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Mary Stuhr Diabetes Education Expert
Published By Beth Lueders on November 13, 2018

The world’s more than 425 million people living with diabetes—30.3 million in the United States alone—are at risk for health complications due to their blood sugar disease. Diabetes can cause irreparable harm to the heart, eyes, skin, nerves, blood vessels, feet and kidneys, and in some cases, diabetes can be life-threatening. November 14 is the annual World Diabetes Day when more than 1 billion people in over 160 countries join together to help promote diabetes education, prevention and care. The International Diabetes Federation and the World Health Organization established World Diabetes Day in 1991 to help tide the intensifying rate of diabetes and its health concerns across the planet.

One of the top health risks for diabetics is influenza and its ever-fluctuating flu viruses. Because the U.S. flu season typically starts in October and November and peaks in December through February, people with diabetes are advised to take special precautions during these late fall and winter months. The Centers for Disease Control and Prevention (CDC) reports that flu activity can continue as late as May, and some seasonal flu viruses can thrive year-round. The CDC warns that even people with well-managed diabetes “are at high risk of serious flu complications, which can result in hospitalization and sometimes even death.” These influenza complications include sinus and ear infections; difficulty breathing; inflammation of the heart, brain or muscles; and organ failure, particularly of the kidneys and lungs.

“The flu is challenging for anybody, but it is more so for people with diabetes,” explains Mary Stuhr, a registered dietitian and certified diabetes educator with the Diabetes Education Center of the Midlands in Omaha, Nebraska. “Dehydration, a changed eating schedule and how the body responds to infection can all make the management of blood sugars more difficult.”

The Diabetes Education Center, staffed by registered nurses, registered dietitians and consulting endocrinologists, provides education and empowerment to people with diabetes to better manage their chronic disease. Diabetes weakens the body’s immune system, so contracting the flu makes fighting the respiratory virus even more challenging. When influenza infects a diabetic, blood glucose levels rise in response.

Emergency Warnings Signs of Flu in Adults

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms that improve but then return with fever and worse cough

“Increased blood glucose is an effect of illness,” Stuhr says. “If people aren’t feeling well enough to eat as they normally would, it can make it harder to control or manage their blood sugars. If they have a fever, that actually increases the likelihood of becoming dehydrated, which limits the ability of the body to control blood glucose by flushing it in the urine. If your blood sugars are over 250 mg/dl, your body will be more resistant to your own insulin or the insulin you’re taking by injection, so that is also a concern.”

How Diabetics Can Fight the Flu

Stuhr recommends a number of safeguards for diabetics to counter the flu:

  • Get the flu shot. “The flu vaccine is recommended yearly,” Stuhr states. “Even if people do get the flu, chances are it’s going to be a milder form. Don’t use fear of getting the flu from the vaccine be a barrier to getting the vaccine. Some people develop pneumonia as a result of the flu, so there is a pneumonia vaccine available, too.”
  • Develop a sick-day plan. “Talk with the doctor ahead of time about what medications are OK to take when you’re sick with the flu or a cold, and how to adjust your medications, if necessary,” Stuhr advises. “Also, talk with the doctor regarding when you should be calling them if blood sugars are high.”
  • Check your blood glucose more frequently on sick days. Follow your healthcare provider’s recommendations for treating high and low blood glucose. Checking for ketones is important for those with Type 1 diabetes and people with Type 2 diabetes who are on long-acting and meal insulin therapy. If blood glucose is 250 mg/dl or higher and it’s not coming down with insulin, then do a ketone blood or urine check. If you do detect ketones, call your doctor to discuss next steps. A trip to the emergency room may be indicated.
  • Stay well-hydrated. “Staying hydrated is really important,” says Stuhr. “People with diabetes always wonder if their drinks should be regular or sugar-free. If they’re taking in very little, it might be the appropriate time to have a sweetened drink like a half cup of regular soda, Gatorade® or ginger ale. Generally, we talk about spacing out food, i.e., eating every three or four hours; following your meal plan; and choosing soft, bland foods. But when you’re sick and not eating or drinking much, you need to discuss with your doctor the best intake for you.” A fever, vomiting or diarrhea also can lead to troubling dehydration for diabetics.
  • Take medications on schedule. “What I’ve seen over the years is that people get sick with the flu or something else, and because they’re not eating as much as they normally do, they stop taking their diabetes medication and the blood sugars go even higher,” Stuhr observes. “People assume that if they’re not feeling well and not eating much, they don’t need to check blood sugars, but that is not true. When you are sick, it is still important to take diabetes medications on schedule and to check blood sugars.”

As another flu precautionary, Stuhr directs her diabetic clients to frequently wash their hands and avoid people who are sick. She also reminds those with diabetes to avoid cough syrups with high sugar content and decongestants with ingredients like pseudoephedrine or phenylephrine that can make blood sugars hard to control.

“And the suggestion is if you’re not getting better in 72 hours or are getting worse, or if your blood sugars are greater than 250 mg/dl or you’re having problems with them being too low (70 mg/dl or less) and you’re not able to adjust them, you should call your doctor,” Stuhr counsels. “When you do call, explain what your blood sugar numbers have been, how much you’ve had to eat, what your temperature is, the medications you are actually taking, and how much diarrhea or vomiting you’ve had. All that’s important to share with the doctor.”

Stuhr adds that World Diabetes Day is an opportune time to look into diabetes education programs in local communities because “diabetes education does have a positive effect on people’s health,” not just during flu season but every month, week and day of the year.



Author Beth Lueders

About the Author

An award-winning journalist who has documented stories in nearly 20 countries, Beth Lueders is an author, writer and speaker who frequently reports on diverse topics, including aging and health issues for both U.S. and international corporations.

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