Diabetes and the Flu: A Dangerous Duo
Help keep patients with diabetes healthy this flu season with a few of these quick reminders on vaccination, medication, comorbidities, and more.
This slideshow has been adapted for Patient Care Online from its original publication on our sister site, Endocrinology Network.
The Flu and Diabetes. Over 30 million people in the US have diabetes and these patients are at a 6 times increased risk for flu-related hospitalization.1 Secondary infections such as pneumonia, bronchitis, and sinus infections are a serious issue for patients with diabetes who are infected with influenza.2 Flu infection may also cause blood glucose levels to decrease putting patients at risk for hypoglycemia.
Diabetes Comorbidities and the Flu. Many patients with diabetes suffer from related comorbidities such as heart disease. People with diabetes and congestive heart failure or cardiomyopathy on diuretic therapy are at higher risk for dehydration during the flu. Weakness and dehydration can also put diabetic patients with peripheral neuropathy at high risk for falls during flu infection.
Flu and Diabetes Management. Severe myalgia and fever linked to influenza can be debilitating making it difficult for patients to perform daily routines. Physicians should reinforce to patients the importance of continuing to manage diabetes while sick to avoid potential hospitalization. Also, staying hydrated and avoiding hypoglycemia are key; consuming ~50 g of carbohydrates every 4 to 6 hours and drinking 8 oz of fluid/hour are good strategies.
Diabetes, Medications, and Flu. The risk for complications with some diabetes medication can be higher during influenza infection. SGLT2 inhibitors may put patients at risk for diabetic ketoacidosis when the flu dulls appetite and thirst; taking NSAIDs without caution may lead to drops in blood glucose when patients with diabetes are not eating and drinking normally. It is suggested that patients try to eat small frequent meals to avoid these complications.
OTC Remedies and Diabetes. Many patients take OTC medications to alleviate flu symptoms without knowing their ingredients. Many cough and cold medications contain enough sugar and alcohol to impact blood glucose levels. Multi-symptom remedies can be dangerous as well if labels are not read carefully to note all ingredients. Patients with diabetes should talk to their CDE or pharmacist before self-prescribing anything for flu symptoms.
Final Thoughts: Diabetes and Flu. Patients with diabetes should continue to check their blood sugar and treat their diabetes “as usual” when they have the flu, remembering to consistently wash their hands. When in doubt, patients or caregivers should consult an expert about the flu, medications, and their diabetes. When self-prescribing remedies for flu symptoms, patients should proceed with caution and pay particular attention to ingredients and possible interactions with blood sugar and diabetes medication. It is essential that patients with diabetes stay updated on recommended vaccines including influenza, pneumonia, and shingles.
References:
1. National Foundation for Infectious Diseases. Call to Action: The Dangers of Influenza and Benefits of Vaccination in Adults with Chronic Health Conditions. http://www.nfid.org/idinfo/influenza/cta-dangers-of-influenza-in-adults-with-chronic-health-c.pdf. Published September 2018. Accessed September 6, 2019.
2. Centers for Disease Control and Prevention. Flu and People with Diabetes. https://www.cdc.gov/flu/highrisk/diabetes.htm. Updated February 5, 2019. Accessed September 6, 2019.
Flu season is quickly approaching and patients with diabetes are at particular high risk of serious flu-related complications that can result in hospitalization or even death. For this reason, it is imperative that patients with diabetes receive the flu vaccination every year and are educated on different ways to keep themselves healthy as the temperature drops. Click through the short slideshow below for a few quick reminders on how you and your patients can work together to keep them safe and healthy this flu season.
