Got diabetes? Need advice? Of course you do! And you came to the right place: Ask D'Mine, our weekly Q&A column hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico. Earlier this summer, Wil tackled a question about those pesky mosquitoes that seem to target those of us with diabetes so frequently.

And today, Wil's got some insight on another breed of hot-weather bug that's in the news these days: Ticks. Yep, for pets and people with diabetes, there is some important info you should know, and Wil's scratching that itch this Labor Day Weekend -- a time when many are officially saying goodbye to summer with outdoor activities...

{Have diabetes questions of your own? Email us at}


Fred, diabetes dad from Colorado, writes: Autumn is my favorite time of year to be in the great outdoors, and we’ve got a campout planned for the long weekend. But I’ve read ticks are, pardon the pun, on the uptick. Any special worries around ticks and our seven-year-old type 1 son?

Wil@Ask D’Mine answers: Ahhh… Labor Day weekend. An extra day for the working man (and woman) to chill with family and forget all cares. Like you, many thousands will flock to the great outdoors for cookouts and campouts.

But you are right, the outdoors will be waiting to flock back. Yeah, those creepiest of the creepy crawlies, ticks (shudder), are on the upswing. There are more of them. They are expanding their ranges. And brand-new types are even showing up. How does all of that affect us with sweet blood?

Well, I have mixed news about the impact of ticks on PWDs (people with diabetes), but before we can get to that, we need a tick primer so everyone can understand what makes ticks, well, tick. 

Unlike mosquitoes, which we talked about a while back, ticks really are vampires, which is to say they live on people’s blood. Mosquitoes, by contrast just need to borrow some blood. Females need extra protein to help produce thier eggs, but otherwise they live on flower nectar, like humming birds. But the damn blood-sucking ticks are treating us mammals like the drive-up window at a fast food joint.

Ticks are actually part of the spider family, and while there are more than 800 species on the planet, they come in two broad varieties: Soft ticks and hard-shell ticks. Both types will be happy to suck your blood, but hard ticks are the biggest issue for us humans. The little bastards live a complex life cycle, which we have to talk about for a second, because it explains why they are the second-largest disease vector for humans. BTW, vector is a term for something like an epidemiology FedEx truck. Well, its biological equivalent. Officially, the definition of vector is “any agent that carries and transmits an infectious pathogen into another living organism.” Simply put, a carrier of disease. 

What makes ticks such huge carriers of disease is that they aren’t monogamous, and we all know the more you sleep around, the more likely you’ll catch a social disease, and the more likely you’ll pass it along to someone else, becoming yourself, a vector. (Come on, you knew I’d find a way to bring sex into this, even though we are talking about creepy blood-sucking spider cousins). Here’s how it works, ticks have a four-stage lifecycle: Egg, larva—which interestingly only have six legs—nymph, and adult. After hatching, all the stages are blood-eaters. Working through all the stages is a three-year process, Methuselahistic compared to the 10-day mosquito lifecycle. Apparently, during this time they attach to many, many, many hosts. Once a tick latches on, and its saliva has an anesthetic so that you don’t feel the bite, it can sip your blood for days.

So like I said above, if you sleep with a lot of people, you’re likely to catch something. Likewise, if you are a tick and you bite a lot of people, you’re also likely to catch something. Of course, the diseases transmitted by vectors rarely affect the vector, which means it can keep on spreading disease, as the disease won’t kill the little sucker. When feeding, ticks ingest any pathogen the host has. But like toddlers with soda bottles, they are sloppy drinkers, so there’s a lot of back wash into the host’s blood stream. I think you get the picture.

As they move from host to host, ticks spread diseases. At least 16 of them, many deadly serious, including: Lyme disease, Rocky Mountain spotted fever, and Ehrlichiosis. Interestingly, one tick bite can deliver multiple pathogen types including bacteria, spirochetes, rickettsiae, protozoa, viruses, nematodes, and toxins -- causing the physician-education site Medscape to point out that the tick shotgun bite is a “phenomenon that has led to atypical presentations of some classic tick-borne diseases.” In other words, docs are left scratching their heads trying to figure out just what the hell is wrong with their tick-bitten patients, who might be suffering from overlapping symptoms from more than one disease.

