Diabetes and Vaccinating Against H1N1

by Leighann on November 9, 2009

(November 9 is D-blog day. Though this post is about vaccinations, diabetes permeates our daily lives and many of the decisions we make for our family.)

I tend to stay out of the whole vaccination debate. I know some parents choose not to vaccinate their children for various reasons or beliefs. We have decided to vaccinate our children as scheduled and as advised by our doctors and by the American Academy of Pediatrics.

As a parent of a child with an underlying health condition, I have been asked by several parents what I personally think about vaccinating against H1N1 and what I would suggest for them. And while I am about to give you my reasoning as well as some information from the CDC, which I consider a reliable source, you can make your own decision for yourself and your family and I encourage you to go the the following websites (www.cdc.gov/flu, www.cdc.gov/h1n1flu, www.flu.gov) as well as speak with your own physicians for advice.

Our First Sick Day

You already know that my daughter Q was diagnosed with Type 1 diabetes in the spring of 2008. Although we had her condition under control, a simple illness last fall wreaked havoc on her health. She got whatever was going around her preschool. An illness that might make most healthy children down for the count for a few days, but back playing in no time.

She was home from school when her blood sugar levels began sky rocketing. Illness, any illness can make blood sugar levels rise, even with insulin boluses to try to bring them down. I had left messages both with the endocrinologist in St. Louis and with our local pediatrician as this was our first real “sick day” since diagnosis. While waiting on return calls, my daughter sat down to eat her mid-morning snack. Sitting at her usual spot, she turned to me and before a word came out of her mouth she vomited on the floor.

The scary thing for a diabetic is that vomiting can mess with blood sugars, especially when you’ve recently given insulin to cover food that is no longer in your stomach, but on the floor.

But, was the vomit because her blood sugars were so high that she was developing ketoacidosis? Or was it from her illness?

I was frantic at this point. I was able to check her urine for ketones and it was positive. Her blood sugars were in the 300 or 400’s. I finally talked to the nurse in St. Louis and she said to take her to the emergency room. As I was getting our things together, the local nurse called and advised the same.

Of course my parents were out of town and my husband was unreachable at work, which only added to the panic as I could not take the little guy with us. Eventually we made it to the emergency room where an inept nurse made three attempts to get an IV in her. (I was not happy about that!) We were told that the only doctor who would see a diabetic child himself was sick and that if her blood sugar levels and ketones didn’t decrease that they would have to transport her to St. Louis.

In the end she ended up staying over night to get extra insulin under their watch and lots of fluid and she returned home the next evening. Of course after our hefty deductible (I will pay whatever it takes to make sure my kids are healthy, but it still hurt to fork out that money).

Our first sick day was quite traumatic for me as her caretaker because I didn’t know what to do or how bad it would become.

(Care teams always tell newly diagnosed patients to get in contact with them on their first sick day for exactly this reason.)

Sick Day This Fall

Q began kindergarten this year and week after week notes were sent home saying that someone in her class presented with flu-like symptoms. At the first chance we had, the entire family went to the flu shot clinic and got the vaccine for seasonal flu.

One Monday I got a call saying that my daughter’s blood sugar was in the 300’s at lunch. I drove over and she was negative for ketones. She seemed fine otherwise and was in a hurry to get out to recess.

The thing is that often her blood sugar levels rise before there is any physical manifestation of illness. By the time I picked her up at 2:45 she was feverish and lethargic.

Tuesday morning I talked with our pediatrician’s office securing an appointment for that afternoon with the on-call doctor. Between the morning and afternoon, my daughter did develop ketones. I was fearful that we were heading in the same direction as before and would end up in the hospital.

Her symptoms other than fever included a sore throat and fatigue. She was tested first for strep throat and then for the flu. (Neither test was joyful and I had to talk her down from near hysteria when they threatened to hold her down and do the tests against her will.)

Though the rapid tests were negative, a few hours later the doctor told me that she should be started on Tamiflu just in case it was the flu. If you test positive for flu, you definitely have it, but a negative result does not mean you don’t. A trip to Walgreen’s at 9:00 PM and we began treatment.

Her fever subsided the next day, but her blood sugars and ketones remained high. Any other child would have been able to return to school 24 hours after being fever-free. But she needed her blood sugar levels and ketones closely monitored, should she be headed toward ketoacidosis.

The H1N1 Vaccine

Before her bout with illness, I was undecided on the H1N1 vaccine not having given it much thought since it wasn’t available in our area yet. I saw a story on 60 minutes showing kids and teenagers in perfect health who were fighting for their lives. I listened to how the H1N1 vaccine is made and why it affects the young so severely. I was sold. When the school district sent home a form asking if I would like my child vaccinated, I signed on the dotted line.

A couple of days later the public health district announced that it was having a clinic to immunize those children 6 months to 5 years. My husband took our son.

Not knowing exactly when they would be vaccinating in school, I called public health the next day and asked if I could bring my daughter to the clinic since she’s five. I took her that afternoon. When they said that they were also offering it to caretakers of high risk children, I decided to get the vaccine myself.

Both children still need their second dose and vaccination in the school doesn’t occur until mid-November. Since immunity doesn’t begin immediately, I am glad that my children received the vaccination at the earliest time for our area. None of us have had side effects except for sore arms. We all got the injection rather than the mist. (Children and adults in high risk categories should not receive the flu mist which contains live virus.)

Why Diabetics Need Protection

It’s not the flu that is necessarily going to adversely affect your diabetic child, but what the illness does to the diabetes. As you learned from our story from last fall, an otherwise perfectly healthy diabetic child can quickly go from bad to worse and need immediate emergency care from exposure to even the mildest of illness.

I wouldn’t want my own child to suffer the complications from the seasonal flu or H1N1 if there was a prevention available.

Advice from the CDC

Although my children have already received the first vaccination, I participated in a conference call last week with CDC pediatrician Dr. Georgina Peacock to learn more about H1N1 and the vaccine. Because I have been asked my opinion so many times, I wanted to hear first hand what the experts are saying and ask questions of my own to confirm my thinking.

The doctor reiterated what I already knew:

  • That the vaccine is made the same as the seasonal flu vaccine which has a history of being safe.
  • The H1N1 vaccine is only separate from the seasonal flu vaccine because the strain was introduced too late to be included in the regular vaccine.
  • H1N1 can cause complications for diabetics because blood glucose levels can be elevated during illness.

(From the CDC website🙂 Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

CDC resources about the flu:

More CDC resources for people with diabetes or other health conditions:

Keep your sick kids home from school. Visit www.cdc.gov/h1n1 for more information.

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