Flu, RSV, Pneumonia, COVID-19 and Diabetes

By Roberta Kleinman|2024-01-17T15:22:01-05:00Updated: June 28th, 2023|General Information, Health & Wellness|0 Comments
  • Flu, RSV, Pneumonia, COVID-19 & Diabetes

Flu, RSV, Pneumonia, COVID-19 and Diabetes

Patients with diabetes are not more likely to contract a severe respiratory tract infection, but when they develop one, they are more likely to get complications leading to a possible hospitalization. Reasons why this happens include: diabetes causes immune dysfunction, diabetes causes insulin resistance and the body’s possible exposure to high blood sugars creates chronic inflammation. The risk of severe viral complications goes down when your diabetes is well controlled.

This season, the flu, pneumonia and RSV have become the “tripledemic” in hospitals nationwide. There is also an uptick in cases of COVID since the summer months. In reality, if you feel sick yet test negative for COVID, you should still stay home and isolate. It makes sense that you are infected with another virus or possibly a bacterial infection such as strep. Since COVID precautions have been reduced nationwide, respiratory viruses are surging. The 4 respiratory viruses to be concerned with right now are: RSV (respiratory syncytial virus), flu, pneumonia and COVID. All these viruses rise during the fall, winter and spring months. These viruses spread by:

  • Inhaling droplets from someone’s infected cough or sneeze.
  • Close personal contact such as hugging or shaking hands.
  • Touching an object or surface with the virus such as a doorknob, exercise machine, handrail, a countertop or a computer.

RSV (respiratory syncytial virus)

Although the mildest of the 4 viral infections, “Up to 14,000 older adults die yearly from RSV.” RSV affects the lungs and breathing passages. RSV is airborne and can survive on hard or soft surfaces. It can be passed by kissing, shaking hands, or sharing a drink. You can get it at any age, but it is most common in children under 2, anyone who is immunocompromised, those with chronic illnesses-diabetes and those over 65. Severe cases of RSV can lead to pneumonia. Having RSV can lower your resistance and make you more prone to other viruses and bacterial infections.

The first week of symptoms is when you are most contagious. The symptoms can mimic the common cold unless it becomes more severe. Symptoms include a cough, sore throat, congestion, fatigue, fever and possibly a headache. RSV usually lasts 5 days. The cough can linger for months. The virus remains alive for hours on hard surfaces so cleaning with a disinfectant should be used.

The usual tests given are a blood test to measure WBC (white blood cells), a chest X-ray and swabs of mouth or nose secretions. If the symptoms worsen, then hospitalization may be required. There you would receive IV therapy and supplemental oxygen. At this point, there is no vaccine for RSV.

Flu (influenza)

The flu started early this year and hit hard. It is diagnosed most often in nursing homes, in the hospital, in military barracks and student dorms where people sleep in group and in close contact. It is also more prevalent in night shift workers who have poor sleep habits.

The flu is a respiratory virus affecting the nose, throat, and lungs. Most people can recover on their own but adults over 65, those who are immunocompromised and those with chronic diseases including heart, lung, kidney, liver disease and diabetes may develop severe complications. “85% of flu related deaths are in those over 65. Older adults are 6 times more likely to suffer a heart attack 7 days after catching the flu.”

The flu comes on suddenly with symptoms of a fever, chills and sweats, a dry hacking cough, body aches and pains, headache, chest congestion and a stuffy, runny nose. “It feels like you were hit by a truck.” The flu virus mitigates and changes with new strains yearly. Pneumonia is a serious complication of the flu. Usually, it is diagnosed by a WBC blood count, a physical exam and a PCR test which will identify the flu strain.

There is a flu vaccine available each fall starting in late August. The best time for the vaccination is late October since flu season runs through March. All flu vaccines are “quadrivalent”. They protect against 4 different flu viruses. The CDC recommends “everyone over 6 months get a yearly flu shot.” The spread of the flu once it is in a household is 38%. The flu vaccine process has been used for over 80 years.

It contains inactivated viruses, so you do not get the flu from the vaccine. It takes about 2 weeks for the flu vaccine to be totally activated and produce antibodies. Flu shot effectiveness varies from year to year. “Each year a flu shot is formulated based on predictions of strains. The 2022 shot is “well-matched to the strains. The flu shot is usually 40-60% effective.”

