A 20-year-old student at my son’s college in New York just died yesterday from H1N1 complications. Whether or not this student had an underlying health issue has not been made public.

My son has had type 1 for three and a half years and is very well controlled with his A1c normally in the 5.6 to 5.9 range. His endocrinologist at the Naomi Berrie Diabetes Center is suggesting he receive Tamiflu if he gets the flu or if he comes into contact with someone who has the flu. I am reading now that people with diabetes are at risk for a more severe case of the flu. Since this H1N1 flu mainly affects people ages five to 24, how worried should parents of diabetic children and young adults be? With the death of this young man, I am quite nervous.

At the moment, there has not been major increased risk in young people with type 1 diabetes compared to all other young people. The “swine” flu seems to be hitting adolescent and young adults more than other populations so this is somewhat different than other flu epidemics of the past. So, high school and college is a prime target. The CDC and the AAP recommendations are consistent with immunizing as many people as possible and this would apply to those with diabetes as well. If diabetes is poorly controlled, then there is more risk; with good control, the risk is probably very similar to the rest of the population. The thing different with diabetes, of course, is that any illness, the swine flu or any other viral or other illness, requires more insulin, ketone checking and prevention of ketoacidosis. If your son has such good control, then reviewing sick day management would be extremely important with him so that he is reminded of how to check for urine or blood ketones, how to decide about booster sick day insulin doses, extra fluids, when to call for assistance (vomiting, weight loss, inability to control the sugar surges, etc.). That’s what we are doing with all of our patients and expect that this will be helpful.

SB