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How To Treat Flu Or Colds With Diabetes

by John Walsh, P.A., C.D.E.

Flu: Flu Symptoms | Prevention | Flu Vaccine | Flu Treatment
Cold: Cold Symptoms | Treating a Cold | Prevent An Early Demise

Flu season usually begins in early December and winds up in late March, but a 1999 outbreak began in Alaska in September, and unusual summer influenzas have also been seen in some parts of this country over the last few years. On average, adults develop 2 to 3 colds or flus per year, and children as many as 6 to 12.

Knowing when to visit the doctor can be tricky. Here are some criteria to help you make an informed decision.

Consult your physician if:

• a cough gets worse instead of better
• your illness lasts longer than a week
• your symptoms get worse instead of better
• a high fever occurs
• sinus pain, earache, or toothache develops

Viral strains change every year, and about every 30 years an especially severe outbreak or pandemic occurs. A very deadly variant appeared during World War ! and became what is now called the Spanish flu pandemic. Some believe it started on March 11, 1918, at an Army training camp in Fort Riley, Kansas. However, an earlier outbreak probably began earlier in 1916 at a large British war camp near Etaples, France, where large numbers of live chickens and pigs were kept in close proximity to thousands of encamped soldiers. By late spring of 1918, the flu had killed 48 soldiers at Fort Riley. The following fall, it reappeared with a vengence in the fall, killing more Americans, Europeans, Africans, Indians, and New Zealanders than all the wars of the 20th century combined.

The Spanish flu was unusual in that most of the deaths occurred in people in their 20's, in contrast to most flus which prey on the elderly. It is likely that the immune system of those in their 20's had never been exposed to a similar virus, making them more vulnerable. A pandemic of the same magnitude today would kill 180 million people, if it were not for the availability of today's flu vaccines, flu medications (see below), and anti-inflammatory medications.

In the USA, an average of 10,000 excess deaths above the number expected for that time of year occurred each winter between the years 1957 and 1986, with three years showing an excess of 40,000 deaths. During the last pandemic in 1957, there were 70,000 excess deaths in the USA. Historically, virologists believe we are overdue for a pandemic.

Flu

Flu Prevention

Most transmission between people occurs through the air following a sneeze or cough. Although less likely, a virus may also be passed through touch. Simple measures such as covering the mouth and nose with a Kleenex or handkerchief when coughing or sneezing, and washing the hands frequently are some of the most effective ways to reduce viral exposure.

Preventing a flu and pneumonia is easier than preventing a cold through administration of simple vaccines. Obtaining a flu vaccine is recommended for everyone with diabetes before the middle of November each year, but even a late vaccine is better than no vaccine. Vaccination also helps avoid spread of the flu to your family. People who "never get the flu" should remember that they may be carriers even though they never "get the symptoms".

A vaccine is made up of part of different viruses with no live virus present, so it cannot give you the flu. A flu vaccine consists of altered strains of what researchers guess will be the three most likely candidates to spread during the coming winter months. Their predictions are generally far better than those for the weather. Their guess effectively prevents symptoms in 80 percent of people exposed. Only people who should not get vaccinated are those with an egg allergy or a history of Guillain-Barre Syndrome.

Some 80 million vaccines are created each year for use in the U.S. and it takes a week or two for the immune system to respond to the vaccine before it can begin to provide protection. An injected flu vaccine can be used by anyone over 6 months of age, including those with diabetes and chronic medical conditions. Once flu symptoms begin, a vaccine is of no use.  

FluMist(TM) is a new influenza vaccine that is given by nasal spray instead of injection. It contains weakened live influenza virus rather than killed virus. The live virus in the vaccine is cold-adapted so they will grow in the nose and throat cavities, but not in the lower respiratory tract where temperatures are higher. FluMist is approved for use by healthy people between the ages of 5 and 49. It is not approved for use in diabetes or other chronic diseases, in pregnancy, nor in children or adolescents who receive aspirin.

Flu Vaccination Is Highly Recommended For

• everyone aged 50 or older
• those with diabetes, asthma, heart disease, lung disease, history of bronchitis, kidney disease, anemia, HIV/AIDS, or cancer
• if you live or work in residential or medical facilities
• women past the third month of pregnancy between December to February
• medical personnel and their families

All older adults who have children in the household should automatically get a yearly influenza vaccine. A large study of over 300,000 adults over 65 done by the V.A. and published in the April, 2003, issue of the New England Journal of Medicine, found that a simple flu vaccine cut the risk of dying from any cause during the flu months in half among people this age.

Flu symptoms can turn into pneumonia with little warning. An adenovirus infection can trigger a bacterial pneumonia, which kill an average of 40,000 people in the U.S. each year. Especially at risk are those over the age of 65, residents of nursing homes, people with heart or lung problems, and anyone with a chronic disease like diabetes or kidney disease. 

Everyone with diabetes should obtain a pneumonia vaccine which needs be taken only once for lifetime protection. Pneumococci are the most common bacterial cause of bacterial pneumonia and vaccination eliminates this particular risk. A pneumonia vaccine also protects against varieties which are resistant to antibiotics. A pneumococcal vaccine is a terrific investment of your time.

Death rates for the flu are 100 times higher in adults than in children, with the most vulnerable being adults over the age of 50. Remembering their vitality and resistance to flus when they were children, people do not realize how vulnerable they are to the same illness as an adult. The first thing to realize in preventing an unnecessary early death from the flu is that you are vulnerable, especially when you have diabetes.

