Are People with Diabetes Immunocompromised?

What does it mean to be immunocompromised?

Simply put, the term “immunocompromised” means that the person’s immune system is not functioning properly to fight off infections. This could be due to a number of reasons, including underlying health conditions, or specific medications that the person is taking.

For example, patients who are HIV-positive are considered immunocompromised. This is because HIV invades the T cells (a type of white blood cell), which are a major component of our immune system. When functioning normally, T cells help to effectively clear various infections. Because HIV affects the T cells, the immune system of these patients may not respond as effectively, and they may struggle with complications from infections that most healthy people would easily recover from.

Similarly, some classes of medications can directly inhibit immune system responses. For instance, patients who are taking anti-rejection medications following an organ or tissue transplant are considered immunocompromised. This is also the case for patients who take immunosuppressive agents for other reasons, including for the treatment of certain autoimmune conditions and cancers.

Also, because immune system function is underdeveloped in very young children and declining in the very elderly, one may consider that the very young and the very old might be considered immunocompromised to a degree (because the immune system is not functioning quite as efficiently as it does in a healthy adult).

So, what about diabetes? Could diabetes, on its own, affect our immune system function to such a degree that would be considered “immunocompromised”? Are people with diabetes, by definition of just having the condition, immunocompromised?

It is known that high blood glucose levels can negatively affect immune system function, likely doing so through several mechanisms. High blood glucose levels are linked to negative clinical outcomes in the context of infections. The importance of maintaining optimal blood glucose management, and especially during infection and in the hospital setting, has been described in the scientific literature.

It is also well-established that patients with diabetes who achieve the recommended A1c levels have a markedly lowered risk for developing infections or complications from infections as compared to those with higher A1cs. You can read more about the connection between blood glucose levels and health complications here.

One expert commentary published in the Canadian Medical Association Journal explains,

“The evidence indicates that an immunocompromised state occurs only in the context of poor glycemic control with severe complications such as diabetic ketoacidosis or in adults with vasculopathy and peripheral neuropathy.”

There is some debate concerning the pathophysiology of both type 1 and type 2 diabetes as related to aberrant inflammatory responses and what this could mean for responses to certain infections. However, this is a complex and multifactorial topic, of which much remains to be elucidated at this time, and we cannot generalize based on theoretical and/or poorly characterized physiological processes in this patient population.

What is well-established, is that for patients who are able to maintain optimal glycemic management, and in the absence of other factors (such as related complications, a medication that may suppress immune system function), diabetes, on its own, does not make the patient automatically immunocompromised. However, for patients who frequently experience very high blood glucose levels and certain associated complications, immune system function can be negatively affected. This subset of patients might be considered “immunocompromised” due to the frequency and severity of hyperglycemia as compared to those with more optimal glycemic management and/or other complicating factors.

Also, it’s important to remember that when talking about an entire population of people with diabetes, on average, these patients are more likely to be immunocompromised. In addition to (generally) having higher than normal blood glucose levels for a considerable proportion of time, many people with diabetes are more likely to also have other health conditions that may negatively affect their immune system function. One example, in particular for patients with type 2 diabetes, is obesity, which is known to negatively impact immune function.

In summary, to accurately determine whether a patient with diabetes is “immunocompromised”, we must consider their overall health, including other health conditions, the medications that they use, as well as their age and glycemic management. Simply having diabetes does not, on its own, necessarily mean that the patient is immunocompromised, although as a group, this patient population is more likely to have immune system function issues.

Source: diabetesdaily.com

What Should I Do If I Have Symptoms of COVID-19?

As the global viral outbreak continues, you may be wondering what special considerations there are for people with diabetes to keep in mind. In particular, what should you do if you begin to experience symptoms consistent with the infection? This article reviews the most common COVID-19 symptoms, discusses potential issues specific to people with diabetes, and provides a guideline of how to respond if you become sick.

Symptoms of COVID-19

Be on the lookout for the following most common symptoms of COVID-19:

  • Fever
  • Coughing (especially dry)
  • Shortness of breath

Other symptoms may include fatigue, body aches, and sore throat, among others.

