Ask D’Mine: Tattoo Risks, and Those Crazy Canadians

Happy Saturday! Welcome back to Ask D’Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil offers thoughts on the risks people with diabetes (PWD) face when getting ink, and those international differences we see in glucometer result numbers!

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 
Jessica, type 1 from Georgia, asks: Am I risking life and limb by getting a tattoo and taking insulin?

Wil@Ask D’Mine answers: Getting a tattoo nowadays isn’t risking life and limb, but in some cases might be risking limb. Read on.

Here’s the thing: What’s a tattoo? Well, in the most basic terms, it involves tearing the shit out of your skin and stuffing ink particles into the wound. Therein lies the theoretical risk. A tattoo is a wound. A self-inflicted injury, to be sure, but a wound nonetheless.

Trivia question for the day: do PWDs have a hard time healing when wounded?

You bet your sweet tattooed ass, we do. Sometimes. Of course, how well we heal depends on how well our blood sugar is contained (right now I’ve banished “controlled” from my diabetes vocabulary). If your blood sugar levels are pretty close to normal, you’ll heal pretty much like anyone else, and getting a tattoo really isn’t an issue. If your blood sugar is crazy high, you won’t heal well, the wound might get infected and will both mar the design by scarring and maybe lead to the classic infection, ulcer, gangrene, and amputation thing. Insulin has nothing to do with it—it’s all about the sugar.

So the first thing you need to do before getting a tattoo is to be honest with yourself about how contained your diabetes is. The higher your A1C, the worse you will heal, and thus the higher the risk that getting inked is gonna result in a bad outcome.

But how high is too high, and how low is low enough?

Taking a page from a field of medicine, where do surgeons want us at before slicing us open? Well, beyond the fact that everyone agrees that cutting on someone with an A1C above 9.0% is a bad idea, there are no universal guidelines; but most surgeons don’t like to preform elective surgery on PWDs with A1Cs above 7.5, with many wanting scores as low as 6.5. Of course surgeons live in fear of getting sued. So we have to take that into account.

I generally tell my patients wanting tattoos that they need to be under 7.0 to be on the safe side. But there are other factors to consider. How long have you had diabetes? The longer you’ve had it, in general, the slower you will heal. Especially in the extremities. Which leads me to…

Where on your body do you want to get a tattoo? An ankle tattoo might give a veteran PWD more trouble than one on the shoulder. Which then leads me to…

How large is the design? A big frickin’ full-sleeve job is riskier than a cute little inch-high Pooh Bear tattoo. And no, I don’t have an inch-high Pooh Bear tattoo.

And then there’s one other important consideration, which has nothing to do with diabetes at all, and that’s the charmingly named blood-borne pathogens. Hey, all kinds of creepy crap can live in blood, and you sure as hell don’t want to pick up someone else’s creepy crap when getting a tat. So, here are Wil’s Medical Rules for hepatitis and HIV-free tattoos: Make sure your tattoo artist autoclaves his gun and ink pots and uses a fresh factory-sealed tattoo needle just for you. But wait, I’m not done yet, because we need to talk about Wil’s General Rules for tattoos: Find an inker with artistic talent, don’t put a lover’s name on your body, and never get a tattoo while drunk. I’ll leave it up to you to decide if my General Rules came from reasoned common sense or unfortunate personal experiences.

Oh, and one last thing. Don’t forget Wil’s Mom’s Rules for tattoos in general: Never get a tattoo anywhere on your body that you can’t cover up easily if you need some help from Mom, or a bank loan, or get subpoenaed to testify before Congress. Hey, it could happen.

Disclaimer: I have tattoos. Some were from my previous life (before diabetes), and others since.

Glenda, type 2 from Vermont, writes: I was visiting my cousin in Canada, and she has diabetes too. It so happens we both have the same make and model of meters, and one morning we were both doing a fingerstick and she had a crazy low number. I thought she was going hypo, but she said it was normal! It turns out my USA meter gives blood sugar in mg/dL and hers in mmo/L, and the results couldn’t look more different. What’s up with that?

Wil@Ask D’Mine answers: Meters speak two languages. In the vast majority of the world, blood glucose is recorded in mmol/L which stands for millimole per liter. Here in the USA we use mg/dL, which stands for milligrams per deciliter.

In science there are two ways of looking at concentrations of anything: by weight or by molecular count. Weights are in grams, and molecular counts in moles (not to be mistaken with small sight-impaired burrowing mammals). So mg/dL is a measure of weight, while mmol/L is a measure of molecular concentration.

Why are we in the States weighing sugar while the rest of the world is counting its molecules?

Once upon a time, back in the 1960s, most of the civilized countries of the world realized that everyone would benefit from a global standard when it came to measuring stuff. And so was born Le Système international d’unités (or SI for short), an international agreement about how to measure anything that can be measured, and get everyone on the same page with a system of units to do just that (commonly known as the metric system). The result was an international treaty to standardize measurement world-wide. Fifty-six nations signed.

The USA wasn’t one of them.

Along with Burma and Liberia, we haven’t adopted the global SI system. I swear, there are days when it can be embarrassing to be a U.S. citizen. And I’m sure the citizens of Burma and Liberia feel exactly the same way.

Why haven’t we joined? Lord only knows. I looked and looked, and couldn’t really find a good explanation anywhere. It’s probably related to the assorted aborted attempts to establish the entire metric system here.

But you’re right, to those of us in the USA, who are used to thinking in ranges that have 300 or more “points,” the system in the rest of the world seems impossibly low, impossibly narrow, and even more impossible to grasp. For instance our 100mg/dL equals 5.6 mmol/L. Our 300 equals their 16.7.

It all sounds so weird… but I suppose you can get used to anything in time. And speaking of time, just when will the USA join the rest of the world?

I wouldn’t hold my breath for too many millimoles if I were you.
 

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.