Someone who is seriously ill, such as with a pneumonia, may have difficulty recognizing how ill they have become, especially as they become oxygen-deprived. Oxygen deprivation can be recognized by others as fast breathing and a greyish discoloration of the skin. With diabetes, an ER visit is needed immediately if oxygen deprivation is seen, the blood sugars become very hard to bring down, you have shortness of breath, your urine shows moderate or large ketones, or your heart rate is high (usually 30 bpm above normal, or over 100).

Prevention:
1. Get a flu vaccine every year. It's a great investment of your time, reduces your risk of dying during the winter months in half, and helps reduce spread of the flu to others.
2. Get a pneumococcal vaccine now! Needed usually once in a lifetime, it prevents about 80% of pneumonia cases, which in most years will cause twice as many deaths as influenza itself.

Vaccination is always your best medicine.

Flu Treatment

Once flu symptoms begin, they can be greatly reduced with certain prescription medications. Two agents, active against the more common influenza A-type virus, are amantadine and rimantadine, which have been used to treat Parkinson's disease for many years. Both are effective against an active flu, but rimantadine is less likely to cause side effects, such as confusion and agitation in the elderly. Ramantadine works very well in treating influenza A, but it is critical to start the prescription as soon as the flu symptoms begin, especially within the first 24 to 48 hours. 

If you have diabetes, are a school teacher, a daycare worker, a healthcare worker, or are at risk for any health reason, talk with your doctor about having a prescription handy for use. Ramantadine and amantadine should not be used by children, pregnant women, or with liver disease, kidney disease, or epilepsy.

Another newer class of influenza medications, called neuraminidase inhibitors, causes modest reduction in flu symptoms. Tamiflu (oseltamivir phosphate) by Roche Laboratories was the first to receive FDA approval and is available in the U.S. by prescription. This class of drug works on both influenza A and B by inhibiting a virus-specific enzyme called neuraminidase. Tamiflu may be more effective at preventing the flu. Doseage is 75 mg. twice a day for five days, but to be effective it must be started as soon as possible. A second neuraminidase inhibitor, Relenza, which is given as an inhaler rather than tablets, must be used with caution due to rare cases where it may cause breathing problems. This may occur in people with asthma and COPD, or in those with no previous breathing problem.

Costs for flu treatment are approximately $5 for generic and $15 for nongeneric amantadine, $25 for Ramantadine, $45 for Relenza, and $55 for Tamiflu. Unless there are other reasons for not taking aspirin, it is the preferred treatment for fever associated with the flu. 

A Cold

Reduce Cold Symptoms

Getting Rid Of Colds: After catching a cold, symptoms can usually be greatly reduced by taking large doses of chelated zinc or zinc sulfate by mouth at the very first sign of a cold. To reduce cold symptoms in an adult, about 50 mg of chelated zinc is needed every 8 to 12 hours until symptoms resolve. Do not take zinc at high doses (the MDR for zinc is 15 mg a day) for longer than a few days when treating cold symptoms. Doses as high as 150 mg a day have been taken for several months in the treatment of rheumatoid arthritis and poor wound healing, but this may cause nausea, vomiting and diarrhea. Prolonged use of high doses may also cause a temporary drop in HDL (protective cholesterol) levels, and create a copper deficiency because zinc competes with copper for uptake.

Clinical studies looking at the use of zinc tablets for the treatment of cold symptoms are rare, but it's easy to tell if zinc is going to work. Have 25 mg. zinc tablets available, and at the earliest sign of cold symptoms, take two tablets. If the zinc is going to work on this viral strain, your symptoms will largely disappear within 30 to 60 minutes. If a marked improvement is not seen following the first dose, zinc is unlikely to work for that strain or for whatever else might be causing your symptoms.

Zinc treatment usually causes a rapid reduction in symptoms which will last for several hours. After 8 to 14 hours, the cold symptoms gradually begin to return. Another dose of zinc will again cause the building symptoms to subside. Twice daily dosing needs to be kept up until your own immune system takes care of the virus, usually in four to five days. Occasionally, an extra 25 mg. dose may be needed midday.

Each rhinovirus-14 has 360 binding sites for ionic zinc (Zn +2). Large doses of zinc appear to prevent the virus from binding to cell membranes (Med Hypotheses 1996 Mar; 46(3): 295-302). Zinc is known to have direct antiviral activity, to interact with cell membranes, and to boost the immune system. Because of the fast onset of activity seen with zinc tablets, it is highly likely that ionic zinc directly stops the replication of rhinoviruses.

Zinc lozenges have also been touted for treating colds, but they have a checkered history. One research study showed that some lozenges shorten cold symptoms, while others actually lengthen them (J Antimicrob Chemother 1997 Oct;40(4):483-93). Some zinc lozenges show no effect, possibly because of the contradictory effects from different compounds found in the lozenges. (Arch Intern Med 1997 Nov 10;157(20):2373-6) 

Zinc deficiency is relatively common in long-term diabetes, but this does not likely make anyone more likely to catch a cold. Signs of a zinc deficiency include sunlight intolerance (needing to wear sunglasses on sunny days, when you did not need to do so in the past) and decreased dark adaptation (other people pass you by as you try to find a seat in a darkened movie theater).

Zinc tablets are the most effective over-the-counter treatment for colds. Vitamin C (100 to 250 mg. 4 to 6 times a day) and the herb Echinacea may also help in a mild way to reduce symptoms. Standard therapy of warm liquids, rest, cough syrups or tablets, and decongestants can all be helpful.

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