While I can’t comment on the effects of every health condition in connection with getting tattoos, as the mother of a Type 1 diabetic I am (sadly) intimately acquainted with this disease. And since diabetes affects all ages and all walks of life, and there are over 24 million people just in the United States suffering from one form of the illness or another, it’s understandable that a large number of diabetics will eventually find themselves contemplating a tattoo. But is that a good idea? Is it safe for a diabetic to be tattooed?
Type 1 vs. Type 2 Diabetes
First, it’s good to understand the distinction between the two major forms of diabetes— Type 1, which is often referred to as Juvenile Diabetes, and Type 2, which used to be called “Adult Onset” Diabetes. The terms Type 1 and Type 2 are more accurate because sometimes adults can get Type 1, and sometimes kids can get Type 2. And while both forms of the disease have similar symptoms, they are actually very different.
Type 1 diabetes is an auto-immune disease, which basically means that the immune system gets confused and accidentally starts attacking good cells instead of bad ones. In the case of Type 1 diabetes, the body attacks the islet cells of the pancreas, which are responsible for producing insulin. Without insulin, none of us can survive; insulin serves as a key to unlock the sugar in our body and turn it into energy. Without that key, the sugar builds up in the body and becomes toxic. Currently there is no way to prevent Type 1 diabetes, no way to stop it once it has started attacking the pancreas, and no cure. Type 1 diabetics depend on an outside source of insulin to stay alive – many of them take up to eight injections of insulin a day or, as in the case of my daughter, wear a pump that delivers a steady drip of insulin through an IV type tube 24/7. Without insulin, a Type 1 diabetic could go into shock and die within a day or two. Too much insulin and they could go into shock and die within a few hours. Not maintaining a balance whittles away at their overall health bit by bit, eventually leading to more serious problems like neuropathy, kidney failure, blindness, and loss of limb(s).
Type 2 diabetes usually affects adults, because it’s typically the result of years of environmental exposure, bad eating habits, weight gain, and just general aging. It’s often referred to as “Insulin Resistance” because while the pancreas creates insulin just fine, the body doesn’t process it properly. Sometimes it will act like the insulin isn’t even there (resisting), allowing the sugar to build up in the person’s system and make them feel lousy until suddenly a rush of insulin will come to the “rescue” and dump so much at once that their blood sugar drops dramatically, leaving them feeling miserable again. Sometimes Type 2 diabetes can be prevented with good eating habits and exercise; sometimes it can also be reversed the same way after diagnosis. Treatment usually involves taking a pill that gives the body a boost to produce more insulin and process what it makes. If the pill doesn’t work, insulin injections may be necessary. If a Type 2 diabetic doesn’t treat their condition, the body will usually sort things out in the short term, which is why so many go undiagnosed for so long. But in the long term, years of unregulated blood sugar levels lead to serious problems like neuropathy, infection, kidney failure, and loss of limbs. Either way, diabetes is not nice.
But what does any of that have to do with getting a tattoo? Well, understanding the disease and how it affects the body can also help you to understand how other things will affect it as well.
Maintaining a Balance
Maintaining that happy medium between too little and too much insulin is a constant struggle for every diabetic. Little things that most of us take for granted—having a cold or playing a game of one-on-one with a friend—can send their blood glucose levels skyrocketing or plummeting without warning. Diabetics may check their blood glucose levels eight times or more a day, because that’s the only way they can know what’s going on and correct a problem that might be developing. Special supplies have to be packed before taking a hike or even going to the grocery store, to be sure that all possible emergencies can be averted or remedied. Regular visits to an endocrinologist or diabetes specialist (3-4 times a year) for A1C testing are also essential.
Needless to say, managing one’s diabetes requires almost an aggressive level of diligence, and not all diabetics are willing to put forth the effort needed to maintain that balance. When that happens, their body experiences a roller-coaster of highs and lows, and it’s the highs that slowly but surely destroy the nervous system and kidneys. The damage that is done isn’t reversible, and it is cumulative, so the more highs a diabetic has and doesn’t correct, the more lasting harm it does. That’s when it starts to interfere with their immune system and their ability to heal.
In addition to neuropathy induced by high glucose levels, diabetics often suffer from arterial hardening, which slows down circulation. The lack of blood and oxygen flow makes it very difficult for the body to heal, especially in the lower extremities of the body such as legs and feet. Add high cholesterol and high blood pressure to the mix (as is often seen in Type 2 diabetics) and a simple cut could turn into a life-threatening infection.
With Type 1 diabetics, the additional risk is whether or not they have other medical conditions besides diabetes. Since it’s an autoimmune disease, Type 1’s can sometimes be afflicted by additional autoimmune disorders such as Celiac, Graves Disease, Addison’s, and Vitiligo. If a Type 1 is battling more than one autoimmune disease, it’s just as important that they’re treating and managing those problems, too.
So, it comes down to this: if a diabetic wants a tattoo, they’ve got to be fastidious about their disease management and have good control over their blood glucose levels. Otherwise, a tattoo could be downright dangerous. So, what determines whether or not a diabetic has control? The hemoglobin A1C test is the most important tool to knowing how well one’s diabetes is being managed.
