Tattoos and Body Piercings: A Guide for People with Diabetes

The best way to know if it’s safe for you to get a tattoo with diabetes is to see your doctor or healthcare provider. They can review your numbers, draw your A1C, and determine if your diabetes is controlled. If your diabetes is not well controlled, or if your blood pressure is elevated, you should take measures to get both within range prior to getting a tattoo.

After you are evaluated by the healthcare provider and they confirm that your diabetes is under control,you will be given clearance to get a tattoo or a piercing. It will also be a good idea to have the doctor write a note, or even a prescription, in attention of the tattoo parlor or piercing clinic that will be performing the procedure. Normally, a tattoo or piercing establishment will take the word of the client, and the forms that you fill out there should have a question about diabetes, and whether it’s controlled.

Your response should be honest on the form, and if your diabetes is not well-controlled, lying about it could be to your peril. The question is on the form for your own safety, Understand that it is imperative that your diabetes must be controlled, along with your blood pressure, prior to obtaining a piercing or tattoo with diabetes.

Considerations for getting a tattoo or piercing with diabetes

There are many things that your doctor or healthcare provider should consider prior to giving you the ok for the procedure, even with your blood sugar and A1C in your target ranges. If it’s a tattoo, your doctor may want to know its location on your body. Areas farther away from the heart, and areas with poor blood flow are harder to heal, and people with diabetes may have existing compromised circulation in these areas.

If it’s a body piercing, where will it be placed is important to consider. Will gauges be used, or bars that are larger in diameter than the usual size studs commonly used for earrings? Will the procedure involve using a gun to pierce the skin with a small stud, or will it be a more complex procedure that involves puncturing the skin with a large bar, while holding a portion up with surgical tweezers? Will it be a procedure in which a gauge will be inserted into a larger hole made in the skin?

These factors can help your doctor or healthcare provider determine if the procedure is one that you may have trouble healing from afterwards since you have diabetes.

Your healthcare provider should also consider any complications that you have related to your diabetes, especially issues such as diabetic skin conditions, and complications of diabetes related to neuropathies, or nerve damage, or circulation issues such as Peripheral Arterial Disease. The last thing you want as someone with diabetes is to end up losing a limb due to amputation.

Picking your creative design, and making sure you can live with it forever

Tattoos are especially permanent. That’s why you want to really think about it, and weigh whether you might regret it later.

There is no turning back with some of the body piercings either. Often, as you grow and mature as a person, you learn that you may not make the same decisions as you did when you were younger. You may not have the same tastes, or likes, and your body piercing, or tattoo could become one of those things that you regret doing in your life.

To help prevent making unfortunate tattoo or body piercing choices, avoid getting the procedures on a whim, when under the influence of alcohol, drugs, or peer pressure. It’s best to think about these things for a very long time.

As far as for a tattoo design, deciding on a design that you can live with for the rest of your life, and what’s more, like, or even love, for the rest of your life, is no easy task. On top of finding a facility that uses safe, sanitary practices, you also want to use a tattoo artist that is an actual artist.

A piercing clinic performs a sterile invasive procedure of inserting a large piercing bar into the skin.

Have your blood sugar levels controlled before you get a tattoo or body piercing with diabetes

If you are considering a tattoo or body piercing, and you have diabetes, you should make sure that your A1C are withing your target, which for most people is less than 7%. If you manage to keep your blood sugars in a target range everyday, or at least most days, then you can rest assured that your A1C will be low enough to get a tattoo or piercing as well. Still, you must speak with your healthcare provider first, before getting either a tattoo, or a body piercing.

Ensure that the place and the person you are going to see is licensed or accredited

All tattoo parlors and piercing agencies are licensed and accredited by the state in which they provide tattoos and body piercings. Local environmental health agency representatives know how many tattoo and piercing licensed establishments there are in their county or locale. In our county, there is one inspector in the county Environmental Health office who is trained to conduct inspections, and provide sanitation and safety ratings for tattoo and piercing merchants who are licensed by the state.

They go around, and check each facility for sanitation and safety, ensuring that they follow state guidelines for licensure of tattoo parlors and body piercing establishments. They will issue a grade from A through F, like the grades given to restaurants. These are the types of tattoo parlors and body piercing facilities that you want to look for. Look for those with an “A” rating, and never get a tattoo or a body piercing from someone who is not licensed by the state, and has received an “A” rating.