Just how do ticks find us in the first place? Believe it or not, they have good noses. Or whatever it is that spider-like critters use to smell (actually, in the case of ticks, they smell through Haller’s organs in their front legs). Ticks find hosts primarily by breath and body odor, and also by sensing body heat, moisture, and by vibrations.

Tread softly in the forest.

Of course, ticks aren’t just in forests. Human-biting ticks are found in large numbers outdoors literally everywhere in the country, except Alaska. Here, check out these CDC maps for the ranges of the various common human-sucking ticks. Ready to bail and move to Alaska? Don’t forget that Alaska has epic mosquitoes, so there’s that. Ticks are spreading into new areas as the planet heats up, resulting in more human contact, and a three-fold growth in tick-borne diseases over the last few decades.

After sensing us, ticks wait in ambush, what tick-ologists call “questing.” Using their rear legs, they hold on to the tips of grasses, shrubs, or leaves of trees with their front legs outstretched. When a host brushes by they grab on and climb aboard. 

So what about it, PWDs? Like mosquitoes, do ticks prefer us to our sugar-normal hiking companions? For once, it doesn’t appear so. But that’s simply because of the passive ambush-hunting style of ticks. They perk up when they smell a host, any host, but they don’t have the luxury of being choosy. Anything with blood that’s within reach will do, be it a PWD, a sugar-normal, or the family dog along for the hike. So even if ticks can smell PWDs further away, it doesn’t matter. With the exception of one Asian tick new to the U.S. that can scamper towards a host, most ticks are stuck waiting for the host to come to them.

But we’re not out of the woods yet. 

Once bit, our outcomes are worse than our other camping companions because in general, our immune systems are weaker and less likely to fend off the wide assortment of diseases it’s possible to get from ticks. So for us PWDs, some extra care in avoiding ticks is in order.

OK, how do you avoid the little suckers, you ask? Short of staying inside all your life (which even then is probably no guarantee of safety), when you or your little PWDs are outdoors in grassy, brushy, or wooded areas treat your clothing and gear with products containing 0.5% permethrin, especially your boots, socks, or pantlegs.

WTF is permethrin? It’s a sorta miracle product that’s used both as a medication and an insecticide. It’s even made the World Health Organization’s list of essential medicines. Apparently, it kills ticks on contact, and it’s possible to buy pre-treated outdoor clothing from outfits like Columbia, ExOfficio, L.L.Bean, REI, and the like.

Apparently DEET insect repellents can also keep ticks at bay, along with those containing the substances picaridin, IR3535, para-menthane-diol—known as PMD to its friends—or 2-undecanone. Oh, and the CDC says that Oil of Lemon Eucalyptus is also helpful.

Plus, the simple-minded precaution of staying in the middle of any hiking trail is helpful. If the ticks can’t reach you, they can’t get you. Contrary to myth, ticks don’t jump.

Now, the tick wars don’t end when you get home. It’s more than possible to transplant them from the great outdoors into your bedroom. As soon as you return to the great indoors, throw your outdoor clothes into your clothes dryer on high heat for at least 10 minutes to kill any ticks you’ve hitching a ride on your clothing. Note that ticks will survive the washing machine, but a shower shortly after coming in from the great outdoors can wash un-attached ticks off your bod. 

Lastly, have a partner do a fully body check, or if you are partnerless, use a hand mirror. In your case, Fred, make a careful tick check of your kid. I’m told tick-prone locations are your underarms, in and around the ears (thinner skin), inside your belly button (ick!), behind your knees, in and around your hair, between your legs, and around the waist.

If you find any, don’t believe the old wives’ tales of needing to use a burning match to make the tick let go and back out, painting it with nail polish, or downing it in rubbing alcohol—just use tweezers and pull the little effer out. The head won’t break off. Sometimes the mouthparts will break off, if they do tweezer them out. If you can’t, the body will heal fine and dissolve them.

So there you have it. Thanks probably only to how they hunt, ticks are an equal opportunity scourge. Diabetes, for once, hasn’t painted a giant bull’s eye on our backs. But once bitten, well, that’s a different story. So take precautions, and check carefully for ticks when you return to civilization, and your labors.


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.