Field Notes

Diabetes and the Flu: What You Need to Know

There are certain groups of people who are at risk of serious flu complications each year, including those with diabetes.

Seasonal flu activity can begin as early as October and continue to occur as late as May. Flu cases were reported at the University of Alabama at Birmingham (UAB) as early as September, and now is the time to prepare for the upcoming flu season, says Fernando Ovalle, MD, a professor of medicine in the UAB School of Medicine and senior scientist in the UAB Comprehensive Diabetes Center. “Diabetes can weaken your immune system against the flu, and it also puts you at an increased risk of flu-related complications,” he says. “The weakening of the immune system makes it harder for your body to fight the flu virus. Being sick also can raise your blood glucose and prevent you from eating properly. You are also at risk of flu-related complications like pneumonia.”

Ovalle says there are several steps people with diabetes can take to try to protect themselves from the flu virus:

  • Get a flu vaccine shot vs the nasal spray vaccine, which isn’t safe for people with diabetes.
  • Talk to your health care provider about the pneumococcal vaccine to potentially help protect you against developing pneumonia.
  • Keep track of blood glucose since illness can affect it.
  • Wash your hands often with soap and water or an alcohol-based hand rub.
  • Try to avoid close contact with sick people.
  • Practice good-health habits such as getting plenty of sleep and exercise, managing stress, drinking plenty of fluids, and eating healthful food.

For people with diabetes who think they have the flu, Ovalle suggests doing the following:

  • Contact a health care provider immediately. Flu symptoms include fever or feeling feverish or experiencing chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue. In children, vomiting and diarrhea can be common.
  • Continue taking medications prescribed to treat diabetes.
  • Test blood glucose every four hours and track results.
  • Stay hydrated; drink lots of calorie-free liquids.
  • Try to eat normally.
  • Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.

— Source: University of Alabama at Birmingham


Egg-Allergic Children Now Have No Barriers to Flu Shot

All children should have flu shots, even if they have an egg allergy, and it’s now safe to get them without special precautions. This finding comes from the latest update on the safety of the flu vaccine for allergic patients, published in the October issue of the Annals of Allergy, Asthma and Immunology.

Egg allergy is one of the most common food allergies in children. By the age of 16, about 70% of children outgrow their egg allergy. Most allergic reactions to egg involve the skin. In fact, this allergy is the most common one in babies and young children with eczema.

Further, the flu is responsible for the hospitalization of more than 21,100 children under the age of 5 annually, yet only two-thirds of children receive the vaccination each year. Some go unvaccinated because of egg allergy.

The current recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices is to observe children allergic to eggs for 30 minutes after a flu shot and to have the shot given under the care of a primary care provider (if the reaction to eating eggs is only hives) or an allergist (if the reaction is more serious).

However, “In a large number of research studies published over the last several years, thousands of egg-allergic children, including those with a severe life-threatening reaction to eating eggs, have received injectable influenza vaccine [IIV] as a single dose without a reaction,” says allergist John Kelso, MD, a fellow of the American College of Allergy, Asthma, and Immunology.

This update concludes that, based on the available data, "Special precautions regarding medical setting and waiting periods after administration of IIV to egg-allergic recipients beyond those recommended for any vaccine aren’t warranted. For IIV, language that describes egg-allergic recipients as being at increased risk compared with non–egg-allergic recipients or requiring special precautions should be removed from guidelines and product labeling."

“The benefits of the flu vaccination far outweigh any risk,” Kelso says. “As with any vaccine, all personnel and facilities administering flu shots should have procedures in place for the rare instance of anaphylaxis.”

— Source: American College of Allergy, Asthma, and Immunology