Looking out for the ratings of tattoo parlors and body piercing facilities can help to ensure that you find one where safe practices when performing the procedure have been demonstrated. They have been trained, and they know what the state guidelines for tattoos and body piercings are. Beware of the do-it-yourself home-based tattoo “artists,” who think that they don’t have to play by the rules.

Not only can they give you a tattoo that looks unprofessionally done, but they can give you Hepatitis C, Hepatitis B, and HIV from the use of non-sterile equipment, and the re-use of needles from patient to patient. These home tattoo “artists” may also lack an autoclave to use on their equipment between customers.

If they aren’t playing by the rules, then don’t try them out. When you have diabetes, you must make sure that whomever you use for tattoo or body piercing services is a quality provider. It can be the difference between having a great procedure with no complications, and having an infection that progresses to a more serious issue.

Let the artist know of your diabetes so they can give you personalized aftercare information

You must be 18 years old to consent to get a tattoo. From a study of teenagers from age 11-18, where eight percent of them had tattoos, and 27 percent of them had body piercings, it can only be concluded that their parents must have signed for them to get their first adolescent or teenage “tats.”

When you go into a facility for a procedure, you will be given a consent form for the procedure, where you will be releasing the tattoo parlor or piercing establishment from any problems you may encounter related to being tattooed or pierced in the after-care phase. It is on this form that they will ask if you have diabetes, and if it is well controlled.

As said, be honest. If your A1C is a 9%, they will likely not let you get the tattoo or piercing, but that’s ok! You shouldn’t get it if your A1C is much higher than 7%, and your blood sugars have been out of your target ranges. Work on getting your blood sugars in to your target range, and your A1C down so that you can revisit the idea of getting a tattoo or body piercing. Remember, better safe than sorry later.

You also want to let the tattoo artist know that you have diabetes so that they can tailor your after care to be extra vigilant against infection. Tattoo artists and body piercing professionals who are licensed are trained to understand about diabetes and the risk of infection. They also should know what the signs of a low blood sugar are, and how to treat one.

Risks and Safety warnings

It's a good idea to talk to the person performing your procedure, and make sure that they know what to look for if you were to start having a low or high blood sugar during the procedure.

Risk of experiencing low blood sugar during a tattoo or body piercing procedure

Prior to the procedure, discuss low and high blood sugar symptoms. Talk to the tattoo parlor owner or the person doing your tattoo, or to the body piercing professional, and make sure that they understand what could happen if you were to have a low blood sugar. Educate them of the signs and symptoms, have your glucometer and supplies close by, and medication if applicable, ready if you need them. Keep a 15-gram carbohydrate options with you as well. Don’t leave them in the car.

Experiencing a high blood sugar during a tattooing or body piercing experience

Getting tattoos and body piercings can be painful. It’s stressful on the body, and it may raise blood sugars. This will be temporary, and usually goes away within a day, but if blood sugars were high upon entering the tattoo parlor or piercing facility, then they could get dangerously high during the procedure.

In this case, you will want to have plenty of water to drink, have your insulin with you if you take extra doses for high blood sugar, and always keep your glucometer and supplies with you. Carry them with you to the facility. Re-educate your tattoo or body piercing professional about the signs and symptoms of low and high blood sugar in case they need a refresher course.

Make sure the facility uses a new needle just for you, with fresh ink in disposable containers

If it’s a licensed facility, with an “A” rating, you should ge an individual inking needle used only for you, with fresh ink in a disposable container, that won’t have been used on anyone else. This ensures sterility in the procedure, and helps to keep you safe from infections and problems from your tattoo or piercing procedure later.

Autoclave their machines in between customers

All good, reputable and state licensed tattoo and body piercing facilities will have an autoclave machine. This is a machine where they place the instruments to sterilize them between each client getting a tattoo or a body piercing. This is extremely important for infections control. You should look around to gauge the cleanliness of the facility. If it looks dirty on the surface, chances are you might catch an infection by having a procedure there.

Healing may take longer than those with no diabetes

If your blood sugars are not within your target ranges, and your A1C has crept up over 7%, then you could have a tough time healing if you get a tattoo or a body piercing. You could get an infection that could lead to gangrene, and even an amputated limb. That is not a path that you want to be on. That’s why you want to make sure your diabetes is well-controlled, and consult with your doctor or healthcare provider before you have either procedure.

A tattoo for a person without diabetes normally takes about two weeks to heal completely. It can take  person with diabetes up to twice as long to heal after a tattoo or a body piercing. Body piercings may in fact take much longer to heal if they are extremely invasive, such as with large piercing bars.

