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Dr. Bill's Commentaries

Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

People with Diabetes Should Get Flu Shots   (December 9, 2012)

As can be expected every autumn, the flu is here again. According to the Centers for Disease Control and Prevention, influenza activity in the United States is continuing to increase; current surveillance data indicates that the influenza season is getting started early. For better or for worse, the data doesn’t yet provide any information that will be able to judge how severe this year’s flu season will be. This past week, eight states reported widespread influenza activity (Alabama, Alaska, Mississippi, New York, North Carolina, Ohio, Rhode Island and South Carolina), and four states (Alabama, Louisiana, Mississippi, and Texas) reported high flu-like illness levels. These numbers will increase over the coming weeks, so be prepared for the flu.

And for people with diabetes, the flu can be deadly. The CDC states that people with diabetes are three times more likely to die from flu complications than people without diabetes, and that death rates from pneumonia and influenza among African-Americans with diabetes are double the death rates among whites with diabetes.

The CDC’s website has several webpages with information about the flu for people with diabetes:

Diabetes & Flu: What You Need to Know and Do

Diabetes & the Flu

Flu and People with Diabetes

Protect Yourself from Influenza (The Flu)

There’s a lot to digest, so I’ll summarize some of the highlights from these webpages here.

To start with, everyone should

  1. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
  2. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
  3. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
  4. Clean your hands. Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.
  5. Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
  6. Practice other good health habits: Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. And quit smoking.

It’s widely accepted that getting an influenza vaccination or “flu shot” is the best way to prevent getting flu. The flu shot is an inactivated vaccine (that is, it contains killed virus) that is given with a needle, usually in the upper arm. This kind of flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions including diabetes. There are three different variants of these flu shots available: a regular flu shot approved for people ages 6 months and older; a high-dose flu shot approved for people 65 and older, and an intradermal (into the skin) flu shot approved for people 18 to 64 years of age.

There is also a flu vaccine that is given as a nasal spray, brand name FluMist®, which is made with live weakened flu viruses (which do not cause the flu). This version is approved for use in healthy people between the ages of 2 and 49 who are not pregnant. (The CDC isn’t terribly clear on what they mean by “healthy” – saying “Healthy indicates persons who do not have an underlying medical condition that predisposes them to influenza complications”; the FluMist website says to tell your physician if you are  “currently wheezing; have a history of wheezing if under 5 years old; have had Guillain-Barrè syndrome; have a weakened immune system or live with someone who has a severely weakened immune system; have problems with your heart, kidneys, or lungs; have diabetes; are pregnant or nursing; or are taking Tamiflu®, Relenza®, amantadine, or rimantadine.” The label for FluMist also indicates it should not be used if there is a “severe allergic reaction (e.g., anaphylaxis) to any component of FluMist, including egg protein, gentamicin, gelatin, and arginine, or after a previous dose of any influenza vaccine”, or if there’s “concomitant aspirin therapy in children and adolescents” through 17 years of age.)

There also are  antiviral drugs that can be used to treat and prevent the flu.

If you have diabetes, even if your blood sugars are in good control, and are sick with flu-like illness, the CDC suggests that you should follow these additional steps:

  • Be sure to continue taking your diabetes pills or insulin. Don’t stop taking them even if you can’t eat. Your health care provider may even advise you to take more insulin during sickness.
  • Test your blood glucose every four hours, and keep track of the results.
  • Drink extra (calorie-free) liquids, and try to eat as you normally would. If you can’t, try to have soft foods and liquids containing the equivalent amount of carbohydrates that you usually consume.
  • Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.
  • Check your temperature every morning and evening. A fever may be a sign of infection.
  • Call your health care provider or go to an emergency room if any of the following happen to you:
    • You feel too sick to eat normally and are unable to keep down food for more than 6 hours.
    • You're having severe diarrhea.
    • You lose 5 pounds or more.
    • Your temperature is over 101 degrees F.
    • Your blood glucose is lower than 60 mg/dL or remains over 300 mg/dL.
    • You have moderate or large amounts of ketones in your urine.
    • You're having trouble breathing.
    • You feel sleepy or can't think clearly.

To wrap up: If you haven’t done so already, get a flu shot. I’ve gotten mine, and now it’s your turn!

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