Welcome to another edition of our diabetes advice column etradordinaire, Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.
We hate to think about it, but winter is on its way, and vaccinations are on the mind. Wil takes an in-depth look at this prickly issue today, with a few warnings to the wise…
{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}
Dusty from Alabama, type 2, writes: I have a question about getting the flu, pneumonia and shingles shots. I’ve heard it’s important for diabetics to get a flu shot every year, and I personally always ask for a pneumonia shot, too, because I used to get these respiratory infections that settled into pneumonia. But what about a Shingles shot? Is that important too? I’m not sure my insurance covers it, and I have read that Shingles shots are terribly painful, but the disease would be worse. Do you know if Shingles shots are ever covered for diabetics? Is it a one-time vaccination? How long does it last? And is there anything else I should do to prepare to stay healthy for the winter season?
Wil@Ask D’Mine answers: Great questions! Flu first. Anyone with diabetes or anyone who spends much time kissing someone with diabetes should get an annual flu shot. ‘Tis the season right now. Flu season usually starts in October and it takes your body about two weeks to develop the immune response after getting the shot. So get to your doc, your Walgreens (love ‘em or hate ‘em) or your public health office right now, today, before flu season starts.
Getting your flu shot (or nasal spray immunization) is probably the number one thing you can do as a PWD to get ready for winter. The CDC flu page says this year’s vaccine will protect us from three strains expected to be the most common this year, including the over-hyped H1N1 of a few years ago.
Depending on the year, flu strikes between 5-20% of the U.S. population, sending more than 200,000 people a year to hospitals. As many as 49,000 of them never go home again. Most of those deaths are in the elderly, the young, the pregnant, and “people with certain health conditions.”
That would be us.
Everyone, just get your damn flu shots.
Moving on…
Dusty, you’re Big-Time over-immunized on the pneumonia front. A pneumonia shot isn’t an annual event. It’s a twice-in-a-lifetime event. You should get one sometime in your first year of diabetes, or if you haven’t had one ever, get one now. Then you should get a second shot once you are 65 years old. Oh, unless you were 62 when you got your first one. The two shots should be at least 5 years apart. So I don’t know how old you are, but I’m thinking you’re set for a loooooooooooooong time at this point. I poked around the net a bit and talked to several docs. No one seems to know what the risks are of being over-immunized, but the consensus seems to be: He’ll probably be fine, but tell him to quit getting the shot every year! (Along with a few snide comments about your medical team letting you get so many.)
Pneumonia shots do two things: they absolutely prevent pneumonia in some people, and reduce the severity of it in just about everyone else.
Mortuary trivia for those of you who don’t believe in preventive medicine: More than 52,000 Americans die of pneumonia every year. It’s the sixth leading cause of death in our country.
Moving on…
As to shingles shots, this is an early senior-set immunization. Shingles, a.k.a. herpes zoster is simply chickenpox reborn. But even if you’ve had chickenpox (and who hasn’t?) you can get shingles. Here’s what happens: When you get over chickenpox, you don’t rid yourself of the virus. It goes into hibernation deep in your spine where it sleeps for years and years and years. If it wakes up, as it does in about one million folks a year, it causes PAINFULL skin rashes that generally make people pray for a speedy death. The shingles attack lasts for about three weeks and is generally a once-in-a-lifetime event, but, pain in the area of the rash can last for many months after the rash is gone. Sometimes for years. The fancy-pants name for this particular brand of suckage is postherpetic neuralgia. Oh. And you could go blind — that actually happened to my wife’s grandmother — or deaf.
No one knows why the virus wakes up in some folks but not in others. It could be cosmic rays, too many TV dinners, or wearing polyester. Your guess is as good as anyone else’s. It’s waaaaay more likely north of 60, and more likely if your chickenpox encounter was at a very young age. Other than that, it’s roulette. I saw one statistic that said if you live to be 85, you have a 50% chance of getting shingles. Bummer. The shingles part, not the living to 85 part. I saw another study that showed that shingles is on the rise, up 64% over the last thirty years.
I think the bottom line here is that no one in their right or left mind would want shingles. Right? So, science to the rescue! In 2006 Merck’s Zostavax shingles vaccine was FDA approved and now the CDC recommends that all folks over 60 get it.
Insurance coverage varies, although it’s covered by all Medicare Part D plans, for all persons over 60, not just PWDs. The out-of-pocket cost for the shot if you’re not covered is around $200. I’ve been surprised by how many un-covered seniors have ponied up the money without blinking an eye at the clinic where I work. Oh. Right. Most of them knew someone who had just had shingles. Go figure. No one ever said anything to me about it being painful, and I didn’t find many people bitching about that online, so either the pain is worth the gain, or it’s not too bad for most people.
The feds report that the shot is 50% effective in preventing shingles and cuts the risk of that nasty neuralgia pain we talked about earlier by almost 2/3 in those unlucky 50% that still get shingles anyway.
Oh, and Dusty, this is a once-in-a-lifetime shot. Please don’t get one every year.
Note: one day after my 60th birthday (approx… 4,381 days from now), I’m getting my shingles shot.
Other winter stuff… you might want to talk to your medical team about what’s called a sick-day plan. In a nutshell, when you’re sick (flu or garden variety cold) your blood sugars will tend to go wacky. Being sick is bad enough. Being sick and hyperglycemic is double-sucky. You can have a plan in place about how it’s safe to increase your meds as needed, and be sure you keep properly hydrated and all of that.