Don’t get tattoos or body piercings if you have skin conditions related to your diabetes

If you have any kind of diabetic skin condition, or breaks in your skin near the area where you plan to have the tattoo placed, or where you plan to have the piercing, then you shouldn’t get either procedure. People with diabetes can have a variety of skin infections, including:

• Eyelid infections (sties)
• Boils and carbuncles (deep infection of tissues underneath skin)
• Infection of hair follicles (folliculitis)
• Fungal infections around nail beds of fingers and toes (Candida Albicans, or yeast)
• Staphylococcus infections
• Yeast infections in skin folds where moisture lies (jock itch in men), and on feet (athlete’s foot)
• Ringworm (fungus of itchy, ring-like patch of skin
• Itching due to dry skin from diabetes, due to dehydration from high blood sugars or poor circulation (if due to circulation, itching may be on the lower extremities)
• Vaginal internal, and external yeast infection in women
• Yeast infection of mucous membranes of mouth, and skin (corners of the mouth are dry, cracked)

The best way to take care of your skin if your have diabetes, and to prevent diabetes-related skin infections, is to practice good skin care. You should avoid taking prolonged baths in dry weather, and use a mild soap. Apply a non-alcohol lotion to your skin, but not between your toes. Some good ones for diabetes are, Gold Bond for Diabetes, Destin for Diabetes, and Udderly Smooth.

Some of the diabetes skin infections that may be a reason not to get a tattoo or a body piercing are:

• Diabetic dermopathy – this is light brown and scaly looking skin patches that are due to changes in the working of smaller blood vessels that go to the fingers and toes, and to outer layers of skin all over the body.
• Allergic reactions – allergic reactions can develop to diabetes medications, or to other medications, which may cause skin reactions, such as rashes, or even hives, and closing up of the throat
• Eruptive Xanthomatosis – these are about 1-2-centimeter yellow enlargements on the skin that can itch, and have a red center on the hands, arms, feet, legs, and buttock area (seen in Type 1 young men with high cholesterol)
• Acanthosis Nigricans – these are dark spots on the neck, groin, or armpits, or the hands, elbows, knees (most often seen in dark skinned people, i.e.: African Americans)
• Bullosis Diabeticorum – this condition is an eruption of blisters on extremities, and can occur with people with nerve damage, or neuropathies related to diabetes
• Digital Sclerosis – thick skin on the back of the hand thickens, making it hard to move joints. It can occur in other areas of the body, and can occur in one third of T1Ds which are uncontrolled
• Necrobiosis Lipoidica Diabeticorum is caused by changes in blood vessels similar to diabetic dermopathy, with similar looking spots (there are fewer spots, they are larger, and they may reach deeper under the skin than diabetic dermopathies)
• Disseminated Granuloma Annulare are raised areas on the skin that are reddish brown, or skin colored, and occur distally, far from the heart, sometimes on fingers, toes, or ears ³

Placement

Placement of tattoos or body piercings are also important for people with diabetes. Tattoos and body piercings are available in just about any size, and for any part of the body, literally. If you have diabetes, though, there are certain body parts that are better left un-inked. These areas can be prone to poor circulation and nerve damage from diabetes, especially uncontrolled diabetes.

Avoid areas that have poor circulation

People with both Type 1 and Type 2 Diabetes should avoid tattoos and body piercings in the lower legs, and ankle area, and on the feet. Hands and lower arms can also be an area where diabetes can cause circulation to be compromised, and these areas should be avoided.

Anywhere where insulin injections are given should not be used for tattoos or body piercings. This includes the fatty areas on the back of the arms, the fatty areas on the sides of the thighs, and the subcutaneous tissue around the abdominal area, or stomach. Buttocks and shins can also be deficient in circulation if you have diabetes.

After-care

After care is important if you get a tattoo or body piercing, and you have diabetes. It’s important to make sure that you don’t get an infection, and it will help your tattoo or body piercing to heal as it was meant to.

Bleeding may be excess

Following a tattoo or body piercing procedure, depending on the procedure, you may have excessive bleeding.

Scarring

If you are a person prone to keloid development, having a tattoo may cause you to have keloid formation along the ink lines of the tattoo. These will appear as a raised area of skin along the design. Many African-Americans who get tattoos have problems with keloid formation, but it is only a cosmetic problem, and it doesn’t cause other problems other than it being an esthetic issue that distorts the look of the tattoo.

