Diabetes and the Flu: The Overlapping Health Challenges in the UK

Dealing with the flu when you have diabetes comes with unexpected blood sugar spikes and an increased risk of superimposed infections.

This post will share how diabetes and the flu impact health and how British citizens deal with this overlapping health challenge.

We will also share how to prevent and manage this situation.

Influenza, commonly known as "the flu", is a contagious respiratory illness caused by the influenza virus. You catch the infection if you come in contact with the virus and then touch your eyes, mouth, or nose. It usually lasts for four to seven days and presents with:

• Fever
• Cough
• Sore throat
• Body aches
• Fatigue

Every year, influenza causes 400,000 deaths globally. The UK has a significant share of this figure. According to a recent press release by the government, the seasonal flu causes about 13,500 deaths in the country each year.

This number was higher than average in the most recent flu season at 14,500 deaths. This was the highest recorded figure since 2018, when were 22,500 deaths associated with the flu.

One reason for the increasing mortality from flu is the rise of co-existing health conditions like diabetes. The strict social distancing during COVID-19 also resulted in a period with minimal flu transmission, leading to reduced immunity among the population. When flu transmission started increasing back to normal, its impact was more severe.

Influenza does not usually lead to serious flu complications. It can be easily treated with antiviral drugs, dietary precautions, and proper rest. And healthy patients recover within five to seven days.

Complications arise when a patient with an underlying health condition like diabetes gets the infection. People with diabetes have a compromised immune system, which increases the risk of serious complications like:

• Pneumonia
• Bronchitis
• Sinus infections
• Deterioration of asthma or chronic obstructive pulmonary disease (COPD)

Influenza can also worsen heart-related issues in people with diabetes, leading to cardiovascular complications (such as a heart attack).

The reverse is also true. Diabetes patients face an increased risk of diabetes complications during a flu virus infection. The virus can disrupt glycemic control, leading to erratic blood sugar levels. The flu's inflammatory response can also worsen insulin resistance, complicating diabetes management.

Diabetes is a long-term condition characterised by elevated blood glucose levels. It arises when the body cannot produce enough insulin (a hormone that regulates glucose uptake by cells) or cannot effectively use it. According to Diabetes UK, there are 4.3 million people with diabetes in the UK. An additional 850,000 are yet to be diagnosed, bringing the total number to over five million.

When someone with diabetes gets influenza, they might experience more frequent blood sugar fluctuations. If blood sugar gets too low due to inadequate diet, patients might experience:

• Tremors
• Palpitations
• Sweating
• Unconsciousness
• Coma

If blood sugar gets too high — which is more common in this scenario — patients might experience:

• Abdominal pain
• Excessive thirst
• Frequent urination

In both types of diabetes, the interplay between diabetes and influenza begins when the virus induces stress on the body. Stress triggers the release of two hormones — cortisol and adrenaline. These put the body in the "fight or flight" mode, leading to increased insulin resistance and energy expenditure.

Both of these can send blood glucose on a rollercoaster ride.

Influenza vaccine is an effective way to prevent this. It lowers the risk of death from flu by 24%. It also significantly reduces hospital admissions among type 2 diabetes patients during the flu season.

The UK government actively promotes flu vaccination as part of its public health strategy. It offers free flu vaccines to:

• People aged 65 or older
• Pregnant women
• People in long-term residential care
• Individuals who might be risking people they live with if they don't get vaccinated (such as those who live with a disabled person or an HIV patient)
• People suffering from long-term health conditions listed here

If you belong to one of these high-risk groups, getting your flu shot on time is highly recommended.

Yes, people with diabetes may not be able to recover from influenza at the same pace as healthy individuals (which is 1-2 weeks).

That's because diabetes is an immunocompromised state. High blood sugar levels prevent white blood cells — which fight bacteria and viruses like influenza — from working properly.

This makes people with diabetes more likely to develop infections and take longer to recover from them. In fact, infections like otitis externa (infection of the outer ear) occur almost exclusively in diabetes patients.

If you have diabetes, you might already be taking insulin orally, via traditional injections, or via needle-free injections.

Here's how you should continue with these if you catch the flu:

When considering over-the-counter (OTC) flu medications, be mindful of their sugar content and potential to interact with your diabetes drugs. Opt for sugar-free or low-sugar options, and always check with your healthcare provider before adding a new drug to your routine.

Ketones are acids that accumulate in the blood and urine when the body lacks enough insulin to convert glucose into energy. This occurs when blood sugar levels are consistently high but can't be taken up by cells due to a lack of insulin. The body starts breaking down fat molecules for energy in this situation, leading to ketone production.

Although low ketone levels are normal during fasting or low-carbohydrate diets, excessive ketone production in a diabetic patient points to a dangerous condition known as diabetic ketoacidosis (DKA).

DKA causes the blood to become acidic and leads to symptoms like:

• Excessive thirst
• Frequent urination
• Nausea
• Vomiting
• Abdominal pain
• Altered mental status
• Quick breathing

Infections like influenza are a major cause of DKA. Other causes include:

• Surgery
• Trauma
• Heart attack
• Burn injury
• Heatstroke
• Forgotten insulin injection
• Inability to afford insulin treatment

It's a life-threatening condition that requires prompt medical care. Patients are often admitted to the hospital and treated with intravenous fluids and insulin therapy.

To prevent this, it's a good idea to regularly monitor ketone and blood sugar levels if you have diabetes and flu at the same time.

You can use ketone testing strips to do this. First, collect a urine sample in a clean, dry container. Dip the ketone strip into the urine, ensuring the testing pads are fully immersed. After a few seconds, remove the strip and wait for the colour to change. Compare the strip to the colour chart provided to determine ketone levels. If you detect ketones, immediately seek professional medical advice.

On a side note, it's important to stay hydrated to prevent ketone buildup. Drinking plenty of water helps flush excess ketones from the body.

People with diabetes who develop influenza should adhere to their regular meal plans. If your appetite is diminished, focus on consuming small, frequent meals throughout the day. This approach prevents large fluctuations in blood sugar levels and provides a steady energy source.

You also want to consume a nutrient-rich diet. Try consuming more fruits, vegetables, lean proteins, and whole grains. These foods provide vital vitamins and minerals to support the immune system, aiding in a speedier recovery from the flu.

It's also a good idea to consume foods with anti-inflammatory properties, such as fatty fish (rich in omega-3 fatty acids), ginger, and turmeric. These can help alleviate symptoms and support the body's immune response.

If you consume alcohol (even in minimal quantities), avoid it completely. It can interfere with medication and lead to dehydration.

Prevention is better than cure. Here are some preventative measures that can help lower your risk of getting influenza in the first place:

• Get your annual flu shot on time
• Wash hands with soap and water for at least 20 seconds, especially after coughing, sneezing, or coming home from public places. If soap is unavailable, use an alcohol-based hand sanitiser.
• Refrain from touching your eyes, nose, and mouth with unwashed hands and in public places. These areas are entry points for influenza.
• Wear a mask during the flu season and maintain a six-foot distance from people who are not from your household.
• Keep monitoring your blood sugar levels and see your doctor if they are deranged.

Both influenza and diabetes are common conditions in the UK. And both can worsen each other when they occur together.

This is why it's important to consult a healthcare provider if you're a diabetic who has caught influenza.

It's even more important to take timely flu shots, practice hand hygiene, and maintain social distancing because prevention is better than cure. You can also consider switching to our needle-free insulin injection to ensure you stick to your regimen and prevent massive sugar derangements.