A1C is glucose “infused” hemoglobin, which is a protein inside your red blood cells that’s responsible for carrying oxygen from your lungs to the rest of your body. If a person’s blood sugar is high, the excess sugar attaches itself to the hemoglobin. The fusion created is permanent for the life span of the red blood cell, which is typically around 120 days. Scientists have discovered that testing a person’s A1C level, or how much glucose has been bound to the hemoglobin, gives them a pretty accurate report of a patient’s average glucose levels over the past 90-120 days. That’s why it’s so important for every diabetic to have an A1C test every 3 months.
The reason this is important if a diabetic wants a tattoo is because the A1C test result is the best indicator of how well that person is managing their diabetes. A non-diabetic human’s A1C is typically between four and six percent. A diabetic with excellent control of their blood glucose may actually manage to get inside that range, but it’s extremely difficult. The goal of most diabetes patients is to remain under 7%. Eight and nine percent are mid-to-high ranges that indicate a significant number of high blood sugar numbers. Ten percent and over is considered badly controlled diabetes or could also be a newly diagnosed patient; it takes a while to get the numbers down.
If a diabetic wants a tattoo and their last two to three A1C tests were under 8%, and they don’t already have neurological problems, heart disease, or kidney damage, getting a tattoo should be safe. They just need to keep it clean and continue to keep their blood glucose levels in range. Their body shouldn’t have any trouble healing the tattoo as long as they take good care of it.
However, if a diabetic wants a tattoo and their last few A1Cs were 9% or over, or if they’re already experiencing neuropathy and circulation issues or kidney problems, getting a tattoo could literally put their lives in danger. If the tattoo can’t heal quickly, it becomes a playground for bacteria which leads to infection, which can in turn lead to gangrene and even heart disease. This is not something that should be taken lightly—if you’re a diabetic and you don’t have your sugar under control, do not get a tattoo. It’s just not worth losing your leg or your life over!
What the Artist Needs to Know
If you’re a tattoo artist and you know a client is diabetic, I suppose the responsibility is theirs to decide if this is a wise idea or not. You can’t grill them about their A1C results, but you might want to inform them that mismanaged diabetes and tattoos don’t go well together. But in most cases, you probably won’t even know your client is diabetic. They don’t look any different unless you happen to see them checking their sugar or dialing in an insulin dosage on their pump. Many with uncontrolled diabetes may sit in your chair and you’ll never know it unless they come back two weeks later, trying to blame you for the infection they got. I think this is just one of many reasons that every client sheet should have a medical disclaimer.
But if a client tells you that they’re diabetic and asks if it’s still okay for them to get a tattoo, that’s where this information will come in handy. You can share with them what you’ve learned here, and it never hurts to suggest that they get an official “okay” from their diabetes doctor. And I would add to their client sheet that you discussed the risks with them and they accept responsibility for their decision. It’s important that you protect yourself from liability if a client gets sick from a tattoo when they have a pre-existing condition.
Before beginning the actual tattoo, especially if it's going to be a large one, the client should check their blood glucose level and then continue to check once every hour or so. The strain that getting tattooed puts on the body can be even worse for a diabetic, and the last thing either of you wants is for them to have a seizure in the middle of a tattoo. Monitoring blood sugar levels is the best way to prevent that from happening.
Diabetic Seizures & What to Do
Diabetic seizures look a lot like epileptic grand mal seizures, but they're a lot more serious because they're caused by severely low blood glucose, which can be life threatening. An epileptic will usually come out a seizure without the need for medical intervention and be just fine. A diabetic, on the other hand, needs medical help and fast after a seizure in order to raise their blood glucose before their body starts to shut down. If a client has a seizure in your shop, it can be pretty scary, but knowing what to do can help.
If a diabetic is having a seizure, there are certain things that people who are close to them have probably been trained to do in the case of emergency, such as administering an emergency Glucagon injection, which causes a fast glucose spike. I wouldn't recommend anyone who hasn't been trained to try this, even if they know that the person carries one on them, and it could become a libel issue against the artist and/or tattoo shop for making a medical diagnosis and treating a medical condition without a license. But if the client has a friend there that knows what to do, back away and let them take control. However, if you're on your own when it happens, help them to the floor as gently as you can and hold them as still as you can until the seizure is over, keeping their head from hitting the ground. If it's possible, you can try to get them to drink some juice or soda while they're seizing, but that's easier said than done (and could again be considered "illegal" in some areas for you to make a medical diagnosis and treat it, even with something as benign as juice, because if for some reason the seizure is not due to low blood glucose, the extra sugar could actually make the problem worse). Once the seizure has stopped, they will likely be unconscious. Put something soft under their head while you call 911, or have someone else call 911 for you so you can support their head in case they start to seize again. Do not give them any candy, as they will likely choke on it, and keep their head turned sideways on the floor in case they vomit, which doesn't usually happen but it's better to be safe than sorry.
The Bottom Line
Diabetes may not be the worst disease out there, but it's still very serious and wrought with complications. If you're in doubt as to whether or not you should get a tattoo, talk to your doctor. If you're in doubt whether you should tattoo someone you know is diabetic, it might be better to walk away from the money in order to save a potential client from harm.