Your Fall Immunization Checklist

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen W

It’s hard to believe that the last few days of the lazy, hazy days of summer are upon us. I don’t need the calendar to clue me in on this. I just visit my backyard deck and notice the sun has moved so I don’t need the table umbrella anymore to deflect the sun. I do need a hard hat, though, because the acorns are dropping like rocks from the sky!  I don’t have any children I have to get ready for back to school, but I have always been a lover of the back to school mentality:  organization, new beginnings, and fresh notepads!  Now, revealing my love of notepads instead of iPads reveals my generation, so I will admit that Fall also gets me to thinking about my Winter health maintenance.  I want to briefly review some immunizations that should be regularly updated for people living with Diabetes that you can add to your list of things to discuss with your health care provider at your next visit. 

Prevention of illness is important for everyone, but people living with Diabetes may have more complications from some common illnesses.  Everyone with Diabetes should get the flu vaccination in the Fall.  Flu can be a very serious disease that could put you at greater risk for developing pneumonia, and there are reported fatalities due to complications.  The flu vaccine will not prevent other common cold weather illnesses, but it will greatly decrease the likelihood of developing flu.  The flu vaccine is developed each year based on the type of flu that was seen the previous year and projections of the type of flu anticipated in the present season – that’s why it needs to be given annually.

Prevention of pneumonia is also very important as this is another serious disease with the potential for significant complications and death. This vaccine should be given to all people with Diabetes at diagnosis. You will require a booster if it has been more than 5 years since you received the first immunization and if you were immunized before you were 65 years old. There is no scientific data available at this point that supports more frequent re-vaccination.

Tetanus shots might not be high on your list when it comes to preparing for Winter illnesses because rusty nails is what usually pops to mind.  When we received our tetanus immunizations as a child, it was meant to prevent tetanus (lockjaw), diphtheria, and pertussis (whooping cough).  Diptheria and pertussis were thought to be well controlled worldwide, but a tetanus booster would be given every 10 years primarily to protect us if we had a broken bone or a serious cut.  However in recent years, pertussis has increased across the country and a change in vaccine has been recommended.  The Advisory Committee on Immunization Practices (ACIP), the group that develops vaccination recommendations, updated their guidelines for Tdap in June 2012.  The new guidelines state that all adults receive a single dose of Tdap, regardless of the interval since the last dose of tetanus. Subsequent tetanus booster doses should continue to be given at 10 year intervals.

I hope that this review has given you a few topics to think about and to review with your health care provider at your next office visit.  Each person’s health status is individual to them, so take some time to make a list on one of your new notepads:  #1 My Health. You deserve to be #1.


Managing Sick Days and Diabetes

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

Although anyone can get sick at any time of year, it seems that as we approach fall and winter the chances for illness are greater. When you have Diabetes and get sick— to use a pop culture catch phrase— it’s complicated.

When people living with Diabetes talk about sick days, they’re referring to how they’ll take care of their Diabetes when they get a cold or flu. Illness puts additional stress on the body and your blood sugar levels can increase (or be hard to manage in general). But when you’re sick, the last thing you want to do is figure out how to control the fluctuations in your blood sugar!  Things can get very dangerous very quickly if you don’t know what to look for and how to prepare. That’s why it’s important to plan ahead for when you’re sick so you can try to avoid any additional complications, and why it’s a good idea to discuss sick day management with your provider at your next scheduled appointment (before you get sick).

Some common conditions that can require you to use your sick day plan include (but aren’t limited to) colds, flu, stomach bugs, urinary tract infections, and/or skin infections like an ingrown toenail.  Any illness with fever or gastrointestinal symptoms such as vomiting and diarrhea need special attention—even a mild case of any of these illnesses cans cause challenges with your blood sugar regulation.

I want to review a few key points to help you feel confident with your sick day management.  The first thing is you’ll need to check your blood sugar regularly.  At a minimum you should check before meals and bedtime, and you may need to check more often (especially if you’re using insulin).  Next, you’ll need to keep your dietary intake as close to normal as possible.  This may be difficult, especially if you aren’t feeling well enough to eat, but you need to try to keep your carbohydrate intake stable to help with glucose control.  I’ve included a list from the American Diabetes Association website to help you with some food choices (these foods contain between 10 and 15 grams of carbohydrates):


1 double-stick Popsicle
1 cup Gatorade
1 cup milk
1 cup soup
1/2 cup fruit juice
1/2 cup regular soft drink (not diet)


6 saltines
5 vanilla wafers
4 Lifesavers
3 graham crackers
1 slice dry toast (not light bread)
1/2 cup cooked cereal
1/3 cup frozen yogurt
1/2 cup regular ice cream
1/2 cup sugar-free pudding
1/2 cup regular (not sugar-free) Jell-O
1/2 cup custard
1/2 cup mashed potatoes
1/4 cup sherbet
1/4 cup regular pudding

It’s imperative that you continue to take your medications—however adjustments may need to be made. Dosages of sulfonylureas and basal and bolus insulin may need tweaking based on your intake and glucose values to avoid any hypoglycemia. Over the counter medications can be tricky and since many have added sugar in them, it’s always best to check with the pharmacist first (although there are sugar free cough medications and lozenges available).

It isn’t always necessary to call your provider when you’re sick, but it’s best to call them and let them know what’s going on if:

*You aren’t getting better after a couple of days

*You’re having persistent diarrhea or vomiting and can’t keep any fluids down

*You have a fever above 100.5°F that’s not coming down to normal

*You have ketones in your urine

*Your blood sugar readings are consistently above 240 mg/dl after checking twice over a few hours

The biggest thing about good Diabetes management is being as prepared as possible. Many things that may be required during illness are not the things that people with Diabetes might normally keep on hand. I suggest starting a “Sick Day Tackle Box” that has everything you’ll need so when you are sick, you don’t have to try to gather everything when you feel miserable.  Some items to keep in there include testing supplies (extra glucometer, batteries, test strips and lancets, ketone strips), glucose tablets and a thermometer; as well as some regular jello, juice boxes and small cans of regular soda.  Write an inventory list with the contents of you box and any expiration dates and review it every 6 months.  Also, keep an updated list of phone numbers with your health care provider, local emergency room, and family contact numbers on hand.

Living with Diabetes takes a lot of planning, but that planning can keep you healthier and able to enjoy your life to the fullest. Here’s hoping these suggestions are rarely ever needed and we all have a healthy fall and winter.