Protecting Yourself from Pneumonia: Essential Tips for People With Diabetes

With flu (and now, COVID-19) season in full swing, people with diabetes face the added challenge of being more susceptible to pneumonia. 

Pneumonia is a serious infection of the lungs that can be triggered by various pathogens, including viruses, bacteria, or, in rare cases, fungi and parasites. While it can affect anyone, certain groups are more vulnerable to pneumonia. Children under five and adults over 70 years of age, as well as individuals with chronic health conditions like cardiovascular disease, chronic kidney disease, and diabetes, are at a higher risk of pneumonia. Understanding its impact on people with diabetes is crucial for preventing and managing potential complications.

Symptoms of pneumonia

Our lungs have millions of tiny air sacs, called alveoli, that help take in oxygen and eliminate carbon dioxide. In pneumonia, these alveoli fill up with fluid or pus, making it difficult for the lungs to function and oxygen to reach our bloodstream. Pneumonia can cause the following symptoms:

• Chest pain that may get worse when you breathe deeply or cough
• Cough, which may produce discolored mucus
• Shortness of breath
• Fatigue 
• Fever, sweating, or chills
• Loss of appetite
• Nausea and vomiting (especially in children)
• Confusion (especially in older people)

If left untreated, pneumonia can lead to several complications, including respiratory failure, lung abscesses, and acute respiratory distress syndrome – a severe form of respiratory failure. 

It’s important to seek medical care if you’re experiencing any of these symptoms, as early diagnosis and treatment can help prevent complications and improve overall outcomes. 

Are people with diabetes at higher risk?

Diabetes, along with heart disease and chronic liver disease, is among the most common health conditions that put people at higher risk of developing pneumonia. Studies have shown that diabetes is also linked to a higher risk of more severe illness, especially in people with COVID-19 pneumonia. 

“Those with diabetes are exposed to a higher risk of infection in general, including respiratory infections,” said Dr. Stefano Del Prato, an endocrinologist and chair of the European Diabetes Forum. “Their defense mechanisms against microorganisms are impaired due to the deleterious effect of chronic hyperglycemia,” he explained. 

In other words, when blood sugar levels are too high for a long time, the body's immune defense is weakened. High blood sugar can compromise the function of neutrophils, a type of white blood cell that acts as “first responders” that rush to the site of infection to destroy pathogens. Studies are still being done to better understand the impact of diabetes on the immune system. 

Pneumonia prevention

Although people with diabetes are at an increased risk of developing pneumonia, there are steps you can take to prevent becoming infected and avoid the complications of this serious respiratory illness. 

Get vaccinated

Both the Centers for Disease Control and Prevention (CDC) and the American Diabetes Association (ADA) recommend certain vaccinations for people with diabetes, some of which can help protect against the viruses and bacteria that cause pneumonia.

There are two types of vaccines in the U.S. that protect against the bacteria that cause pneumonia, including pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20) and the pneumococcal polysaccharide vaccine (PPSV23, or Pneumovax). The type of vaccine and how many doses you need depends on your age and vaccination history. In general, all children should receive a four-dose series of PCV13 or PCV15 by 15 months of age. For people with diabetes who didn’t complete this series, the CDC recommends following a catch-up schedule. 

Viral infections like the flu, COVID-19, and respiratory syncytial virus (RSV) can be complicated by pneumonia. The ADA and CDC both highly recommend an annual flu shot for adults with diabetes. 

Also on this list is the vaccine for COVID-19. It’s recommended that individuals six months of age and older receive the initial COVID-19 vaccine and any available boosters. Additionally, adults with diabetes who are 60 years of age or older should receive a single dose of the RSV vaccine. 

It’s important to discuss your immunization history with your healthcare provider so that they can provide individualized recommendations for ways to protect yourself against pneumonia and viral infections that can cause pneumonia. 

Other prevention tips 

While everyone can take certain preventative measures to protect against infection, such as washing hands frequently, avoiding smoking, and maintaining overall health through a balanced diet and regular exercise, it’s important for those with diabetes to also manage their blood sugar. For example, one study found that metformin use was associated with significantly lower risks of bacterial pneumonia and better respiratory outcomes in people with type 2 diabetes. It is important for all people with diabetes, including those with type 1 and type 2 diabetes, to frequently monitor their blood glucose levels.

How to take care of yourself with pneumonia

Healthcare providers use a variety of methods to diagnose pneumonia, including clinical symptoms (as described above), chest X-rays, and blood tests. Usually, a course of antibiotic treatment is prescribed, but regardless if the cause is bacterial or viral, staying hydrated and getting lots of rest can also help your body recover from infection. 

For people with diabetes, it is especially important to frequently monitor blood glucose levels. Del Prato explained that even if your blood sugar is typically well-managed, having pneumonia can still cause it to rise. This is because when the body is fighting an infection like pneumonia, it releases certain hormones (like cortisol and glucagon) to help cope with the stress. These hormones can make the body less responsive to insulin. As a result, blood sugar goes up, even if diabetes is well managed. 

“On the occasion of an infection such as pneumonia, blood glucose needs to be carefully monitored for timely treatment adjustments, often requiring the introduction of insulin treatment or adequate insulin dose titration,” said Del Prato.

The bottom line

People with diabetes are at higher risk for developing pneumonia – but with the right precautions, it’s manageable. Vaccination, blood sugar management, and prompt diagnosis and treatment are key to preventing complications. By staying proactive and working closely with a healthcare provider, you can help reduce your risk and recover more quickly.

Learn more about protecting yourself against infection here:

• How To Start Using a CGM
• Sick Day Management: Practical Tips, Strategies, and Advice
• What You Should Know About COVID-19 Vaccines and Diabetes