There can be minor reactions to the flu vaccine such as redness at the injection site, muscle aches, a low-grade fever, fatigue or a headache. Since only 26% of adults received this year’s vaccine, flu rates remain high and tens of thousands are being hospitalized with the flu.

The flu is also way out of control this year due to:

  • Lower masking rates
  • Less handwashing
  • More day care centers back open after COVID
  • Less social distancing than the last 2 years
  • More indoor gatherings than the last 2 years
  • Schools back in session
  • More traveling by planes and ships
  • More workers back in the office


Pneumonia is a lung infection (viral, fungal or bacterial), that inflames the air sacs in the lungs causing trouble with breathing, fever, light sensitivity, cough, stiff neck, low oxygen levels and chest pain. It causes the lung tissue to swell. It is passed by direct contact of mucus or saliva.

There are over 3 million cases a year in the US. It is common in children under 5, older adults (65 or older), alcoholics, people who are immunocompromised, smokers, people with cancer, those on chemotherapy, people with diabetes, liver, kidney or heart disease or COPD.

Other symptoms include lower than normal body temperature especially in older adults, confusion, and rapid and difficult breathing. The air sacs can fill up with fluid or pus. Tests for pneumonia include a history, physical exam, blood tests to check WBC, a chest X-ray, pulse oximetry test (for oxygen saturation) and a sputum test.

Viral pneumonia is most common following RSV, flu or COVID-19, other viral infections. Some people are treated with anti-virals like Tamiflu, Relenza or Rapivab to shorten the virus as well as decrease the severity of the virus. It must be given in the first 5 days of symptoms. The most common form of bacterial pneumonia is streptococcus.

Over 55,000 people die from pneumonia, yearly, in the US. Viral pneumonia is treated according to the symptoms with fever relieving medications and OTC cough medications. Bacterial pneumonia is treated with antibiotics. There are pneumonia vaccines available since 2000. There are currently 4 types of pneumonia vaccines, with Prevnar 20 as the one given to those over 65. It protects against 20 types of pneumococcal bacteria.


COVID-19, also known as Coronavirus, is a respiratory illness which has become common since February 2020. It continues to evolve and mutate. It usually includes both the upper and lower respiratory tract which can lead to breathing problems and pneumonia. COVID keeps changing but the general symptoms still include cough, fever, shortness of breath, chills, headache, muscle aches and change in taste or smell.

COVID can appear as early as 2 days after exposure or up to 14 days after exposure. An anti-viral called Paxlovid may be given during the first 5 days of symptoms. It is more serious in older adults and those with diabetes, obesity, or other chronic medical conditions. More than 75% of deaths were in those 65 or older.”Having your Covid vaccines up to date can reduce the likelihood of heading to the hospital by 94%.” The probable thought is a yearly COVID vaccine will become similar to a yearly flu vaccine to keep up with mutations.

The most contagious COVID variant now is the XBB.1.5, a variant related to Omicron. The new variant causes more gastric symptoms. At this point, there is no evidence that this variant is more severe than the other Omicron variants. “Only 15% of those eligible have received their updated 3rd COVID booster.”

Over 40% of cases in this country presently are XXB.1.5. Like with other COVID-19 variants, you can get this variant more than once. According to recent information from the UK “XBB.1.5 may be more immune to the vaccines and your past infections.” The best things to do at this point for prevention is keep rapid tests available, test before a gathering and continue to wear a well-fitting mask for indoor events.

Specific with diabetes

With all these respiratory illnesses, remember “viral infections can spike blood sugars.” Your body responds to illness by pushing out stress hormones that increase your ability to fight the infection but also raise blood sugars.

The best way to stay safe is to:

  • Continue to take your diabetes medications as prescribed.
  • Contact your health care provider if symptoms get worse or if you do not start to feel better.
  • Contact your physician if you become confused, short of breath, spike a high fever or if your lips or fingertips turn bluish.
  • Test blood sugars more frequently-every 4 hours and document patterns if you do not wear a CGM or insulin pump.
  • Even with a lack of appetite try eating small portions of high-quality protein and whole grains every 4-6 hours.
  • Stay hydrated with calorie free beverages- water, broth, low sugar Gatorade or hydration/electrolyte sticks. Make sure they are not loaded with sugar.
  • Be aware of OTC products like cough syrups that contain sugar or additives which may spike your blood pressure.
  • Follow up with basic CDC guidelines and viral respiratory illnesses, including recommendations for vaccines and boosters in your higher risk group.

