Within the context of the medical recommendation that kids with type 1 diabetes be on the Priority List for the flu vaccine, there has been a discussion of whether their immune system is considered “compromised” versus “dysfunctional.” Is their immune system “compromised” or “dysfunctional?” If our kids’ immune systems were fine, with the exception of the attack on the beta cells, it seems there would be no need for special recognition with regard to things like the flu vaccine.

There is no evidence that, with reasonable, not even great glucose control, the kids that we see have any more risk from flu or other infectious disease than the general population of kids. The only major risk is related to what happens when a person with diabetes gets another illness, i.e., ketoacidosis management. So, most of the immunization recommendations in our practice and most other pediatric endocrine practices around the world are not any different for immunization recommendations. The general CDC type recommendations are all-inclusive and especially important for the vast majority of folks with diabetes who have chronic out-of-control hyperglycemia. Or, they also have heart compromise issues. Simply stated, we do not make a big push for such things as flu vaccines, but do not oppose them if parents/patients so desire.

The issue of immune dysfunction as a cause of the diabetes in the first place is much more complicated and has to do about genetic control of autoimmunity. I suspect that this is very different than fighting off viruses and bacteria. Most of the old literature about poor ability to mount immune responses for such exogenous “illnesses” really reflect chronic hyperglycemia. We just do not see such problems nowadays. However, our clinic-wide A1c avenge is 7.4% and not 10-12% as in many other sites.

SB