Wil Dubois

Yep, we're sticking with our fear theme for the month of October. Who's afraid of a big bad flu shot? You might be surprised!

Only way to find out is to brave this edition of our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}


Nancy from Pennsylvania, type 1, writes: I was wondering if any other PWD has had this happen to them. I was diagnosed with Type 1 five years ago at the age of 48. The first two years of my diabetic life I received an annual flu shot. However, 2 years ago I started wearing an insulin pump. I went for my annual flu shot and within two weeks of getting my shot, my basal rate increased two-fold. Not Happy! I discussed this with my endo and she really had no explanation for this increase. This basal increase was permanent. I haven't gotten a flu shot since and my basal hasn't increased. I've had a consistent A1C of 5.8-6.0 so it's not like I don't take care of myself. Afraid to get the Flu shot again...


Wil@Ask D'Mine answers: Yeah, I know: we talked about the flu shot here at Ask D'Mine just the other day. But this was so frickin' bizarre I just had to talk about it (no offense Nancy). First, I gotta say, I've never seen anything like this happen. I've never heard of anything like this happening. I even spent some time with my favorite search engine and couldn't find anyone else reporting anything like this. Well, there was this one guy, but he was also talking about his alien abduction experiences and his past life as Elvis, so I wasn't inclined to give his flu shot story much credence.

You, however, don't seem to be a kook, so we need to figure out what's up with your basal. Next, I fired off an email to an endo friend to ask her if she'd ever heard of anything like this happening before and her reply was "Nope. And cannot think of a mechanism that would cause it either."

So flu shot 101: A traditional flu shot is just a vial of dead flu. It's used to prime the body's immune system to recognize the live flu virus. The nose spray stuff is live flu, but it's had the crap kicked out of it first so that it's very weak. You can think of either one as training wheels on a kid's bike. You use the training wheels to learn how to ride. Once ya got it down, you take the wheels off and you're fine. Your body needs to use flu training wheels for about two weeks after the shot, then it can tackle real live flu viruses.

So for two weeks your body is developing its immune response. I could see, maybe, by some stretch of the imagination, that you might need a wee bit more insulin during that period. But a two-fold increase? Holy crap! And then one that stays around? Also deepening the mystery is the fact you'd had two annual flu shots previously with no ill effect (but of course every year it's a different strain). Also weird is the fact that the basal issue hit pretty much at the end of the immune response period, not at its onset.

You're not gonna like what I have to say next.

I think whatever caused your basal change had nothing at all to do with the flu shot. Issues of cause and effect can be really tricky. That's why it takes so many months to investigate plane crashes. A plane goes down in a storm. Did the storm cause it? Maybe. Or maybe the engine failed. Or the crew was drunk. Or the wing broke.

So bear with me for a moment. Assume, just for the sake of argument, that the flu shot wasn't the cause of your permanent two-fold jump in basal. What else could have caused it?

One thing that jumps to mind has to do with the unique kind of diabetes you have. You're an adult-onset type 1 like me. We're kind of an odd-ball set. (Note that this past week was an awareness campaign about this kind of diabetes, called LADA.) One of the more bizarre elements of adult onset is an extremely extended honeymoon phase. The honeymoon phase is like Custer's Last Stand at the Battle of the Little Langerhan. Picture the poor troops of the Beta Company surrounded by the circling bloodthirsty savages of the immune system, intent on great bodily harm. (Attention beloved Native American readers: no offense intended, just go with the flow of the analogy, OK?) The insulin-producing beta cells keep up the fight as long as they can, but ultimately, they are killed to the last man by the body's haywire immune system.

The honeymoon phase is actually a pain in the ass, as far as I'm concerned—both from clinical and personal experience. Some days the pancreas can squirt out some insulin. Other days it can't. Some days it squirts out quite a bit, other days not so much. It's like juggling feral cats. It's a blessing when the last troops fall because then all the insulin has to come from outside your body and, frankly, it's easier to control that way. Fewer variables.

In most younger type 1s, the honeymoon phase lasts a few months. Rarely more than six, but sometimes up to a full year. In adult onset folks, however, the honeymoon can run longer. A year and a half. Maybe two.

Three years seems a stretch, but that could be what happened to you. It could be that your body had some stable endogenous insulin production for several years, but the savage immune system finally broke the lines of the last standing beta cells and wiped them out. Did the flu shot have anything to do with it? Ummm.... Maybe? I mean the flu shot is designed to kick the immune system in the pants, after all. Did it stir up the natives, as it were? I don't know. This is probably where I'm supposed to say, "Damn it Jim, I'm a writer, not a doctor."

We should also look to your pump. How long had you been on the pump when this happened? It looks like you got it the same year you got the killer flu shot. Normally you'd use a lower total daily dose of basal on a pump than with shots, but your mileage may vary. Are you sure you had all the pump settings dialed in right? This generally takes some time.

I should also ask if you changed the style of infusion set on your pump. Oh, and did you...errr... you know... gain any weight? Any changes to other meds? I've got quite a long list in my office of meds that tend to f—[D&R1] , up blood sugar. Various psych meds, steroids, and hepatitis C meds tend to be the worst, but blood sugar can also be raised (requiring more basal) by dozens and dozens of meds for every malady under the sun, even including cholesterol-lowering drugs and some vitamins.

I can understand that you are not happy, but does it really make a difference how much insulin your pump pumps so long as your A1C is so awesome? (And I am very jealous, by the way.) And I can understand why you are afraid to get another flu shot. You have visions of another two-fold increase dancing in your head. I mean, if that actually happened every time you got a flu shot you'd need to get a super-sized pump in a couple of years!

So I validate your fear. Once burned, twice shy. I get it. I understand it. I don't believe your flu shot caused the basal issue, but there is no way to ever know for sure. Crazy unheard of things happen every day, right?

The flu shot is part and parcel of good diabetes therapy, but it's not like you're going to die without it. Well, you might. I mean, you could get flu, get pneumonia, and die. Happens to almost 50,000 people a year; but you could just as easily be run over by a FedEx truck while jaywalking.


I guess I wouldn't blame you for skipping the shot if that's the choice you've made.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.