Swine flu (H1N1 influenza) and diabetes   (September 14, 2009)

The news reports about the H1N1 influenza pandemic (popularly known as "swine flu") keep coming, but one aspect of the story is constant: although the majority of the cases are mild, the H1N1 influenza virus is occasionally a killer.

This morning's news report is that the first doses of the vaccine should be available in early October, rather than mid-October. Last week, it was that the H1N1 vaccine probably will only need a single dose to be effective (previously, it had been surmised that perhaps two separate doses of H1N1 might be needed to protect against the virus). And we hear of colleges with thousands of students isolated or quarantined because they all have symptoms consistent with H1N1 flu. But most concerning is the reports that over 3,000 people have died from swine flu since the new virus became apparent in Mexico in April.

The deaths are frequently described as occurring in people with underlying diseases, but occasionally in healthy young adults. The underlying diseases are rarely described, and I have been watching to see if diabetes is mentioned as a comorbidity -- and it occasionally is. For example, a 51-year-old Italian man with chronic heart problems had become the country's first swine flu victim; the man had long suffered from diabetes as well as heart problems, doctors said. While fighting the flu virus, he developed a staphylococcal infection, pneumonia and kidney problems.

If you are have diabetes, what should you do?

First, be informed.

The Centers for Disease Control and Prevention (CDC) has several webpages on the H1N1 flu. One that is updated regularly is 2009 H1N1 Flu (Swine Flu) http://www.cdc.gov/h1n1flu/ [Editor's Note: No longer being updated as of March 2012.]

They also have a webpage about H1N1 and diabetes, which has numerous hyperlinks to other information: H1N1 Flu (Swine Flu) Information http://www.cdc.gov/diabetes/news/docs/swine_flu.htm [Editor's Note: No longer being updated as of March 2012.]

Other agencies also have information of interest: The HHS has a webpage with what has to be the catchiest title: flu.gov http://flu.gov/ It has information about bird flu, swine flu, and "routine" flu.

Second, plan to get all the flu shots this autumn.

You should get the "routine" flu shot, which is already available, and later, when it's available, also get the H1N1/swine flu shot (or shots, if it turns out that two shots are needed for protection from H1N1). Every year, there's a risk of an epidemic of routine viral flu, and this year is no different. The "routine" flu shot will help decrease the risk of getting the routine flu, but will not protect against the new H1N1 strain. And contrariwise, getting the H1N1 vaccination will not decrease the risk of getting routine flu.

Third, follow routine advice that the CDC is suggesting for everyone:

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread that way.
* Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
* Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.

And finally, for people with diabetes, there's additional advice:

* Remember that being sick by itself can raise your blood glucose. Moreover, illness can prevent you from eating properly, which further affects blood glucose.
* People who come down with the flu may become disoriented and not think straight, and affect your ability to cope with your diabetes, even if you usually have things under excellent control.
* Be sure to continue taking your diabetes pills or insulin. Don't stop taking them even if you can't eat. Your health care provider may even advise you to take more insulin during sickness.
* Test your blood glucose frequently, perhaps every four hours, and keep track of the results.
* Drink extra (calorie-free) liquids, and try to eat as you normally would. If you can't, try to have soft foods and liquids containing the equivalent amount of carbohydrates that you usually consume.
* Weigh yourself every day. Losing weight without trying is a sign of high blood glucose and/or dehydration.
* Check your temperature every morning and evening. A fever may be a sign of infection.

Call your health care provider or go to an emergency room if any of the following happen to you:

* You feel too sick to eat normally and are unable to keep down food for more than 6 hours.
* You're having severe diarrhea.
* You lose 5 pounds or more.
* Your temperature is over 101 degrees F.
* Your blood glucose is lower than 60 mg/dL or remains over 300 mg/dL.
* You have moderate or large amounts of ketones in your urine.
* You're having trouble breathing.
* You feel sleepy or can't think clearly.

The H1N1 virus is a real risk for those of us with diabetes. For most of us, catching it will cause a week or so of misery, but it may cause more grief, so be aware, and be prepared. And get your flu shots!