We are honored to publish an interview conducted by the late Elizabeth Nelke Pfeifer, who passed away in September. Elizabeth was a vigorous participant in the diabetes online community, TypeOneGrit, and a friend of ASweetLife.
In this interview, Elizabeth talked to Dr. Ari Brown, a Texas pediatrician who has spoken nationwide on cold and flu prevention and treatment.
The flu in children with diabetes can be particularly troublesome. At a minimum, the flu can make glucose management more challenging as the body’s natural immune response tends to increase insulin resistance and cause rising (and otherwise unpredictable) blood sugars. More serious cases, which may involve dehydration, lack of appetite, and intense fever, can even trigger diabetic ketoacidosis. In flu season, and at earliest sign of infection, it pays to be vigilant.
What are symptoms of flu vs a cold?
Typically, a common cold virus begins with a runny nose, scratchy throat, and cough and maybe a fever. Runny nose and cough can worsen over the next few days and linger for about 7-10 days. If there is a fever, it usually lasts 3-4 days. Influenza virus (aka “the flu”) is usually much more acute and dramatic at its onset with fever (often 102 F or higher), shaking chills, headache, body aches and the feeling like you just want to crawl under the covers and escape life. Occasionally there is vomiting but mostly headache and body aches at the beginning. Runny nose, cough, sore throat come on a little later in the next 24 hours usually. Fever can last up to a week, as can the other miserable symptoms. Contrary to popular belief and name, the “stomach flu” is not THE FLU that we refer to when dealing with the Influenza virus. So, stomach upset—prolonged vomiting and diarrhea is not THE FLU.
How do parents know when to have a child checked for flu?
Because influenza virus shows early during illness (first 48 hours), it can potentially be treated with antiviral medication to lessen the severity and duration of the illness, which is particularly helpful for people with chronic diseases, it is important to see your child’s doctor within 48 hours to be evaluated for flu.
How can we help prevent the spread of the flu?
To proactively prevent the spread of the flu among your family or community, I suggest the following tips:
- Get your flu vaccine every year. Yes, it’s safe. Its effectiveness varies from year to year, but it helps reduce risk of getting the flu. Without the flu vaccine, your protection is 0.
- Wash your hands often, with soap and water for 20 seconds. Use alcohol-based hand gel if that isn’t an option.
- Don’t touch your face! You’d be surprised how many times a day people wipe their eyes, rub their noses, or kids put hands into their mouths. All those places allow germs to be introduced into your body and can lead to infection.
- Disinfect surfaces with a reliable product. Germs spread person to person, but germs also live for hours on hard surfaces like toys, doorknobs, countertops and shopping carts.
Blood glucose often goes up during an illness. Does the flu typically cause blood glucose changes? At what level of BG should the parent of a T1 child seek emergency medical care?
Any infectious disease can alter blood sugar levels as well as a person’s food and liquid intake, so anytime your diabetic child has a significant infection, he or she should be evaluated.
What other symptoms of the flu can be problematic for a child with T1D? Are there other flu symptoms that should prompt seeking emergency care even if blood glucose is in range?
Flu can cause high fever, which requires increased hydration,and can cause sore throat. This impacts the desire to eat or drink, which can be problematic for a T1D child.
Other worrisome symptoms to seek medical attention for are diminished urination (less than every 8 hours) or labored/shallow breathing, confusion or disorientation.
What are some comfort measures parents can take to help a child with the flu, that will not further raise blood glucose in a child with T1D?
Try to get your child to eat and drink normally. Electrolytes and hydration are critical to maintain when a child is running a high fever. For additional advice, I suggest consulting an endocrinologist.
Are there any prescription or OTC medications or supplies that the parent of a T1D child should have on hand during flu season? Should parents use any OTC flu products if their T1D child is diagnosed?
You can stop the spread by killing germs with disinfecting wipes. (I wipe my desk with a disinfectant wipe every day before I leave my office!) Disinfecting surfaces is a crucial step to cold and flu prevention.
Additionally, fever reducers/pain medication such as ibuprofen and acetaminophen help alleviate symptoms like body aches, headaches and fever. Saline nose drops, humidifiers and taking a nice, steamy shower also help. I don’t typically recommend cough and cold remedies for any patients with or without DM—and they lack FDA approval for kids under age 6.
