If you have diabetes, your immune system may not function as well as it should. This puts you at higher risk for infections—and for more severe outcomes if you do get sick.
The 2025 ADA guidelines include specific vaccine recommendations to protect people with diabetes. Vaccines are a simple but powerful tool to stay healthy.
| Factor | Effect |
|---|
| Immune dysfunction | Reduced ability to fight infections |
| Hyperglycemia | Impairs immune cell function |
| Hospitalization risk | Higher for vaccine-preventable illnesses |
| Complication risk | Higher rates of severe outcomes |
| DKA trigger | Illness can precipitate diabetic ketoacidosis |
| Infection | Risk in Diabetes |
|---|
| Influenza | 6x higher hospitalization risk, 3x higher death risk |
| Pneumonia | Leading cause of death in older adults with diabetes |
| Hepatitis B | Blood glucose monitoring can transmit virus |
| Shingles | Higher risk, more severe disease |
| COVID-19 | Higher risk of severe outcomes |
| Recommendation | Details |
|---|
| Who | All people with diabetes ≥ 6 months old |
| When | Annually, before flu season (fall) |
| Type | Inactivated influenza vaccine (IIV4) or recombinant vaccine |
| Avoid | Live attenuated nasal spray (contraindicated) |
Why important:
- Reduces hospitalization by ~40%
- Reduces cardiovascular events
- Reduces death from flu complications
| Vaccine | Who Needs It | When |
|---|
| PCV20 (Prevnar 20) | All adults with diabetes | One dose |
| OR PCV15 (Vaxneuvance) + PPSV23 | All adults with diabetes | PCV15 first, then PPSV23 ≥ 1 year later |
| PPSV23 (Pneumovax) | If not received PCV20 | One dose |
Age-based guidance:
- Under 65: One PCV20 OR (PCV15 + PPSV23 at least 1 year later)
- 65 and older: If PCV15/PPSV23 given before age 65, revaccinate with PPSV23 at age 65 (≥ 5 years after first PPSV23)
| Recommendation | Details |
|---|
| Who | All adults with diabetes < 60 years; consider ≥ 60 |
| When | As soon as possible after diabetes diagnosis |
| Schedule | 3-dose series (0, 1, 6 months) or 2-dose series (0, 1 month) |
| Why | Blood glucose monitoring devices can transmit hepatitis B |
Special consideration for assisted monitoring:
- Residents of long-term care facilities
- People receiving assisted blood glucose monitoring
- Higher risk from shared devices
| Recommendation | Details |
|---|
| Who | All people with diabetes |
| When | According to CDC schedule (primary series + boosters) |
| Type | mRNA vaccines preferred (Pfizer, Moderna) |
| Boosters | As recommended based on age and risk factors |
| Vaccine | Recommendation |
|---|
| Recombinant zoster vaccine (RZV, Shingrix) | Two doses, 2-6 months apart, for adults ≥ 50 years (especially recommended for diabetes) |
| Live zoster vaccine (ZVL) | No longer recommended in the US |
Note: Shingles risk is increased in diabetes, and post-herpetic neuralgia can be more severe.