Large piercings can also leave areas of scarring. Repeated piercings in the same ear related to the hole closing can cause scarring, or cause a tear in the ear lobe if the procedure is repeated too many times. Sometimes, piercings that are done with small gauge studs grow back with little or no scarring, but bigger piercing “bars,” and other piercing apparatus (they pierce with just about anything these days), may leave huge scars. Certainly, gauges placed in earlobes will leave disfigurements that may not be something you don’t want to have for the rest of your life.

How to Prevent infected tattoos and body piercings

To prevent an infection, follow all your aftercare instructions as they are given to you. Clean your site as directed, and report any of the signs and symptoms of infection listed below to your doctor.

What to do if you have an infection

Deficient circulation and open skin can lead to an increased incidence of infection in the area where the ink is administered underneath the skin surface, or in areas where piercings procedures are done. You could take a long time to heal if your tattoo gets infected, or if your body piercing doesn’t heal up like it should.

Signs and symptoms of an infected tattoo or body piercing include:

• Weeping at the site of the tattoo that is brown, greenish, purulent or yellow drainage, or any other color than clear
• Redness and swelling at the site of the tattoo or body piercing
• A fever
• Increased pain or throbbing at the site of the tattoo or body piercing
• Increased healing time

If you notice any of the signs and symptoms of an infected tattoo, or if you have questions about how your tattoo is healing, consult with your doctor or healthcare provider. If your tattoo is infected, you will want to start on an antibiotic treatment right away, and not wait. If your doctor orders antibiotics to treat your infection, make sure to take it as directed, and take all the medication until it is gone. This helps prevent the development of super bacteria, that are resistant to current antibiotics available on the market.

Medical alert tattoo

Tattoos can also be used to identify someone with a chronic condition, including those with diabetes, and they may be used to replace Medical Identification bracelets, and other similar jewelry. This is fine to do, if certain precautions related to pre-care, procedural care, and after-care for the person with diabetes receiving the tattoo, are followed.

Generally, a person with diabetes will pick a medical symbol, such as a caduceus, that also displays the name of the type of diabetes that they have. They may also use many different symbols that signify diabetes.

The main thing is that it’s identifiable. It may be a challenge to find an area to place a medical tattoo that will easily be seen and identified by medical personnel, but will not cause problems for the diabetic when getting the procedure, such as in the wrist area.

For example, a medical alert bracelet is most often worn on the right wrist, but this is an area of decreased circulation for a person with diabetes, and therefore shouldn’t be tattooed. On the neck, near the carotid artery, is one place where medical personnel go to check pulse, so this may be one option for placement of a medical ID tattoo.

Placing a tattoo in an area on the chest near the heart may also be an option for people with diabetes wishing to get a permanent medical identification tattoo. Make sure you have a good tattoo artist, with a steady hand. You want the text in your medical identification tattoo to be legible, otherwise medical professionals will have no idea what it means. You will want to use a style of letters that is easily read, and not cursive or script.

Would you have regrets if you got a tattoo or a body piercing?

It’s certainly possible that after getting a tattoo, you may decide that you no longer like the design after many years. Old age mellows, and so really think about it before you commit to it. Getting laser treatments to remove it amounts to a burning off your skin. It costs a lot and  insurance doesn’t cover it because of it’s cosmetic nature.

Is there an alternative to getting a tattoo?

Yes, you could get a temporary tattoo. This allows you to try out different images without having to live with them permanently on your body. If you fall in love with one of them, and you can’t live without it, then you will know you have found the right tattoo design for you.

Is there an alternative to body piercings?

There are clip on earrings, and other clip on mock piercing clips that you can use to simulate the look, if that’s what you are after. ⁴

Are there any other considerations for getting a tattoo or a body piercing with diabetes?

People with Type 1 Diabetes may often be affected by more than one autoimmune disease. If a Type 1 Diabetic has more than one autoimmune disease, then they must be managing all their conditions well prior to obtaining a tattoo or a body piercing. This situation complicates things, and when Type 1 Diabetics have Celiacs, Addison’s, or Grave’s disease on top of Type 1 Diabetes, they should likely see an endocrinologist, and consult with them before having any procedures.

Interesting factoid about tattoos and diabetes

There is something that researchers are working on that may provide a way for people to get “SMART” tattoos. These tattoos will use a special ink with nanoparticles that have tiny LED lights implanted in the skin. These new SMART nanoparticles will be a way to keep track of blood glucose levels. Now if there was ever a reason to get a tattoo with diabetes, that would be the best one.

Over to you

What do you think about our article about getting tattoos and body piercings with diabetes? Have you ever had either procedure done, and had any complications related to your diabetes? Also, please share any comments or thoughts in our comment box below.

TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on May 02, 2020