Just like many chronic illnesses, type 1 diabetes (T1D) can “open the door” to viruses and bacteria, especially when blood sugar levels are high over a long period. 

If you live with T1D, and depending on your age and blood sugar control, you’re up to four times more likely to be hospitalized with an infection than the general population. And although modest, the risk of death is also higher for people with T1D.

Vaccines help fight against infections, especially viruses. Diabetes specialists’ associations and public health authorities therefore recommend that people with T1D follow their province’s vaccination schedule for the general population and receive a few additional vaccines as well, which are often offered free of charge to people with diabetes. 

However, please consult with your healthcare team before you make an appointment. While vaccines are safe and reliable for people with T1D, some are not indicated if you have allergies or a weakened immune system (e.g., if you take medications that weaken the immune system, such as treatments for certain cancers or forms of arthritis, or following an organ transplant). 

The vicious circle of T1D and microbes

If your blood sugar remains above 10.0 mmol/L most of the time on a daily basis, your immune system may be weakened, making you more vulnerable to viruses and bacteria.

When you’re sick, your blood sugar levels may be even higher and even harder to keep within the target range (between 4.0 and 10.0 mmol/L), which will make you predisposed to complications (e.g., pneumonia requiring hospitalization). Infections are stressful for your body, which will release large quantities of glucose into the bloodstream and reduce the effectiveness of insulin. These two phenomena working together is the perfect recipe for hyperglycemia, and it often requires an increase in insulin doses. But, be careful! If you’re having difficulty eating sufficiently, or if you’re vomiting, you may experience hypoglycemia. 

Contracting an infection will cause a blood sugar imbalance, which will ultimately put you at an even greater risk of contracting other viruses or bacteria. Hyperglycemia caused by infections often leads to additional medical visits and hospitalization.

To avoid getting caught in this vicious circle, it’s important to maintain good general health, limit your exposure to tobacco smoke, adopt good hygiene habits (including washing your hands regularly) and consider vaccination.

Do vaccines carry any risks?

Vaccines are not guaranteed to provide total protection against an illness, but science has clearly established their effectiveness in reducing the risk of contamination and, particularly, the risk of contracting a serious infection. For example, the influenza vaccine won’t protect against all respiratory infections. And some years, the vaccine will even be slightly less effective, but it will still protect against severe forms of the illness. 

Vaccines are associated with unpleasant side effects such as aches, pain at the injection site and fatigue, but these are often minimal and temporary. The risk of serious complications does exist, but it is very, very marginal. 

As the advantages outweigh the disadvantages, vaccination is considered safe and is recommended for everyone, and especially for people with T1D. Vaccines don’t affect your blood sugar control (except for possible moderate and temporary hyperglycemia following the injection), whereas infections often result in significant and prolonged hyperglycemia, predisposing you to serious complications (e.g., more severe symptoms, hospitalization).

Which vaccines are recommended?

Of all vaccines available, some are specifically recommended for people with diabetes. 

Recommended vaccines for T1D

Influenza (flu)

Why?

  • Highly contagious respiratory infection caused by the influenza virus.
  • T1D is associated with a higher risk of developing complications such as bronchitis, sinusitis, otitis and pneumonia, which may require hospitalization. 
  • The vaccine reduces the risk of hospitalization by 40% for people with diabetes (type 1 and type 2).

Who?

  • People aged 6 months and over living with T1D, and their families.

When?

  • Yearly vaccination in early autumn.

Cost?

  • Free across Canada.

Pneumococcal infections

Why?

  • Pneumococcus-type bacteria found in the respiratory tract, causing infections such as sinusitis, otitis, pneumonia and meningitis.
  • People with diabetes (type 1 or type 2) are 2.5 times more likely to develop such infections, to be hospitalized and to suffer rare but potentially permanent after-effects (e.g., deafness, brain damage). 
  • Vaccinated individuals see a significant reduction in the risk of hospitalization for pneumonia.

Who?

  • Children and adults: T1D is included in the criteria for people at risk of pneumococcal infection.

