Diabetes & flu: a devastating combination

Gary Finnegan

Gary Finnegan

January 24th, 2019

Gary Finnegan

Flu hits diabetes patients hard – nurses and GPs can help improve vaccination rates

‘I remember the fever and fatigue as being unbearable,’ recalls Maximino Álvarez, a diabetes patient who has had flu twice. ‘It is an unpleasant experience which should be avoided.’

Flu infection can be serious for anyone but for people with chronic diseases, such as diabetes, the risk of hospitalisation can be as much as ten times higher than the rest of the population.

‘Anything that affects your health has an impact on your diabetes,’ explains Maximino. ‘With flu, your blood sugar levels are affected and it becomes difficult to keep it under control. Resistance to fast-acting insulin is a frequent effect of influenza infection.’

Dr Xavier Cos, a GP specialising in diabetes care, says people with diabetes are more severely affected by any respiratory tract infections and can suffer serious complications as a result.

‘The reaction to the infectious process often exacerbates their metabolic disease,’ he says. ‘In many cases, they are also not as well able to fight the infection so a cascade of consequences can follow – just as in older people or those with chronic lung or kidney diseases.’

Vaccine-prevent diseases

Flu and pneumococcal disease – both of which can be prevented by vaccination – are serious respiratory diseases that can increase the risk of hospitalisation. ‘Epidemiological data tells us that people with diabetes who suffer from flu or other respiratory problems are at higher risk of hospital admission and likely to spend more days in hospital,’ says Dr Cos.

His advice? ‘It makes sense to vaccinate all diabetes patients against flu given the potential for complications.’

Maximino echoes this view but acknowledges that too few people with diabetes are being vaccinated. ‘Even if someone with diabetes perceives their risk to be low, I would recommend vaccination because you lose nothing but could prevent illness,’ he says. ‘You don’t want to risk having a rough time, possible hospitalisation and seeing wild blood sugar numbers for several days which will have a detrimental effect on your haemoglobin values.’

Some people with diabetes are not aware of the specific additional risks that flu infection poses, while others are complacent because they consider themselves to be generally healthy, he said.  

Read: ‘Flu vaccine good for diabetes’

With many diabetes patients now managed in primary care, GPs and specialist community-based nurses could help to improve vaccine uptake rates. ‘Their role is crucial,’ Maximino says. ‘From my conversations with diabetic patients, a recommendation by a healthcare provider is a key factor in getting the jab, even though it does not work in all cases. HCPs should continue spreading the message about flu vaccination, and also should set an example by getting the vaccine themselves.’

Dr Cos notes that not all health systems are alike, but in those where primary care is the gateway to the health system, it is essential that GPs and practice nurses are well informed about vaccination and diabetes.

‘A lot of type 2 diabetes patients visit their primary care professional regularly,’ he says. ‘Flu vaccination should be a normal part of regular diabetes appointments.’

While the message about flu vaccination for older people is generally well understood, the benefits for people with diabetes, as with other chronic conditions, are not as widely considered by some healthcare professionals and patients.

Dr Cos says health professionals require support to be more confident in how to advise and coach patients: ‘We are asking our citizens with this chronic condition to make important behavioural changes. This requires a good communication strategy – an area that often in not well covered at the university and during specialised medical and nursing training.’

Anne Felton, President and founder of the Federation of the Federation of European Nurses in Diabetes (FEND) says nurses should take a proactive advocacy role.

‘All nurses working in the diabetes, whether in primary or secondary care settings, should be vigilant and proactive in raising awareness of the importance of flu vaccine,’ she says. ‘Nurses should counsel patients and their families to avail of the flu vaccine programme.’

Mrs Felton emphasises the importance of women in their reproductive years availing of flu vaccination. ‘It should be an integral part of care for this particular group,’ she says.

More on chronic illnesses: ‘COPD patients should have flu and pneumo vaccines