Diabetes is a highly complex metabolic disorder that affects almost every bodily system, and immunity is no exception. Those living with diabetes catch infections more often that are both common and rare. Diabetes causes both qualitative and quantitative defects in immunity, which is why the CDC strongly recommends those with diabetes to get vaccinated for most common ailments.
Many diseases can be easily prevented with vaccines. In diabetes, the risk of catching influenza is much higher, and it may also worsen the control of blood glucose. Similarly, data indicates that hepatitis B has a higher prevalence among people with diabetes. Vaccines can also help to protect from dangerous infections of lungs (pneumococcal) and brain (infectious meningitis).
The immune system or immunity plays an important role in protecting our body from various infections. The immune system may engulf infections; it may neutralize them by secreting chemicals. Bone marrow, thymus, spleen, and lymph nodes are the organs of the immune system. Immune cells are produced in bone marrow while other organs help these cells to mature and function. Since diabetes alters the functioning of most organs, the immune system is not untouched.
People who have diabetes are not just more prone to infections; research has shown that they are also at a higher risk of death due to these infections. One of the reasons for a higher mortality rate due to infections in diabetes is the weakening of various organs. A study by Bertoni et al. showed that those living with diabetes are at three times greater risk of dying due to infections when compared to the healthy population. However, their research also demonstrated that this elevated risk is only with those who are suffering from cardiovascular diseases along with diabetes.
Further, research indicates that those who are living with diabetes are only moderately at higher risk of catching most of the common infections. But they are potentially at a higher risk of catching some rare infections like mucormycosis, emphysematous or gangrenous cholecystitis, emphysematous urinary tract infections, malignant otitis externa or necrotizing fasciitis. Further, the course of many infections may be much more severe. Though the treatment of infections in diabetes is similar to healthy individuals, however, infections may respond poorly to treatment in diabetes. So, the progression of diseases like pneumonia, tuberculosis, may be far more severe than in others.
So what exactly causes immune dysfunction in diabetes?
Though researchers do not fully understand the reason for an immune defect in diabetes, they know that it is caused because of a combination of reasons. In diabetes, certain infections just become more aggressive or virulent due to the high content of glucose in the blood. Diabetes affects the initiation of immune responses by decreasing production of cytokines, phagocytic activity of immune cells, and low mobility of various white blood cells. Further, diabetes causes dysmotility of the gastrointestinal tract and urinary tract, inadequate blood supply to various organs, and neuropathy.
What are the recommended vaccines in diabetes?
To learn about all the recommended vaccines, you must consult the physician, as lots would depend on your location, lifestyle, age, gender and traveling habits.
Two of the vaccines that are strongly recommended are influenza and pneumococcal vaccines. These two vaccines can significantly protect you from respiratory infections, decrease the duration of hospital stay, and cut down the mortality rates. The influenza vaccine is created each year depending on the circulating strains in the country, and it is usually taken each year in September or October. The influenza vaccine has to be taken on a yearly basis due to the decline in immunity after the year or changes in viral strains. The current pneumococcal vaccine includes 23 antigens and can confer 85-90 percent protection from various types of pneumococcal infections. These vaccines are highly beneficial in the elderly as they may have additional risk factors like cardiovascular, renal and pulmonary diseases.
Other suggested vaccines are DTP (diphtheria, tetanus, pertussis) that requires a booster dose every ten years, MMR (measles, mumps, rubella), varicella-zoster, hepatitis B and human papillomavirus (HPV).
Boosting immunity naturally
Vaccines are an excellent, effective, and affordable way of protection against some of the most dangerous infections, however, there are still a number of infections that do not yet have a vaccination.
- Control carbohydrates and portion size-high blood glucose level or frequent spikes cause chronic inflammation, insulin resistance and thus weakening the immune responses. Therefore for healthy immune responses eat regularly, but in small portions. It is also a good idea to eat five or six times a day in small portions. Eat more of complex carbohydrates, fruits, and vegetables. Get half of your energy from carbs, 30 percent from proteins, and the rest of the 20 percent from high-quality fats.
- Micronutrients to boost immunity- some of the vitamins like vitamin C and E are known to boost immunity, and have antioxidant properties. Citrus fruits and green vegetables may help to boost immunity. Omega-3 fatty acid is another good way to keep the immune system balanced, and fish and nuts are good sources of omega-3 fatty acids. Selenium is a micronutrient that is good for immunity, which may be taken as a supplement, brown rice and chicken may also provide it. Finally, include flavoring herbs like ginger, onion, and curcumin in the daily diet. Probiotic-rich drinks or food products like yogurt may also help.
- Move more often and intensively- diabetes is a disease of sedentary lifestyle. Those who exercise regularly are at much lower risk of catching a cold and other seasonal infections.
- Practice mindfulness- remember that stress is one of the most common causes of low immunity. Stress causes an increase in cortisol that lowers the immunity, even in healthy subjects.
Finally, get enough of daily sleep and quit bad habits like smoking or excessive drinking. It is best to use all the available methods to strengthen immunity. Vaccines are a safe and excellent way to protect from many dangerous infections, while natural methods work well for protecting people from more casual infections like a common cold.
- CDC. CDC’s Vaccine Information for Adults with Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/diabetes.html. Published November 1, 2016. Accessed February 7, 2018.
- Bertoni AG, Saydah S, Brancati FL. Diabetes and the Risk of Infection-Related Mortality in the U.S. Diabetes Care. 2001;24(6):1044-1049. doi:10.2337/diacare.24.6.1044
- Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012;16(Suppl1):S27-S36. doi:10.4103/2230-8210.94253
- Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26(3-4):259-265.
- American Diabetes Association. Influenza and Pneumococcal Immunization in Diabetes. Diabetes Care. 2004;27(suppl 1):s111-s113. doi:10.2337/diacare.27.2007.S111
- Kesavadev J, Misra A, Das AK, et al. Suggested use of vaccines in diabetes. Indian J Endocrinol Metab. 2012;16(6):886-893. doi:10.4103/2230-8210.102982