ARLINGTON, Texas — Fighting the flu often means battling through fever, chills and a sore throat. For patients who also manage diabetes, respiratory infections carry an increased risk of more severe illnesses.

“When people with diabetes are ill, they can see more fluctuations in their blood sugar than normal,” which can lead to hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar), said Ethan Chandler, M.D., family medicine physician on the medical staff at Texas Health Harris Methodist Hospital Alliance and a provider with Texas Health Physicians Group. Among the potential serious complications are pneumonia or diabetes ketoacidosis (DKA). DKA develops when the body can’t produce enough insulin and can lead to diabetic coma or death, according to the American Diabetes Association.

“Early intervention is best, so patients with diabetes should contact their medical provider if they become significantly ill, fatigued or have difficulty controlling blood sugar levels,” Chandler said.

Patients are encouraged to discuss how to manage illnesses with their providers before flu season arrives, so they are better prepared if they get sick.

The U.S. Centers for Disease Control and Prevention recommends using antivirals to treat the flu. Steroids are used to treat pulmonary inflammation caused by viral or bacterial infections, as well as to treat allergies.

But for patients with diabetes steroids can lead to serious health concerns.

“One of the common side effects for someone who closely monitors their blood sugars and takes steroids for flu or cold symptoms, is having elevated blood sugars from the steroids,” said Carole Covey, B.S.N., R.N., NRP, CEN, CFRN, FP-C, a nursing supervisor at Texas Health Presbyterian Hospital Dallas’ emergency department.

Frequently Covey said she sees patients come into the ED with side effects from taking steroids. 

“Whether you are seeing your primary care provider or doing a telehealth visit or seeing an urgent care provider, it’s important to communicate that you have a history of diabetes,” Covey said.

Brenda Haile, B.S.N., R.N., CDCES, a certified diabetes care education specialist for Texas Health, is working to empower patients for successful self-management.

“I have seen patients who needed to use insulin to manage high blood sugar at the hospital after they had been managing their diabetes previously with just oral medications,” said Haile, who is part of a team of virtual diabetes care and education specialists who help guide hospital patients newly diagnosed with diabetes or new to insulin at discharge. She works with patients to facilitate diabetes self-management skills, including how to navigate their diabetes while fighting illnesses.

“Prevention is important in reducing the risk of becoming seriously ill,” Haile said.

She encourages patients to develop an illness action plan, which includes getting vaccines, treating symptoms early with antiviral medications drinking enough fluids, monitoring blood sugar levels more closely when ill and taking time off from work for rest and recovery.

“Managing diabetes requires the person living with it to make lots of decisions on a daily basis; illness can create even more complexity when the person is already not feeling well,” said Betsy Richter-Gifford, B.S.N., R.N., CDCES, manager of inpatient diabetes care and education, Virtual Care Delivery. “We want to equip our patients and their families with self-management skills so they can navigate their diabetes even through an illness.”

Tips for cold, flu and allergy seasons for people with diabetes:

• Practice hand hygiene, avoid crowded places and get the recommended vaccines for the flu, pneumonia and respiratory syncytial virus (RSV).
• Maintain stable blood sugar levels through a healthy diet, activity and consistent use of prescribed medications.
• Patients who are prone to allergies should consider taking an antihistamine daily.
• Speak with your medical provider about how to manage your diabetes and other chronic conditions both when you’re well and when you get sick.
• Develop a sick-day plan with your provider.
• Discuss what changes need to be made to your diabetes medications, especially if steroids are prescribed.
• Discuss when to call if your blood sugar level and symptoms are not improving.

Resources:

Information about Texas Health medical resources is available online.

For medical needs that require quick treatment but are not life-threatening, patients can seek high-quality care at Texas Health Breeze Urgent Care centers across North Texas. Texas Health operates 30 locations that offer care 365 days a year from 8 a.m. to 8 p.m. Information about Texas Health Breeze Urgent Care is available online.

Find a Texas Health Physicians Group provider at TexasHealth.org/FindAPhysician.

*Providers employed by Texas Health Physicians Group are not employees or agents of Texas Health Resources hospitals. ^©2025 Texas Health Resources