Diabetes and Influenza

COMING  down with a case of the flu is no fun for anyone.  But it poses extra risks for people with diabetes or other chronic health problems.

A bad case of the flu can lead to viral or bacterial pneumonia, dehydration, ear infections and sinus infections, especially in children.  Influenza can also make chronic medical conditions such as diabetes, asthma and congestive heart failure worse.  Though numbers vary from year to year, an annual average of more than 200,000 hospitalizations and approximately 36,000 deaths are attributed to influenza or complications from influenza in the United States alone.  On a global scale, the flu is responsible for the deaths of half a million people each year.  People with diabetes make up a disproportionately large number of those affected.  They are six times more likely to be hospitalized with flu complications than the population at large.  Deaths among people with diabetes rise 5 to 15 percent during flu epidemics, according to the Centers for Disease Control.  Each year, between 10,000 and 30,000 deaths among people with diabetes are associated with influenza and pneumonia. 

WHY INFLUENZA  IS ESPECIALLY DANGEROUS FOR PEOPLE WITH DIABETES.  Flu symptoms such as fatigue can make it harder to perceive both high and low blood-glucose episodes.   Some medicines, antibiotics and steroids used to treat illness can also raise blood-glucose levels.

” A lot of times people with think that because they aren’t eating, their blood sugar isn’t going to go up,” said Kris Bischoff, certified diabetes educator and registered dietitian at Adams Memorial Hospital in Decatur, Indiana.  “What people don’t understand is that when you are sick, your body has that fight-or-flight response.”  Because your body can’t run away from the germs that are causing the infections, it dumps sugar into your bloodstream to help prepare for battle.  “For some people,” she explains,”a higher blood sugar reading is the first sign that they are getting sick or getting an infection.”

Diabetes can compromise the body’s immune system, making it less effective at fighting viral infections such as the flu.  This puts people with diabetes at greater risk of developing secondary infections such as pneumonia.  And pneumonia is nothing to take lightly; according to the CDC, about 5 percent of cases involving adults who develop pneumonia result in death.

People with type 1 diabetes who get influenza may be more prone to dangerous levels of ketones.  This can cause diabetic ketoacidosis (DKA), which can result in coma or even death.

THE HIDDEN BENEFITS OF GETTING A FLU SHOT FOR PEOPLE WITH TYPE 2 DIABETES    The best way to protect yourself against influenza and the complications that can arise is to get a flu shot.  Not only does the vaccine protect against some of the viruses that can cause influenza, but a recent study has suggested that people with type 2 diabetes who receive flu vaccinations may have a reduced rusk of cardiovascular disease.

The study, published in July 2016 in The Canadian Medical Association Journal, sought to examine the effectiveness of influenza vaccination in preventing hospital admissions for cardiovasular and respiratory conditions.  The research subjects were 124,503 British adults with type 2 diabetes who were studied over a 7 year period, from 2003-2010.  About two-thirds of the people in the study had received influenza vaccinations.

Even after controlling for variables such as age, sex, smoking, medications and body mass index, the researchers found that having received a flu shot was associated with a 30% reduction in flu-season hospital admissions for stroke.  Hospital admissions for heart failure were down 22%, hospitalizations for heart attack were down 19%, and hospitalizations for pneumonia or influenza were down 15% among people with type 2 diabetes who had received a flu shot.

MOST SIGNIFICANT OF ALL:  The death rate among those who received a flu shot was 24% lower than in those who had not been vaccinated, the researchers said.

The study wasn’t intended to prove a cause-and-effect relationship between influenza vaccine and the reductions in death and hospital admissions.  However, the results do suggest that the benefits of getting a flu shot extend beyond simple peace of mind.

References:  DiabetesHealth Magazine/ DEC. 2016  pg. 8-10


Glycemic Index and Diabetes

The glycemic index, or GI, measures how a carbohydrate-containing food raises blood glucose.  Foods are ranked  based on how they compare to a reference food-either glucose or white bread.

A food with a high GI raises blood glucose more than a food with a medium or low GI.

Meal planning with the GI involves choosing foods that have a low or medium GI.  If eating a food with a high GI, you can combine it with low GI foods to help balance the meal.

Examples of carbohydrate-containing foods with a low GI include dried beans and legumes (like kidney beans and lentils), all non-starchy vegetables, some starchy vegetables like sweet potatoes, most fruit, and many whole grain breads and cereals (like barley, whole wheat bread, rye bread, and all-bran cereal.

Meats and fats don’t have a GI because they do not contain carbohydrate

Below are examples of foods based on their GI.