When?

  • Vaccination in childhood, then at age 50 and over for people with T1D.

Cost?

  • Free in many provinces: check with your doctor.

Hepatitis B

Why?

  • Virus transmitted mainly by blood, e.g. through unprotected sexual contact or the use of poorly sterilized equipment (syringes, tattoo needles, razors, etc.), which infect the liver.
  • Risk of contamination doubled for people with T1D aged 23 to 59, especially if the injection equipment or capillary glucose monitoring equipment is shared with others.

Who?

  • Infants and toddlers (according to your province’s vaccination schedule).
  • Adults who were not vaccinated as children, especially those who are immunosuppressed or considered at risk.

When?

  • In childhood.
  • Adult age if considered at risk.

Cost?

  • If you haven’t received it, you could have it free of charge if you meet the criteria for people at risk. Diabetes is not specifically cited, but can be entirely justified.

Zona (shingles)

Why?

  • Develops when a virus that is dormant and hidden in the body’s lymph nodes, the varicella-zoster virus, becomes active due to a weakened immune system that may be caused by stress, age, medication or other health issues (particularly, high blood pressure or heart problems).
  • Causes a painful rash along a nerve, mainly on the chest, neck or eyes. 
  • Over 60% of cases occur after the age of 45. 
  • The vaccine (Shingrix) is said to be over 90% effective for at least 10 years.

Who?

  • General vaccination for people aged 50 and over.
  • People aged 18 and over who live with a chronic condition.

When?

  • Adults.

Cost?

  • Free of charge in some provinces for immunosuppressed people aged 18 and over. 
  • Generally free of charge for seniors (age criteria vary by province).

Tetanus

Why?

  • Bacteria living in soil and excrement that can contaminate the human body through a wound. 
  • Fatal infection if not treated.
  • Can also be transmitted from person to person. 
  • The two main risk factors are diabetes with wounds (e.g., diabetic foot characterized by cracks and fissures) and injection drug use.

Who?

  • Adolescents and adults.

When?

  • In adolescence, and booster dose age 50 and over.

Cost?

  • Free across Canada.

COVID-19

Why?

  • Living with T1D does not increase the risk of contracting COVID-19. However, you are considered at high risk of developing more severe symptoms and complications related to this virus (e.g., pneumonia, acute respiratory distress) after the age of 60 and/or if you have additional health issues, such as overweight or kidney failure. 
  • According to recent studies, men are significantly more at risk than women.

Who?

  • Everyone.

When?

  • Vaccination is recommended every six months if you have not contracted COVID-19 during that time.

Cost?

  • Free across Canada.
  • A combined COVID-19 and flu vaccine will soon be available.

What about children? 

According to various studies, children and adolescents who live with T1D and manage to keep their blood sugar levels within the target range generally don’t contract more illnesses and infections than those who don’t live with this condition. However, if they get sick, they run a higher risk of complications and hospitalization.

In the event of illness, vaccination, particularly against pneumococcus and influenza, helps to fight microbes and prevent complications and unbalanced blood sugar levels. No additional risk of triggering other autoimmune diseases has been reported in children and adolescents with T1D.

Health authorities recommend that children be vaccinated according to the regular vaccination schedule, with the addition of the annual flu vaccine starting at the age of 6 months.

How to encourage vaccination with family and friends

Your family members are a potential source of infectious agents. Therefore, it is recommended that their vaccination records be up to date, including with the seasonal flu vaccine.

In short, it’s important to keep up with your own vaccination coverage, as well as that of your loved ones. Immunization through vaccines is preferable to immunization through infection. Unlike microbes, vaccines don’t put you at risk of illness-related complications, and won’t destabilize your blood sugar levels. 

 

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Written by:  Nathalie Kinnard, scientific writer and research assistant

Reviewed by:

  • Rémi Rabasa-Lhoret, MD, Ph.D.
  • Sarah Haag, R.N., B.Sc.
  • Claude Laforest, Eve Poirier, Jacques Pelletier et Michel Dostie, patient partners of the BETTER project.