A month ago, a septuagenarian with uncontrolled diabetes was diagnosed with pneumonia and then admitted to a Bengaluru hospital after developing symptoms such as fever, cough and breathlessness.
He was immediately put on antibiotics, but his oxygen levels dropped, and he required ventilator support since the infection had started affecting other organs as well.
“Usually in such cases, the chances of surviving were low, but he got lucky and made it,” says his doctor, Dr Subrata Das, senior consultant, internal medicine and diabetology, Sakra World Hospital, Bengaluru. “He recovered after 15 days.”
Diabetes and pneumonia risk
A person with diabetes is at increased risk of pneumonia and flu, and is three times more likely to die of them. Pneumonia can be a serious disease for anyone but if you have diabetes, recovery can take longer than for a non-diabetic person.
“People with high blood sugar have low immunity, which puts them at an increased risk of infections,” says Dr Prashant Chhajed, director, pulmonology and sleep centre, Fortis Hiranandani Hospital, Mumbai. “They also have reduced peripheral blood supply. They can get peripheral neuropathy, which can also lead to infection. It can take longer for them to heal.”
He says that people with diabetes are at risk of a more severe form of influenza infection — they have less ability to fight infections since their immunity is compromised. Sometimes, flu can lead to pneumonia.
“When you get cold or cough due to influenza virus and it affects the upper respiratory tract that includes the mouth, throat and nose, it is called upper respiratory infection,” says Dr Das. “If it affects the lungs, we call it pneumonia.”
Pneumonia can be viral, bacterial or tuberculous pneumonia. “Pneumonia is inflammation and consolidation of lungs,” Dr Chhajed says. “People with uncontrolled diabetes are at a higher risk, irrespective of their age.”
‘Pneumonia and mortality risk: study on diabetic and non-diabetic patients’, a study published by Narmadha MP, Nikhna Jayan and Ron Johny in the Asian Journal of Pharmaceutical and Clinical Research in 2020, says hyperglycemia (high blood sugar) is a strong predictor for mortality following pneumonia in diabetics. It adds that uncontrolled glucose level results in decreased immunity, comorbidity, complication, and resistance to drug therapy.
Dr Chhajed says diabetics are at increased risk of severe infection and may require hospitalisation or even ICU admissions, oxygen or ventilator support.
Dr Das says if the sugar levels are under control, a diabetic would respond to the infection and treatment like a non-diabetic person. “Not all pneumonia cases are severe,” he says. “Some can be treated in outpatient departments as well. Only in some conditions [do] they require admission in the hospital.”
A 2017 study, ‘Pneumonia in Patients with Diabetes Mellitus: A Single-Center Experience’, published by Mahmut Polat, Mehmet Nuri Ozdemir, Erdal Akyer et al in the Eurasian Journal of Medicine and Oncology, says that the duration of hospitalisation is longer for diabetic pneumonia patients. Hospitalisation risk due to pneumonia is said to be 26 per cent higher in diabetic cases, and the risk goes up with longer duration of diabetes and in patients with poor glycemic control. Also, the rate of diabetic pneumonia patients being referred to the ICU is higher when compared to non-diabetic pneumonia patients.
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People living with diabetes should look out for common signs and symptoms such as:
- Chest pain
- Rapid breathing.
Pneumonia and diabetes treatment
After recovery from pneumonia, a lot of people can require oxygen support for a long time. “They may need chest and lung physiotherapy to get back to normal,” says Dr Das. “This includes breathing exercises [done with the help of a] specialised physiotherapist by which the lungs can improve. Sometimes, pneumonia can lead to fibrosis (scarring of lung tissue) as well.”
The symptoms that can remain post-recovery include:
- Cough for about a month
- Oxygen support might be needed for a longer time
- Overall fatigue
- Breathlessness on exertion
- Chest and lung physiotherapy might be required
- Reduced functional capacity.
Pneumonia vaccine for people with diabetes
People with diabetes should ensure that their blood sugar levels are well under control. Dr Das says certain kind of pneumonia can be prevented with vaccination. Everyone with diabetes should get the annual flu vaccine and pneumonia vaccine on the advice of their doctor.
“There is a vaccine for pneumonia as well,” says Dr Das. “So, when they go to the doctor for the check-up, they should enquire if they would need to take it or not.”
Medical experts say people with diabetes are at a higher risk for pneumonia and flu, and take longer to recover. People with high blood sugar have low immunity, which puts them at an increased risk of infections. Hospitalisation risk due to pneumonia is said to be higher in diabetic cases, and the risk goes up with longer duration of diabetes and in patients with poor glycemic control. Post recovery, a lot of people with diabetes can require oxygen support for a long time, and chest and lung physiotherapy to get back to normal. As a precautionary measure, people with diabetes should get the annual flu vaccine and pneumonia vaccine on the advice of their doctor.