* 100% stone-ground whole wheat or pumpernickel bread

* Oatmeal (rolled or steel-cut), oat bran, muesli

* Pasta, converted rice, barley, bulgar

* Sweet potato, corn, yam lima/butter beans, peas, legumes and lentils

* Most fruits, non-starchy vegetables and carrots

MEDIUM GI (56-69)

* whole wheat, rye, and pita bread

* Quick oats

* Brown, wild or basmati rice, couscous


* White bread or bagel

* Corn flakes, puffed rice, bran flakes, instant oatmeal

* Shortgrain white rice, rice pasta, macaroni and cheese from mix

* Russet potato, pumpkin

* Pretzels, rice cakes, popcorn, saltine crackers


Fat and fiber tend to lower the GI of a food.  As a general rule, the more cooked or processed a food, the higher the GI; however, this is not always true.

Below are a few specific examples of other factors that can affect the GI of a food:

* Ripeness and storage time – the more ripe a fruit or vegetabe is, the higher the GI

* Processing – juice has a higher GI than whole fruit; mashed potato has a higher GI than soft-cooked pasta)

* Cooking method – how long a food is cooked (al dente pasta has a lower GI than soft-cooked pasta)

* Variety – converted long-grain white rice has a lower GI than brown rice but short-grain white rice has a higher GI than brown rice.


The GI value represents the type of carbohydrate in a food but says nothing about the amount of carbohydrate typically eaten.  Portion sizes are still relevant for managing blood glucose and for losing or maintaining weight.

The GI of a food is different when eaten alone than it is when combined with other foods.  When eating a high GI food, you can combine it with other low GI foods to balance out the effect on blood glucose levels.

Many nutritious foods have a higher GI than foods with little nutritional value. For example, oatmeal has a higher GI than chocolate. Use of the GI needs to be balanced with basic nutrition principles of variety for healthful foods and moderation of foods with few nutrients.


There is no one diet or meal plan that works for everyone with diabetes.  The important thing is to follow a meal plan that is tailored to personal preferences and lifestyle and delps achieve goals for blood glucose, cholesterol and triglycerides levels, blood pressure, and weight management.

Research shows that both the amount and the type of carbohydrate in food affect blood glucose levels. Studies show that the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response than the GI.

Based on the research, for most people with diabetes, the first tool for managing blood glucose is some type of carb counting.

References.  American Diabetes Association  www.diabetes.org  02/06/2017

What Foods Have Gluten?

Gluten is found in wheat, rye, barley and any foods made with these grains.

Avoiding wheat can be expecially hard because this means you should avoid all wheat-based flours and ingredients.  These include but are not limited to:

*  White flour

*  Whole Wheat Flour

* Durum Wheat

* Graham Flour

* Triticale

* Kamut

* Semolina

* Spelt

* Wheat Germ

* Wheat Bran

Common foods that are usually make with wheat include:

* Pasta

* Couscous

* Bread

* Flour Tortillas

* Cookies

* Cakes

* Muffins

* Pastries

* Cereal

* Crackers

* Beer

* Oats (see the section on Oats below)

* Gravy

* Dressings

* Sauces

This may seem like a long list, but there are still plenty of gluten-free foods out there!  Choose from many fresh, healthy foods like fruits, vegetables, beans, dairy, nuts and gluten-free grains like quinoa or rice.

There are also gluten-free versions of many of the foods above available in most grocery stores.  You just have to look for them!`

You may not expect it, but the following foods can also contain gluten:

* broth in soups and bouillon cubes

* breadcrumbs and croutons

* some candies

* fried foods

* imitation fish

* some lunch meats and hot dogs

* malt

* matzo

* modified food starch

* seasoned chips and other seasoned snack foods

* salad dressings

* self-basting turkey

* soy sauce

* seasoned rice and pasta mixes

There are also many additives and ingredients in packaged foods that may contain gluten.  Always check labels and ingredient lists for these.  For a more comprehensive list of gluten-containing additives, contact your local celiac support group.


Don’t forget that ingredients in food products change freqquently, so always check the label before buying packaged foods.

* Remember that “wheat free” does not automatically mean “gluten free.”  While a product may not contain wheat, it can still contain rye or barley in some form.

* If you have any question about whether a food contains gluten, contact the manufacturer.


Pure oats are a gluten-free food, but most commercially processed oats have been contaminated during the growing, harvesting or processing stages.  In the past, many experts recommended completely avoiding oats those on a gluten-free diet in addition to wheat, barley, and rye.  Now some oats are grown and processed separately, and can be labeled “gluten-free.”

Many people with celiac disease are still advised to avoid oats initially.  However, oats can help provide fiber and other important nutreints.  Over time, most people with celiac can reintroduce pure oats in small amounts (about 1/2 cup of dry oats per day) without any trouble.

If you do choose to include them, let your doctor know and only eat oats that are marked “gluten-free.”

References:  The American Diabetes website.  diabetes.org  02/06/2017