When you do get a vaccine?

Vaccines may cause inflammation at the injection site from the trauma. There are steps you can take to make the experience easier. Your own body’s response also comes into play. Remember, “current vaccinations still offer a strong immune response to these viruses.”

  • Check with your physician to see if it is safe to get your vaccine. List your prescription medications and other medical conditions.
  • Make an appointment for the vaccine so you do not have to wait with a group of people.
  • Avoid drinking alcohol before and after your vaccine.
  • Avoid strenuous exercise or donating blood before or after your vaccine.
  • Eat and drink something small prior to your vaccine. Sometimes being nervous can make your stomach hurt, make you nauseated or make you dizzy. It is better to have food in your stomach.
  • Wear a short sleeve, sleeveless or shirt with sleeves easy to roll up.
  • Offer your non-dominant arm.
  • Relax your arm as this keeps your muscles from tensing.
  • After the “15 minute allergy waiting period” move your arm in big circles slowly, to help move around the contents of the vaccine and not have it concentrated in one location.
  • Plan to take it easy for the rest of the day.
  • You may experience pain and tenderness at the injection site, a headache or slight fever. You can take Tylenol 5-6 hours after the vaccine.
  • You can use an ice pack: 10 minutes on,10 minutes off to relieve swelling after the vaccine.
  • Keep a record of all vaccines and know where it is.
  • Reschedule the vaccine if you are sick, have symptoms of a respiratory virus or if you have been exposed to an illness.

What to eat when you are sick with a virus?

Although these foods will not cure you, you may feel better while eating them:

  1. Chicken soup. An “old standby” chicken soup contains cysteine, an amino acid that increases mucus flow and helps flush out the virus. “It may also exert anti-inflammatory activity on neutrophils-the WBC that responds to infection.” Warm soup has heat and steam which can have a soothing effect on your throat and help with congestion. Vegetables in the chicken soup like carrots, celery and onions contain vitamin C and K and may reduce inflammation. Soup is a liquid which helps keep you hydrated. Dehydration impacts your ability to fight infections. Salt and spices provide electrolytes. Pepper and garlic can boost your immune system.
  2. Whole grains in moderation (carbohydrates). They have anti-inflammatory properties. Oats, brown rice and plain popcorn should be included.
  3. Vegetables and fruits high in water to help with hydration. Cucumbers, bell peppers, watercress, tomatoes, celery and iceberg lettuce contain a lot of water. Watermelon, apples, peaches, honeydew, pineapple, cantaloupe, and strawberries are packed with water to help counter dehydration.
  4. Spinach and broccoli. Spinach and broccoli contain vitamin A,C and E plus antioxidants.
  5. Potatoes in moderation (carbohydrates). Potatoes contain potassium which helps regulate fluid balance and prevent dehydration. Sweet potatoes contain beta-carotene which converts to vitamin A and helps mucus membranes function properly. You can also choose avocados and apricots.
  6. Sugar free fruit popsicles. They can soothe a tender throat and provide fluid. Sugar free fruit popsicles are easy to tolerate when you do not feel well.
  7. Unsweetened coconut water. Your body needs calcium, potassium and sodium which are electrolytes. Coconut water contains natural electrolytes. Use for hydration.
  8. Sunflower seeds. Sunflower seeds contain phosphorous, magnesium, vitamin B6 and vitamin E. Almonds contain vitamin E as well.
  9. Citrus fruits. Oranges, grapefruits, lemons, and limes contain vitamin C to boost production of WBC and help your immunity.
  10. Plain yogurt. Plain yogurt contains active cultures to boost immunity. Yogurt contains protein to protect muscle mass. Yogurt is a fermented food and “fermented foods may have an impact on lung function and immunity. Fermented foods may also help lessen the duration or severity of a virus.”
  11. Fatty fish. Salmon, cod, sardines and anchovies decrease inflammation due to Omega 3 fatty acids. They may also have an anti-viral effect.
  12. Plant protein. Seeds, nuts and nut butters are considered plant protein. These can easily be digested especially when you lack a hearty appetite. Plant proteins reduce inflammation and maintain muscle mass.

