Chances are that you know someone with diabetes mellitus. It affects almost 10 percent of the population, and odds of having diabetes increase with age, with 1 in 4 people having diabetes after age 65. Diabetes mellitus, often referred to as “sugar diabetes” because of the inability to regulate blood sugar levels, results from the body not making enough insulin or not being able to use insulin properly.

Insulin is necessary to move sugar from the blood into cells to be used for energy. Without working insulin, blood sugar rises and damages the blood vessels and other body tissues leading to blindness, nerve disease, kidney failure, heart attacks and strokes.

What does this all have to do with vaccines? It turns out vaccines can play a major role in helping keep individuals with diabetes well.

Diabetes impairs the immune system and interferes with the ability of cells in the body to release chemicals that defend against germs. Additionally, the immune cells that gobble up bacteria or kill infected cells don’t work as well. Researchers have found that some of these issues result from high sugar levels but others don’t. Put another way, even a diabetic with excellent blood sugar control is still at increased risk of infection.

Besides the weakened immune system, diabetics have other problems leading to infection. Nerve damage keeps diabetics from sensing when they may become injured or develop pressure sores. Resulting cuts and ulcers heal slowly due to poor circulation. The open wounds provide easy entry for bacteria and fungi.

Bacteria grow faster in body tissues with elevated sugar levels and this may be the reason diabetics are at risk of infections of the lung (pneumonia), blood (septicemia), spinal cord and brain (meningitis) and urinary tract.

Serious complications are four times more likely to develop in diabetics with these infections compared to otherwise healthy individuals. The stress from fighting an infection can send a diabetic’s blood sugars spiraling dangerously out of control further complicating the course.

Given the additional difficulties, diabetics are much more likely to die than healthy individuals with similar infections. Vaccines, however, can provided needed protection.

Pneumovax, a pneumonia vaccine, is a must. Diabetics should receive it once younger than the age of 65 and again in the senior years. Due to diabetics’ increased risk of skin infections and the fact that tetanus bacteria are just about everywhere in the environment, a tetanus shot is essential every 10 years. A flu shot is needed every year as the flu strikes diabetics particularly hard. Diabetics are at increased risk of shingles and should receive Shingrix once they turn 50.

Diabetics have twice the risk of catching hepatitis B compared to healthy individuals. Many adults have never been vaccinated. Luckily, there’s a new hepatitis B vaccine, Heplisav-B, which requires two shots instead of three and better stimulates the immune system.

Diabetics, who track their blood sugars, follow diet guidelines, take their prescribed medications and are vaccinated, have the best chance at a long, healthy life.

Vaccine Smarts is written by Sealy Institute for Vaccine Sciences faculty members Drs. Megan Berman, an associate professor of internal medicine, and Richard Rupp, a professor of pediatrics at the University of Texas Medical Branch. For questions about vaccines, email

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