have a Living Will—but not because you have diabetes. Sick, well, or inbetween, I think everyone should have a Living Will.
A Living Will, sometimes called an advanced directive, simply spells out your wishes in regards to life-prolonging medical intervention in case something really, really bad happens to you. It’s a legal document, but it isn’t carved in stone, so you can change it later if you change your mind. It keeps family members from arguing over when, or if, to pull the plug when you are lying brain-dead in a hospital in… oh, I don’t known… Cincinnati, or wherever.
As to your family freaking out, no one gives it much thought when any healthy member of society writes a conventional will that sates how their property should be divided after the plug is pulled in Cincinnati. Why should they freak out over this? If you want to use your diabetes as a crutch, by all means do so. You can say to them, “you know I’ve really got a handle on this whole diabetes thing, so there’s really nothing to worry about; but now that I’m more focused on everything relating to health it got me thinking about that whole Terry Schiavo thing…”
Living Wills can be done by local lawyers, via web-based fee-for-service outfits like Legal Zoom, or by using free forms from outfits like DoYourOwnWill, which seems to have a form for every state.
Remember that a Living Will only deals with the narrow issue of how much medical intervention you want in case of a worst-case scenario. It has nothing to do with your money, real-estate, or other property.
I think Living Wills are especially important for people with multiple children. All of your kids are likely to have different views of what they think you want. Also, some may have a harder time “letting you go” than others if the worst happens. Setting your wishes down in a legal way prevents in-fighting and strife between your kids that could give them life-long psychic scars. They may not like your decision, but if it’s your decision, committed to legal paper, they’ll respect it.
Another option you may have heard of is medical power of attorney. You can give someone you trust the full legal authority to make decisions about your health if you cannot. It’s very narrowly focused, so your trusted loved one can’t go sign at the bank and clean out your checking account. Personally, I think medical powers of attorney are kinda cruel. You are passing the buck to someone else, and leaving all the anguish, second-guessing, and possible guilt to them. The Living Will spells out what you want, in advance, and I think that’s the only responsible, adult, considerate thing to do (while you are running around and feeling healthy).
Chris from New Jersey, type 2 writes: I would like to wear shorts this summer and have a tan. I’ve used tanning beds before and am gradual and careful, but have never used one yet as a diabetic. Do you get Vitamin D from this? Am I more prone to burns now? Are my meds affected by this? (I take metformin). I’m also curious about the spray-on tan—is that safer?
Wil@Ask D’Mine answers: So….. let me get this straight. Diabetes is not enough for you, so you want to flirt with skin cancer too? You know the World Health Organization has put tanning beds into its DEFCON 1 category, calling them “carcinogenic to humans,” right? That’s doctor talk for “causes cancer—for sure.” And to be extra clear about this, let me point out that increasing cigarette smoking in a gradual and careful manner still invites lung cancer. Period.
So, please. No more tanning beds.
As to spray-on tans, to the best of my knowledge, they haven’t been proven unsafe yet. But I’ll bet it’s only a matter of time. I mean, come on, People: something that you spray on your body that changes the pigment of your skin can’t exactly be healthy, now can it? That said, the good folks at the Mayo Clinic give the products a grudging thumbs up. Apparently most of them stain the dead skin cells on the very outermost level of your hide to give you the golden glow. Who knew?
As to being more burn-prone, simply joining our diabetic family does not increase your risk of sunburn. Neither does metformin, but it was a good thing to think about because there’re actually quite a few meds that do increase your sun sensitivity, often called photosensitivity in pharmaceutical parlance. You can look at a complete list of the slam-dunk sunburn meds here, but some of the most common ones are the achy joint pain med Aleve and it’s cousins; Phenergan, which, ironically, is given for motion sickness on cruise ships so you can go back to having fun in the sun; and the common anti-acne antibiotic tetracycline.
A much longer list of prescription and over-the-counter meds that can mildly increase your sunburn risk is here. The only diabetes drugs that are listed are the sulfonylurea class like Glipizide.
So, as to vitamin D, this just happens to be something I know quite a bit about right now, thanks to a recent personal health adventure with it. The most common symptom of being low on D is fatigue. But of course, everyone is so short on sleep nowadays, that the vitamin connection is often missed. Did you know that being vitamin D deficient can also cause wicked deep bone pain that doesn’t respond to any amount of pain killers? Even alcohol can’t help unless you drink enough to pass out (my solution to the problem). You’re body normally makes vitamin D using solar power. Here at our mile high+ altitudes in New Mexico skin cancer risks are much higher so we tend to avoid tanning and slather ourselves with sunscreen when we are outside for long. Result: rampant vitamin D shortfalls are being discovered in our clinics, hospitals, and doctor’s offices.
Luckily, the cure is easy. Take D supplements to get your body back on track. To avoid getting off track in the first place, the current recommendations are 10-15 minutes of suntime three times per week.
