Tips from a Diabetes Practice - The Flu Shot and Gluten Free Diet

I just taught a diabetes self-management session to a 63-year old gentleman who came to his one on one appointment with the flu. He was complaining of aches and pains, was congested, sneezing and coughing, had a fever and was just plain miserable. He had not had a flu shot this season but luckily I did! I hope to avoid the symptoms and contract the flu. I gave it my best chance by getting the vaccine. By the way, his blood sugar was 385, way out of range which is common during illness and infection. I thought it was time to share the latest on this season’s vaccine information.

The CDC just came out with new recommendations for vaccines for 2016-2017 season. Although many people avoid vaccinations due to fear of side effects, you should always check with your primary care physician to receive the best suggestion for you. Be aware that people with diabetes experience the flu more frequently and furiously due to the fact that their white blood cells function at a lower capacity especially when blood sugars are uncontrolled. White blood cells help protect us from foreign bacteria. Flu season begins in September and peaks in December through February but can continue until mid- May. People with diabetes also have a higher risk of pneumonia with more intense complications. Remember, when you are ill with the flu or pneumonia, your blood sugars usually fluctuate with higher levels. Let’s review what you need to do this season:

The CDC still recommends an annual flu shot to those over 6 months and older starting in September. They encourage that you receive the vaccine as late as May since “flu viruses are circulating in the community until then”. Most health care providers insist that September through February is the critical time when you have diabetes.
A CDC change is this year’s recommendations is the elimination of the nasal spray form of the “live attenuated influenza vaccine” since it appears to be ineffective. It was a boost for those who wanted to avoid an injection but is no longer recommended.
The options for 2016-2017 have increased. They include the “standard dose trivalent injectable vaccine” which treats against 3 different flu viruses and is injected intramuscularly. Another vaccine called Afluria may be given with a “jet injector” to those 18-64 years old. This is for people who fear regular injections. In 2009, a high dose influenza vaccine was created for those 65 and older who may have a “decreased immune response” compared to younger individuals. Over 30,000 older participants who received the high dose vaccines had “24% fewer infections” compared to the standard dose.
New this year is a trivalent vaccine which is egg-free called ‘Flu Blok’ for those 18 years and older with egg allergies. People with egg allergies are usually the only ones who experience a reaction to the flu shot but each person may experience something unique.
Also new this year is a trivalent vaccine that uses “adjuvant” creating an even stronger response in those 65 years and older, again due to their less active immune systems.
Quadrivalent or a flu shot that protects against 4 different viruses will remain available this season. Your health care provider will know which vaccination is best for you.
A new Quadrivalent vaccine is available that is grown in animal cells instead of eggs. This is another alternative for those with egg allergies. It is called “cell–culture based” and given to those 4 years old and older.
According to the CDC, “this season’s vaccines have been updated to better match recently circulating influenza viruses”. Remember, it is still possible to get the flu after receiving a vaccine but the illness should be “a less severe infection”.
Most people experience a slightly, painful, reddened area surrounding the injection site for 24-48 hours as their only side effect. If you do get the flu after the vaccine it is because it takes two weeks for the shot to become effective. The injection does not contain live flu virus or cause the flu.
For updated information, please call 800-CDC-INFO (800-232-4636) or online at www.cdc.gov.
Flu and pneumonia vaccines are covered by most insurance plans without a co-pay. The pneumonia vaccine protects against the pneumococcal bacteria. Those over 65, with or without diabetes, should be vaccinated according to the CDC.
Look at all possible angles before you make a decision, but don’t just assume you do not need to be vaccinated. It does come down to a personal choice.

I recently counseled a 46-year old female with new onset type 2 diabetes who wanted to know if going gluten-free would cure her diabetes. Here is a summary of our discussion:

What is gluten?

Gluten is a protein found in wheat, spelt, farro, bulger, barley and rye.

Can I always lose weight when I go gluten-free?

No, because there are many foods that are gluten-free but are not carbohydrate-free or calorie-free. Included in that group would be: rice of all colors and types, quinoa, potatoes and corn.

Why go gluten free?

If you feel you have celiac disease and have been tested with a blood test and a small intestine biopsy and it is confirmed then going gluten-free could be your answer. Celiac disease is “an autoimmune disorder which causes destruction to the villi or lining in the small intestine when foods with gluten are eaten. This leads to pain, fatigue, memory issues and a lower quality of life.”

The second reason to go gluten-free would be for non-celiac gluten sensitivity, known as NCGS. There is no specific test for this condition, but those who eat wheat pasta, barley cereal or rye bread and get “bloating, rashes, fatigue and mental fogginess” may do better going gluten-free. Being allergic to wheat is different than having celiac disease since you can continue to eat other grains including barley and rye without side effects.

With diabetes you could lower your gluten foods if you desire and add fruits and vegetables or gluten-free grain carbohydrates. Once again, it is more about the portion size and timing of the food than the choice of gluten or gluten-free carbohydrates.

Gluten may be added to bulk up soups, protein & energy bars, salad dressings, sauces, chips and soy sauce. FDA guidelines still do not need to list gluten in the product so if you do have celiac disease, be very cautious.

“But I’m sure I can lose a ton of weight if I go gluten-free which will help my diabetes.”

There are plenty of foods that are gluten-free that will still cause weight gain since they contain carbohydrates and calories. Stick to foods you can pronounce and easily recognize. Think about foods such as amaranth, millet, peas, lentils, sorghum, rice, potatoes and corn which are gluten-free but can still raise blood sugars and add weight when eaten in large portions. The eating goal with diabetes should be to add a variety of fresh, local, whole foods which contain vitamins, minerals, antioxidants and nutrients with or without celiac disease.

Think back to the Mediterranean diet which includes lean protein, lots of fish, whole grains, legumes, herbs and spices, some fruit and nuts, olive oil and a splash of red wine. Limit red meats, sweets, dairy and eggs. Not only is this way of eating recommended for heart disease, hypertension and diabetes, but also for a reduced incidence of cancer, Parkinson’s and Alzheimer’s. Oh yes, and get plenty of exercise including aerobics for increased insulin sensitivity and weights or resistance training for more muscle mass which increases metabolic rate and calorie burning. This will help with diabetes control more than going gluten-free along with taking your medication properly and keeping doctor visits.

These tips will not only help with your diabetes but with your future health! Good Luck!

Have a question or comment? Post below or email me at [email protected] if you would like to share them with ADW diabetes.

NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.