What if someone is sick in your home with a respiratory virus?

  • Isolate those who are sick in your home.
  • If you have more than one bathroom in your home let the ill person, use it by themselves.
  • Only one person should be deemed as the caretaker.
  • Glove and mask up before you interact with the sick person. Try to stay at least 6 feet apart. Dispose of the gloves and gown as soon as you exit the room. Wash your hands frequently for at least 20 seconds. Do not touch your face.
  • Open windows when appropriate.
  • Use an air purifier.
  • Wipe down hard surface counter tops, phones, doorknobs, hand- rails, light switches with alcohol, hydrogen peroxide or Clorox.
  • Do not share any personal products. Do not share drinks.
  • Only use paper products and plastic silverware for their food and toss immediately.

How to lower your risk of respiratory viruses

  • Wash hands frequently with soap and warm water for at least 20 seconds. Regular soap is sufficient. You do not need an anti-bacterial soap. Use an alcohol based 60% or more hand gel if soap and water are unavailable.
  • Try to avoid touching mucosal membranes such as eyes, mouth and nose. These are all entry points for a virus. Try to completely avoid touching your face.
  • Get quality sleep and try to sleep a minimum of 7-8 hours a night.
  • Keep up your exercise schedule during all seasons. Stick to a minimum of 150 minutes a week. Combine weight training and aerobics.
  • Consider a home air purification system. Understand there are multiple forms of indoor air pollution. It comes from chemicals in the carpet, fabrics on furniture, vinyl flooring, scented candles, air fresheners, cleaning products and fabric softeners among many other things. At least open windows and doors when possible.
  • Stay hydrated. Drinking calorie free beverages is good for your internal organs and helps dilute your blood sugars. Water is part of every cell in your body; 60% of your body is water. Proper hydration can help keep skin and mucus membranes act as barriers to prevent viruses from entering the body. Hydration can decrease nasal irritation from sneezing. Dehydration makes the heart work harder and makes it difficult to regulate your body temperature.
  • If you find your home feels dry from your heating system, consider using a cool mist vaporizer or a humidifier.
  • Never over- heat the room. In cool temperatures keep it warm but not hot. Try to tolerate a cool room and use extra blankets.
  • Eat a healthful diet with lots of fruits, vegetables, whole grains and lean protein.
  • Wipe down all hard surfaces with a disinfectant even when everyone is healthy.
  • Do not shake hands or give hugs.
  • Wear a well-fitted mask indoors among crowds.
  • Wear a mask if you are unsure if anyone around you is sick.
  • Take a rapid test if you plan to go to an event. If everyone does this, your chance of catching a virus decreases.
  • Improve ventilation with open doors, windows and ceiling fans. Even box fans help move air.
  • Recognize and manage stress since it has an affect on your immune system. “Stress whether physical or emotional can increase your risk of infection by 2-3 times.”
  • Talk to your health care provider about taking Vitamin C, a probiotic and a zinc tablet.
  • Avoid contact with sick people.
  • Cover coughs and sneezes with your elbow. If you have tissues available, cough or sneeze in the tissue and dispose of immediately. Then wash your hands.
  • Get some sunshine for natural vitamin D.
  • Consider mindfulness meditation. It allows you to take a step back, pause, reflect and choose a response in a non-rushed or impulsive fashion. Mindfulness meditation can boost your immune system.
  • No smoking.
  • Watch alcohol intake which can lower your immunity.

Having diabetes, especially when out of control, may cause you to get severe complications when you develop a respiratory virus. Know what you can do to avoid this situation. You can have a huge impact on your own health!


  • https://www.mayoclinic.org/diseases-conditions/respiratory-syncytial-virus/symptoms-causes/syc-20353098
  • https://www.health.com/flu-shot-good-match-hospitalizations-rise-6891380
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  • https://www.health.com/what-is-tripledemic-covid-flu-rsv-6823155
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About the Author: Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia. She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past. She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups. More about Nurse Robbie

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