House call
By Catherine O'Neill Grace
Shot of Health
IT'S FLU SHOT SEASON AGAIN. ASK YOUR DOCTOR ABOUT A PNEUMONIA SHOT, TOO. BOTH OFFER EXTRA PROTECTION TO PEOPLEWITH DIABETES.
Eugene P. Barrett, MD, PhD, is a professor of medicine and a director of the University of Virginia’s Diabetes Center. We asked him about the importance of vaccines for pneumonia and influenza.
Q. Why is it especially important for people with diabetes to receive vaccines to protect them from pneumonia and the flu?
A. When someone with diabetes gets an infection — it could be pneumonia, it could be influenza — it puts additional stress on their body’s ability to control glucose. Frequently they just can’t do it. That can lead to a sort of a feedback effect — that is, if they can’t control their blood sugar well and the level starts to rise, that impairs the way the immune system works to clear the infection. So people with diabetes wind up with two problems: They’ve got the infection, and, because the immune system doesn’t work as well in individuals whose blood sugar is high, their bodies can’t clear it.
Q. Who is particularly at risk from pneumonia or the flu?
A. I'm most concerned about people who have type 2 diabetes and are over 60. They may be on medications of which they’re already taking the maximum dose. Let’s say they’re on two or three oral agents already, and they’ve just gotten control of their blood sugar. Then if they get an infection — such as a cold, the flu, a tooth abscess or a urinary tract infection — their body goes out of whack. When that happens, they’re likely going to need insulin. Perhaps they’ve never used it. That puts them in the position of not really knowing what to do next. It can be difficult to manage.
There’s a lot of understanding and management that must be done to educate people with diabetes about taking preventive measures. It’s hard to be sure that people are tuned in to every contingency that may occur. If we can do something that prevents problems from occurring, we save the patient a lot of grief and worsened illness.
Q. Although the pneumococcus vaccine is readily available, the American Diabetes Association reports that only one-third of people with diabetes actually receive it. Why is that?
A. Every fall, when flu season is coming around, there’s a lot of information in the media. Pneumonia just doesn’t get as much notice in the public as influenza does. The flu vaccine can be administered from the fall through the late winter. The pneumococcus vaccine, however, is not so seasonally dependent. You can receive the vaccine any time of year, and you don’t need a booster for another five to 10 years. But, I guess, as with most preventive medicine, people are a little less inclined to ask for the vaccine when they’re feeling fine.
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