Wil Dubois

Welcome back to our diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

We never know where your queries might take us! Today, Wil's delving into blood diseases and chicken soup...

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


George from Wyoming, type 2, writes: I recently visited my doctor and she told me that I have get an immunization for hepatitis because I have diabetes. I don't practice any high-risk sexual activities, or do drugs, or anything like that. What's up with this? Is my doctor out of line? I never heard of people needing hepatitis shots just because they have diabetes!

Wil@Ask D'Mine answers: Wow. Those Wyoming docs are really keeping on the cutting edge of diabetes care. Nope, she's not out of line. This is brand-new stuff.

This year, the annual Christmas present from the Centers for Disease Control and Prevention (the CDC) to the diabetes community was yet another "ya gotta do it 'cause you got the big-D" recommendation.

On December 23, as Santa's elves were starting to load up the sleigh, the CDC issued a recommendation that advised docs that all persons with diabetes who have not already received a Hepatitis B vaccine should get one. Today. Actually, the real wording states that "all previously unvaccinated adults aged 19 through 59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made."

The CDC has placed their recommendation in "Category A," which is more like a summons to appear before the United States Senate than a casual suggestion. It's medical Defcon 1. Time to go to war.

Why? Because a small task force in the basement of the CDC called the Hepatitis Vaccines Work Group of the Advisory Committee on Immunization Practices (I couldn't have made that up if I tried) crunched the infection data from a whopping 17% of the U.S. population, and after some statistical magic to level the playing field for risk factors, found that PWDs have 2.1 times the risk of non-PWDs of getting Hep B.

Other than being a PWD, apparently, what're the other risk factors for Hep B? According to CDC: IV drug use (the non-prescription kind); male-on-male sex; and people who participate in old-fashioned Roman orgies, or what the CDC boringly calls "multiple partner sex."

Why do PWDs get Hep B at twice the rate of non-PWDs? Well, no one knows for sure, but it probably has something to do with our crappy immune systems. People with more... I don't want to say "healthier" here... give me a sec... Ah! People with more robust immune systems are more likely to clear the virus on their own, while we PWDs apparently don't, and can develop acute Hep B, which is bad news. Not only can Hep B actually kill you, but it's also a bit more likely to kill you if you have diabetes.


Oh, and if Hep B doesn't kill you (and it doesn't kill most people who get it) it can absolutely damage your liver, which then limits what drugs you can take for all that ails you, and has a very negative impact on your ability to enjoy Miller Time.

But seriously, chronic Hep B infections lead to cirrhosis or liver cancer in about 15% of its victims. Treating Hep B is dicey, difficult, expensive, and loooooooooooong. But it can be prevented in most people with a simple vaccine. As we're twice as likely to get it, the CDC has decided that an ounce of prevention is worth a pound of cure. Oh, and you PWDs over age 60? Well, that data ain't so strong, so the CDC has issued a "Category B" recommendation for you older D-folks, giving your doc a little more leeway. And what about the young set? Those under 19? They probably already got the Hep B vaccine already as part of their "childhood" immunizations, usually getting the first shot before leaving the hospital after being born.

I work in health care, so I've already had my Hep B shot. Well, actually, it's three shots, but who's counting? But based on the stats I just gave you, if I hadn't already gotten it, I'd be calling my doc now. I don't want to miss out on Miller Time. Or the opportunity to participate in a good, old-fashioned Roman orgy, should the chance ever arise.


Kim from New Jersey, mother of type 1 kids, writes: When my type 1 children get the stomach flu "bug" their sugars go low or even are in good range. Why is this? Does this "flu bug" do something to keep the immune system from fighting itself? It just seems extremely odd that only this "bug" makes my kids go low in range.

Wil@Ask D'Mine answers: Nope, it's not the bug. It's the chicken soup. Or the Jell-O. Or whatever it is that their poor little stomachs can keep down.

Actually, for what it's worth, most type 1s (well, and type 2s, for that matter) see their blood sugars go UP when they are sick. This is because our bodies release a boatload of stress hormones to fight illness. Ummm... think of it like flipping a switch to turn on a turbo-charger. The body ramps up for the fight. That extra sugar is nature's way of giving the body more energy to fight the good fight. Of course, for those of us with sweet blood, more sugar is the last thing we need.

Having high blood sugar when you're sick can make you sicker, and of course, put you at risk for a high-blood sugar emergency like DKA. So generally, you need to have a sick-day plan that spells out how to safely increase your medications to counteract the stress hormones as you get sick, and how to decrease them again as you get well. Your medical team can help you design a personalized sick-day plan.

But stomach bugs are the exception to the rule. Your body still pumps in all the sugar-raising sick-day hormones, but there's a new element at play that affects the balance of insulin and sugar. When you're throwing up everything you eat, you aren't absorbing as many carbs as usual. In this case, if you leave your insulin levels alone, you can go low.

So there's nothing special about the stomach flu virus. People with the stomach flu just can't and don't eat as much as they usually do.

But wait a sec, you say: I know that they aren't eating hardly anything, so I'm hardly giving them any fast-acting insulin either.

Yeah, I know that, but I'll bet a box of doughnuts and the vial of Novolog needed to cover them, that you didn't change their basal insulin. And that's why they coasted low.

Here's what happens:

For type 1s, we always view our basal insulin as being a foundation of solid concrete, but that's not entirely accurate. Basal insulin should be half of your body's daily needs (50 fast / 50 slow). But what if your body's needs change? If your total daily dose drops, it should drop in proportion. Various things can lead you to need less insulin: weight loss; adding an insulin-sensitizing drug; a significant change in diet; or being sick to your stomach. Most of us can't be bothered, but in theory, when you are eating less—either because you're sick or you're on a hunger strike—you should cut back on your basal insulin as well as your fast-acting insulin.

So flu bug + less food = less need for basal insulin. Or flu bug + less food = lower blood sugar if basal insulin isn't lowered.

Oh, and btw: May I present to you the Persons With Diabetes United Parenting Award? I see you said you have type 1 children. As in plural. As in more than one.

You soooooo deserve an award for all you do on a daily basis. One type 1 kiddo, even when well, is a lot of work. More than one? And sick?

You're a frickin' hero in my book.

DISCLAIMER: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collective experiences -- our been-there-done-that knowledge from the trenches. But we are NOT MDs, PAs, CDEs, or patridges in pear trees. Bottom line: we are only a small part of your total prescription. You will still need professinoal advice, treatment, and care of a licensed medical professional.


Disclaimer: Content created by the Diabetes Mine team. For more details click here.


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.