And lastly, for all of you office heroes out there: Just stay the f— home when you are sick. OK? I just hate those people who “never miss a day of work, no matter how sick I am.” You know what? You’re not heroic. You’re idiotic. You’re spreading your germs, and making the rest of us sick.
If you get sick, stay at home and get well. Don’t spread the “love.”
Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
At the risk of going all Michelle Bachmann on y’all, I would like to see the facts behind getting the flu shot for an otherwise healthy diabetic.
I hear the recommendations every year, but the only “facts” I see are the CDC and the ADA “recommend” it for diabetics.
Fair Winds,
Mike
Concerning shingles. I have two attacks of them. Once in my 20′s and just recently last year.
This last attack was a bitch and yep, I do still have some pain every so often in the area where the shingles were at.
Not fun at all.
I get the flu shot every year, but not because I have diabetes. I have had Type 1 for 35 years and don’t feel that I get sicker from common ailments (colds, strep throat, etc) than your average Joe. IMO the flu shot is a relatively painless way to avoid the flu. I can’t think of any reason not to get it. On the other hand, I’m not a conspiracy-driven person who is convinced that a flu shot is big government trying to infiltrate my life.
I do think that a lot of the history of recommendations for “diabetics” is based on the past that most people with diabetes weren’t in the best of health and were for the most part an elderly population. There are many people with diabetes who still fit those descriptions, but there are many “healthy” people living with diabetes. I wear sandals and do lots of other traditional no-no things for diabetics. But I do get a flu shot every year. Not because of diabetes, but for me I think it’s the smart thing to do.
I do too, but for me it’s because I’m diabetic (and also, it works). Oh, and I wear sandals too (smile)!
(My 30th T1 Diaversary was this summer, so we’re in the same zone, Casabby – and I consider myself healthy too.)
I have to protect myself the old fashioned way. I can’t get the flu shot as my reactions to any meds scare the doctors in such a manner that they hide the prescription pads as soon as I walk in the office.
I avoid large crowds, wash my hands, wash the carts at any store, do alot of internet shopping, turn away people who are ill at the door, take my vitamins, stay away from the Family Practice docs, only see my Endo during the flu season.
I thank God every year as I have escaped the flu for over 15 years now!
Now sinus infections…that is another matter all together….grrrr..
Ressy
Had to laugh at your “wearing polyester” comment, Wil. 30+ years ago I worked in a medical research lab where rather large IBM computers on kitchen table size carts were wheeled into each lab room by identcally dressed technicians in green scrubbs. There, they would record every minute symptom on hundreds of rats or mice every day. I was responsible for maintaining the computers. These primitive devices were always breaking down and without fail every labworker would complain “Why does this always happen to me?” I would look them in the eye and seriously ask “What kind of underwear do you wear, cotton or polyester?” Regardless of which answer they gave, I would just nod knowingly and say “Ahh, static.” It was total bull but it made them feel better that God wasn’t punishing them personally.
Why Get the Flu shot?
1- If you have T1, then you probabl have lost at least -25% of your Auto immunity to fight Diseases, Colds and just about everything else, but you haven’t noticed it yet..
2- Go hang around some kids , get the Flu and let me know how that works for you.. That’s how I got the Flu and I get the Shot every Sept. ever since.. and avoid sick people like the Plague..
3. Oh for 15 of my 20 yrs as a Adult T1, I was Self Insured and Paid for alot Out of Pocket.. while only making the ave of about $30k yr..
I remember when it was only $5 at a Clinic and then went upto $10 and now I think it’s like $20-$25, but I get mine thru the VA now and only cost me $9 ( my Deductable)
Cooking at home versus eating out helps A TON in regards to avoiding illnesses in the Winter because people still go to work sick even in restaurant businesses. Make sure to eat healthy and get adequate vitamin D and you will be much less likely to catch something in the first place. Keeping blood sugars as close to range as possible helps, too. Oh and wash your hands often. Just add these things to whatever else your plan involves and you will definitely fare better this year.
I get my flu shot because, when I do get sick, it’s like my immune system says, “While we’re killing this virus, why don’t we bump off a few more beta cells while we’re at it.” My insulin dosage creeps up a little more and never comes back.
I did get the pneumonia shot finally. I dutifully went in my first year for the flu & pneumonia only to have them refuse to do it. After trying to explain, asking them call my PP, who refused to authorize it, and feeling humiliated because they made me feel like I was trying to pull some scam, I left without it. The next year, after my PP got pneumonia, she okayed the vaccine for me, even though I wasn’t 65 and it would be 15 years before I would be. What your PP refuses to know CAN hurt you, a lot. Thus began an escalating series of horrific errors. Rebuilding trust in my health care team has been a slow process.
Interesting – I always thought the reason to get a flu shot if you’re diabetic is because having the flu really sucks when you have diabetes.
In March 2011, the FDA approved the shingles vaccine for those age 50 and older. So 50-somethings can now get the vaccine. I know SO MANY people who have gotten shingles in their 40s and 50s, and it is dangerous and excrutiating.
Since I started to up my vitamin D I have not had a flu shot and never have problem. I am a teacher of young children in public schools. I believe vitamin d is the answer. Make sure it is vit d3.