Special Considerations for People with Diabetes

You may have heard that people with certain medical conditions, including those with diabetes, are considered to be in the high-risk group for developing more serious symptoms of the disease, and have been reported to have a significantly higher mortality rate than those without underlying conditions. While these statistics are both relevant and can be scary, it is also important to keep in mind that your individual risk will vary widely depending on your specific health status, regardless of your diabetes diagnosis. Your age, other related and unrelated health conditions, and blood glucose management profile, all play a role in determining your overall risk. So, while as a whole population, people with diabetes are at higher risk for complications, your individual risk could be much lower than that.

For instance, as per the JDRF, those who have type 1 diabetes are  “not necessarily at higher risk of developing serious complications from the disease. Those at greatest risk are those who have another, or second chronic disease (such as a compromised immune system, heart disease or renal failure).

Talk to your healthcare provider to better understand your individual risk level and recommendations.

Have a Plan of Action If Symptoms Arise

Being adequately prepared ahead of time can help you feel calmer and more empowered if you do get sick. Consider taking the following steps today, if you haven’t already:

  • Take preventative measures. Stay home. Practice social distancing (note: if you already have symptoms, self-isolate!)
  • Wash your hands. Avoid touching your face. Disinfect “high-touch” surfaces regularly.
  • Make sure that your medication refills are up-to-date so that you have the supply you need if you will stay in your home for a long period of time (e.g., at least several weeks). Make sure that you consider supplies used for diabetes management as well as any other medications that you use.
  • Check that you have medications on hand that you would typically use to treat a viral infection, such as a fever-reducing agent, like acetaminophen (Tylenol). Consult with your healthcare provider for advice about their specific recommendations.
  • Have enough food and water in your home in case you stay home for a prolonged period of time (e.g., several weeks).
  • Review the “Sick Day Rules” for people with diabetes. COVID-19 causes mild symptoms in most of the people who are infected. This means most likely, you will be treating your symptoms at home. However, any illness can make blood glucose levels more challenging to manage. It is important to be aware of how illness can affect your management plan and make adjustments as needed, with the help of your healthcare provider, to keep yourself safe during the illness. You can find the standard “Sick Day Rules” as described by the Joslin Diabetes Center here, but discuss your specific recommendations with your healthcare provider.

So, what should you actually do (and not do) if you develop symptoms of COVID-19?

  1. Don’t panic.
  2. Self-isolate. Don’t go to urgent care or the emergency room, unless instructed to do so or you experience serious symptoms (see below). Stay home.
  3. Call your doctor and follow their advice closely.
  4. Keep a close eye on blood sugar levels. Work with your healthcare provider to make adjustments to medications, if needed, to help stay in the target glycemic range as much as possible. Keeping blood glucose levels in check as much as possible can go a long way to helping you avoid complications during any illness.
  5. Manage your specific symptoms (e.g., fever). Ask your healthcare provider for specific at-home treatment advice.
  6. Stay hydrated. This can help you keep your blood sugar levels in the target range and avoid complications.
  7. Be on the lookout for serious symptoms, including those of diabetic ketoacidosis (DKA), as well as the following “COVID-19 emergency warning signs”:
  • Difficulty breathing
  • Chest pain
  • Confusion or difficulty waking
  • Blue tint to the skin (on the lips or face, in particular)

If you experience these any of these symptoms, promptly seek medical care. Wear a mask if out in public.

  1. Continue to wash your hands and clean surfaces regularly.
  2. Continue to avoid contact with others (humans and pets).
  3. Do not discontinue isolation until you get the “all clear” from your healthcare provider.

***

For even more detailed information on what to do if you are ill, read these guidelines from the CDC:

What to Do if You’re Sick

Guidelines for At-Risk Populations

Also, learn even more about COVID-19 illness with diabetes from the American Diabetes Association (ADA) here.

Source: diabetesdaily.com

How to Reduce Urinary Complications of Type 1 Diabetes

This content originally appeared on Integrated Diabetes Services. Republished with permission.Frequency, Impact and Prevention of Urologic Complications of Type 1 Diabetes There are some very widely talked about and avoided complications of type 1 diabetes (T1D) such as retinopathy, neuropathy, nephropathy and cardiovascular disease. However, there are other complications that get relatively little notice but […]
Source: diabetesdaily.com

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