Immunity, vaccination, and risks of Covid for people with diabetes

Covid19 Vaccine update: boosters, variants, and diabetes

Let’s discuss immunity, vaccination, and risks of Covid for people with diabetes. 

We are now more than 18 months into our national response to the spread of the Covid 19 coronavirus in the US.

WE have been through lockdowns, mandated masking, and then vaccination drives. This did something amazing! It controlled and reduced rates of death of a pandemic novel virus for the first time in history! The last time a novel virus hit humanity on this scale it led to the infection of more than 1/3 of the world population and the death of 1 in ten of those people over roughly 2 years. But due largely to vaccination we have been able to quickly reduce death rates from Covid in the US and most of the developed world.

WE were getting to the point of social gatherings resuming, mask mandates lifting, and we all saw the horizon of “back to normal” glowing brightly.  But like a bad infomercial, the CDC shouted “But wait! There’s more!”

Now we find ourselves at risk of being once again mired in delta variant, boosters, breakthrough infections and the threat of hopelessness looming. Questions are rising:

If people who’ve been vaccinated for Covid19 are getting sick are vaccines even working?

The purpose of vaccination is never to completely prevent infection. As we see every year with the flu virus; we can still GET sick after vaccination largely because there are so many variations on the virus out there. In fact, even with vaccinations like chickenpox, the virus still gets in our body, it just means that our body has had a chance to mount a defense in advance. We can recognize the virus more swiftly and so any infection is far less severe, typically to the point of no symptoms as all. But the flu shows us that a small variation in the virus means that it may take more time for our body to identify the virus and initiate the fight. But the troops are still at the ready so we can fight it more effectively even though the small delay in defense means we do get symptoms. Though case rates are increasing death rates among vaccinated people have plummeted. Through vaccination, we have begun to turn the tide of Covid from a deadly pandemic to a manageable endemic.

Why do I only need one flu shot per year but now I need another Covid booster?

There are a few reasons for this difference. The first being the novelty of this virus to humanity. Flu vaccines have been around for about as long as humans have (they might even predate us!)  And so over generations we have been exposed and our bodies have built some intrinsic ability to identify and fight these infections. We also gain antibodies from our mothers through breastfeeding. But this virus is so new that we have none of that so it takes 2 shots to get immunity boosted to the most effective levels.

However, over time we see a waning in immunity. We lose immune memory and that reaction time to the virus gets delayed. The booster refreshed the immune recognition of the virus and speeds response. This is particularly important against the Delta variant which reproduces at a higher rate and is more infectious than the original form that we have seen great results with. Elders lose immune memory more quickly, and people who are immune-compromised don’t have the ability to retain that immune response over time effectively, so they are the first line for boosters. For the rest of us, we are getting boosters to boost our immunity since the new variant is more infectious. When the enemy gets faster we want to stay on our toes.

Ongoing vaccinations also allow for adjustment of the vaccine to meet currently prevalent variations of the virus and so we are likely to continue to see updated versions of both the flu and covid vaccines in years to come.

People with suppressed immune systems should get boosters now, but others should wait until 8 months after their last shot, what about a person with an autoimmune disease like Type 1 Diabetes?

As people with diabetes, we are not innately immunocompromised. In fact, the fact that we have an autoimmune disease means our immune system is strong enough to kick our own butts! So we are no more likely to get sick or get sicker than the general public. Poor glucose management can reduce our circulatory abilities and with reduced circulation, it becomes much harder to fight infections, so chronic elevated blood sugars can leave our immune system less able to fight back once we encounter an infectious agent.

So diabetes alone is not a reason to get an early booster. We are fine to wait the 8 month period to get our booster with the general public.

What about Covid boosters and flu shots?

Last year the recommendation was to wait 2 weeks between all forms of the covid vaccine and flu shot, however, data has shown this to be unnecessary and this has been lifted. We can now get our flu shot and covid vaccine/booster on the same day.

What can I expect after having the covid vaccine booster?

The short answer is, we don’t know for certain what if any impact we will see on blood sugars post booster. We know that in those who have had a booster shot there are reports of localized discomfort, but reports of larger immune responses causing symptoms on par with the earlier immunization series have been lower. It seems that this small boost to the immune system causes less symptomology than the big initial introduction to the system. We can then infer that any blood sugar impact would also be much smaller since blood sugar impact tends to be commensurate with symptom severity and duration.