So, with all of that said, here’s my advice to you: never get in a tanning bed again. Ever. Avoid sprays. Put on your shorts. If you are going to be in the sun more than 15 minutes put on sunscreen. And have a nice summer!
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.
I have some info to add to the Vitamin D discussion:
Watch out for sunscreen-it’s as bad as or worse than those fake tanning lotions due to the chemicals in them-including some carcinogens that certain brands carry.
Also, don’t shower right after your 10-15 minutes in the sun because your skin needs some time to develop the vitamin D and absorb it-if you bathe too quickly this reaction won’t occur and you won’t get all your vitamin D.
Another thing, get a blood test several months after you start supplementing with vitamin D (if you do) so that you know what your levels are-you don’t want to overdose.
If you are older you need more vitamin D than if you are younger. If you have a darker complexion you need more Vitamin D than someone with pale skin. For example black people are at very high risk for low Vitamin D because they require a lot more to maintain a healthy level and they don’t tend to lay out in the sun. Someone with very dark skin could very well need 30 minutes of sun a day.
When your skin turns light pink, your body has received enough. So for a pale person this could very well be 7-10 minutes and for a darker person it could mean 30 minutes. A healthy Vitamin D level protects against many types of cancer. Did you know more people who work indoors get skin cancer than those who work outdoors year round?
If possible, get vitamin D from the sun-it’s better absorbed by the body.
In the winter I take Cod Liver Oil which has vitamin D and healthy fats-it’s cheap and easy. I get blood tests done routinely and have discovered that I need a lot more vitamin D than your average person. I take 10,000 units a day and my blood tests show my vitamin D level is not too high or low. This will vary person to person and levels of Vitamin D in the body can increase faster for some people than for others-while taking the same amount of vitamin D each day. That’s why a blood test is a good idea-overdosing can be very dangerous.
I would definitely avoid tanning beds, tanning lotion, and be careful when selecting a sunscreen. I prefer gauzy long sleeves and big hats to sunscreen.
Many hospitals will help you write a living will or advance directive at no cost to you. Before having surgery, the hospital we use offered me the opportunity to write one up to be kept on file…just in case.
Another important document that people should have on file with their hospital and medical practice they use is an “authorization to release medical information” so that family members can communicate with medical staff about their condition and treatment.
About comas:
A friend of mine left her Type 2 husband at home and went on a trip. She called him every day to make sure he was OK, and he insisted he was. In fact, he got quite irritated with her for her daily calls. On a Friday, she called him, and he insisted he was OK. But on Sunday, when she arrived home at the airport he was not there to pick her up. So she called a friend to come get her, and when they got into the house, they found her husband lying face down on the bed, non-responsive. Of course, they rushed him to the hospital, and he lingered in the ICU for 3 weeks on dialysis before finally dying.
Please don’t tell Type 2′s they can’t go into a coma — they can, and do. It may not be as common as DKA, but it shouldn’t just be brushed off. Type 2′s should be aware of the possibility and know the warning signs, as should their family members. And they should have a plan in case their BGs go up and they can’t get them down. This tragedy didn’t need to happen.
I forgot to mention in my previous post that the man’s blood sugar was 1400. It was definitely a diabetic coma and not a heart attack or anything else.
Wil, as always, I found your “take” entertaining and infomative. Sysy had some good Vitamin D info as well. I had no clue on all that she wrote. Keep up the great work!
I have to disagree on the tanning beds. I had a critical low vitamin D level, thank you statins, last year. My dh got me a tanning bed fitted with special lights. I used it all winter long and what a difference it made in my life. I did follow the instructions and used it for 15 minutes 3 times a week, never got sunburned and got my vitamin d level closer to normal!
Just another POV.
Ressy, are you referring to the tanning beds that have been formulated to safety? I know there is such a thing-they just haven’t hit most areas yet. If you change a tanning bed ballast from magnetic to electronic, you make the tanning bed as healthy as the sun-provided you don’t ever burn. So if this is what you’re talking about, Ressy, then I totally agree with you!
Natalie—siente mucho, I’m sorry your friend lost her husband. Of course, any type 2 who uses insulin, especially if they use the fast-acting kind, is at risk of a low seizure. That said, T2s seem more resistant to bad lows. Their liver’s seem to work better on that whole glucose loop thing.
On the top end, any T2 who runs high (typically in the 600-800 mg/dL range) for a long period can develop what is called glucose toxicity. Not always, but this generally takes a couple of months to happen. Basically the beta cells freak out and shut down, poisoned by the high levels of sugar. When that happens, they can go DKA. If the DKA is treated in time and the blood sugars are brought under 200 mg/dL, their beta cells will fire up again.
But, of course, you are right. I don’t want our type 2 readers to think they are coma-proof. At the same time, I didn’t want the young man living in fear of it either. He’s on orals and is well controlled. His personal risk is very low, but he should still have a living will.
But thanks for bringing this up, I was so focused on the living will that I understated the risks we all share.