Every time fall comes around I hear people debating:
“Should I get the flu shot?”
“Should I vaccinate my kids?”
I’m always surprised to hear just how hesitant people are to vaccinate. This year—with unprecedented focus on viral infections—many of my patients will thankfully be more eager to vaccinate than ever before. But others might be more suspicious.
How will the COVID-19 pandemic change this year’s flu season? Flu season is unpredictable at the best of times, and this year an extra measure of uncertainty means that nobody really knows. Some experts expect that all of our new behavior—socially distancing, masking, working from home—will combine to make this an unusually mild flu season. Others have warned that a possible rise in seasonal influenza combined with a cold-season resurgence of COVID-19 could create a “perfect storm” of disease conditions, in which hospitals are overstrained and many find themselves infected with both viruses simultaneously. Whichever comes to pass, experts on both sides of the matter agree unanimously: you should get a flu shot.
This advice is even more important for people with diabetes. The flu poses a much bigger threat to people with diabetes than to people without it. If you have diabetes, or care for somebody that does, you shouldn’t take the chance that you’ll be lucky enough to avoid the flu.
The flu is a highly infectious and serious viral respiratory infection. Many viruses can give you the sniffles, but the flu actually knocks you out. Flu symptoms can be quite severe and prolonged. In addition, bacterial infections (superinfections) can occur on top of the flu infection—those are situations which can truly overwhelm the lungs.
Everything about the flu is worse with diabetes. Once a patient has the flu, his or her body is stressed, and it becomes much more difficult to control blood sugar levels. Often patients need to increase their insulin doses, or if they are not on insulin they might need to increase their medication or temporarily be on insulin in order to keep blood sugar controlled. People with diabetes also have a tendency to get dehydrated.
When blood sugar levels are elevated, especially above 200mg/dL, the immune cells do not work as efficiently and therefore patients with diabetes may have abnormalities in immune function. Studies have shown that diabetics are sick longer with the flu, have a higher chance of ending up in the hospital, and even an increased risk of death. This is particularly true for patients who have diabetes complications, such as heart disease or kidney disease.
Fortunately, there is sufficient evidence to show that people with diabetes generally have appropriate immune responses to the influenza vaccination. Getting the vaccination is effective in reducing complications of influenza, reducing hospital admissions during influenza epidemics, and even in decreasing the number of deaths.
People’s main concern with the influenza vaccine tends to be that the injection will actually give them the flu. This is not true. While the vaccine can cause soreness or redness at the site of the shot, pains in the joints, and even mild fever, it is nothing like the flu itself. (One good excuse not to get vaccinated is if you have an egg allergy, in which case the vaccine is contraindicated, since the vaccine is developed in eggs.)
We have the tools to prevent influenza. We just have to make sure that the millions of people with diabetes are educated about the risks that influenza poses and encourage them to get a flu shot. It should be a matter of routine every fall. The coronavirus pandemic doesn’t change this reality in the slightest.