I got a covid vaccine to protect others but now I have to wear a mask because I might still transmit the virus, what’s the point?

Though we may have the possibility to get covid those infections are going to be far less severe and far shorter in duration than what we would experience without vaccination. This means that our “viral shedding” levels or the level of virus that we transmit into our surroundings to possibly infect others, will be significantly lower, and of a much shorter duration. Getting vaccinated still helps protect those around me. But wearing a mask continues to be an added step in community protection. It continues to add a layer of protection for those who cannot be vaccinated and the rare few who have a poor immune response to vaccination.

But a far larger reason that vaccination is helpful to the community is to reduce viral evolution and further variants. When viruses get to live in a host for a long time there is more likelihood that the virus will adapt, and we get variants like Delta. So “naturally” acquired Covid infection and immunity leads to longer time of illness and so more variant evolution.  Variants also emerge when the virus has plenty of different hosts to transmit through. The more transmission through more people the more likely we are to see variants, and the more likely those variants are to cause harm. Through vaccination, we can reduce the available number of hosts. (remember SOME people who are vaccinated may get an active infection, but most will not) This creates small pools of available hosts for the virus and limits its potential to change.

I thought Covid doesn’t get kids sick, but now I hear about kids in the hospital with Covid? Should my kid with type 1 diabetes be at school?

Fortunately, though we are seeing more symptomatic infections in kids from the Delta variant than Covid has shown in the past, severe illness in children is still extremely rare. Is it possible? Of course, if enough kids get ANY illness some of them will end up in the hospital from it. (last month my son got laryngitis. We all know this is not a serious illness, it is usually not treated at all other than vocal rest, hydration and maybe ibuprofen for comfort and swelling. After 48 hours with laryngitis my son was in the emergency room fighting for his life with an acute respiratory event! The swelling of the laryngitis was so severe that he got what is commonly known as croup which became life-threatening. Croup sends thousands of kids to the ED every year, but that does not mean that laryngitis is a threat to the safety of our children. My kid just came out on the bad side of the mathematical odds. Boy as people with type 1 diabetes aren’t we familiar with getting the short end of the statistical stick!) Risk assessment is not based on individual results of individual events to individual people, it is based on the potential for long-lasting harm vs the developmental, physical, and academic needs of our children. (I think we would all agree that I would have been a bit too risk-averse if I had decided to home school my child for fear that he may someday once again contract a virus and get laryngitis, but we also can all sympathize with the fact that I am a little more attentive when he wakes coughing in the night and his next sore throat will likely have me a bundle of maternal dread. We can never judge one another on our fears or feelings because we never know what the other person has seen and been through that lead them to what they are feeling)  This is an assessment all parents make every time we let our children play, go to school, ride in a car etc.

So statistically speaking Covid and the delta variant remain a very low risk to our children. Vaccination to reduce that risk and reduce the potential for viral transmission continues to be the purpose of vaccinating our young people. We should continue to make risk assessments regarding or children based on our families, our values, and our child’s needs and make the decisions that work for us with confidence knowing that each child’s path will be different and children thrive in and through adversity. It may be hard for us to watch when our kids don’t get the same cherished childhood experiences we had, but they are building their own cherished memories along the way. If we model to them a mentalist of rational assessment, confident action and disregard of the very loud voice of popular opinion, they will thrive and grow stronger through this time rather than having the scars of fear and judgment on their childhood.

What are you doing?

As a health care provider, I am always aware that I need to live my life demonstrating that I “believe what I preach” So my family is vaccinated, and when the Covid vaccine is approved for younger kids my son will be too. In the meantime, we wash our hands, hydrate and eat healthy foods to support our wellness. We take added precautions before visiting with anyone who is immunocompromised or aged (like extra hand washing, masking up, avoiding physical touch and surface contact that could spread infectious agents to them. When we are ill and contagious, we stay home. My son is in pre-school and per state mandates we mask up in public spaces.  I keep my blood sugar management in healthy ranges, but I also enjoy life. We go to the park, we worship, we go to work. We make choices for our family based on our needs and values and we consider the effects our actions have on those around us. We don’t watch the news very much and we do not engage in judgmental spaces regarding our health, our parenting choices, or those of others.

I hope this info helps you make healthy choices and helps shed some light in these hazy and often dark times. We continue to be available here at IDS for patient consultations both in-office and remote to meet the needs of our community and will continue to share information impartially and frankly.