| Recommendation | Details |
|---|
| Who | All adults |
| Once as adult | Replace one Td booster with Tdap |
| Pregnancy | Tdap during each pregnancy (27-36 weeks) |
| Every 10 years | Td booster after initial Tdap |
| Time | Vaccine(s) |
|---|
| At diagnosis | Annual flu (if fall), Hepatitis B series start, COVID-19 (if not vaccinated) |
| 1 month after Hep B #1 | Hepatitis B #2 |
| 2 months after Hep B #1 | Hepatitis B #3 (if 3-dose series) |
| Anytime | PCV20 (pneumococcal) if not previously vaccinated |
| Age 50+ | Shingles vaccine (Shingrix) |
| Every fall | Influenza vaccine |
| Every 10 years | Td/Tdap booster |
| Concern | Evidence |
|---|
| "Vaccines worsen diabetes" | No evidence vaccines affect diabetes control |
| "Vaccines cause diabetes" | Multiple studies show no link |
| "Flu shot gives you flu" | Inactivated vaccine cannot cause influenza |
| "Too many vaccines overwhelm the system" | Immune system handles vaccines easily |
| "Vaccine ingredients are harmful" | Vaccine ingredients are safe at these doses |
| Situation | Recommendation |
|---|
| Routine vaccination | Monitor blood sugar more frequently for 24-48 hours |
| Sick day rules | Follow usual sick day management if you develop side effects |
| Steroid use | May temporarily raise blood sugar (not in most vaccines) |
| Vaccine | Recommendation |
|---|
| Influenza | Strongly recommended (inactivated vaccine) |
| Tdap | Recommended during each pregnancy (27-36 weeks) |
| COVID-19 | Recommended |
| Hepatitis B | If high risk, complete before pregnancy if possible |
| Avoid | Live vaccines (MMR, varicella, LAIV) |
| Additional Considerations | Details |
|---|
| Pneumococcal | May need second dose depending on timing |
| High-dose flu vaccine | Available and may provide better protection |
| RZV (shingles) | Especially important—shingles more severe with age |
| Individualized schedule | Discuss with healthcare provider |
| Consideration | Details |
|---|
| Live vaccines | Generally contraindicated |
| Timing | May need to coordinate with treatments |
| Antibody response | May be reduced—additional doses sometimes needed |
| Specialist input | Consult with treating specialist |
| Symptom | Duration | Management |
|---|
| Sore arm | 1-2 days | Cold compress, acetaminophen |
| Fatigue | 1-2 days | Rest, hydrate |
| Low-grade fever | 1-2 days | Acetaminophen, fluids |
| Headache | 1-2 days | Acetaminophen |
| Muscle aches | 1-2 days | Rest, analgesics |
| Reaction | Action |
|---|
| Anaphylaxis | Seek emergency care immediately |
| Guillain-Barré syndrome | Rare, report to VAERS |
| Severe allergic reaction | Future vaccines may need to be avoided |
| Information | Why |
|---|
| Vaccine type | Different formulations exist |
| Date received | Timing for boosters |
| Manufacturer | Sometimes needed for subsequent doses |
| Adverse reactions | Important for future vaccinations |
| Location | If records need to be retrieved |
| Resource | What It Offers |
|---|
| Primary care provider | Vaccines and records |
| Pharmacies | Many vaccines available without appointment |
| Local health department | Community vaccine clinics |
| VaxVerify | Digital vaccine record lookup |
| State immunization registries | Official vaccine records |
| Action | Why |
|---|
| Bring vaccine records | Prevents unnecessary revaccination |
| List current medications | Some vaccines have medication interactions |
| Know your allergies | Especially to egg or vaccine components |
| Wear short sleeves | Makes vaccination easier |
| Plan for monitoring | Stay 15 minutes post-vaccine to watch for reactions |
| Action | Why |
|---|
| Monitor injection site | Watch for infection or unusual reactions |
| Monitor blood sugar | Illness can affect glucose control |
| Report severe reactions | To healthcare provider and VAERS |
| Get next dose on schedule | For multi-dose series |
- Flu vaccine annually for everyone with diabetes ≥ 6 months
- Pneumococcal vaccine (PCV20 or PCV15 + PPSV23) for all adults
- Hepatitis B series for adults diagnosed before age 60
- COVID-19 vaccination according to current guidelines
- Shingles vaccine (Shingrix) for adults ≥ 50 with diabetes
- Vaccines are safe and do not worsen diabetes
- Keep vaccine records for future reference
People with diabetes have a higher risk of infections and more severe outcomes from vaccine-preventable illnesses. High blood sugar impairs immune function, and conditions like diabetic complications can make infections harder to fight. Vaccines provide crucial protection.
Vaccines typically do not directly affect blood sugar. However, if you develop side effects like fever or fatigue, these can temporarily affect glucose levels. Monitor more frequently for 24-48 hours after vaccination and follow sick day rules if needed.
Yes, the inactivated influenza vaccine (flu shot) is safe and strongly recommended for people with diabetes. The nasal spray live vaccine should be avoided. The flu shot reduces hospitalization and complications from influenza by 40% in people with diabetes.
Most diabetes medications do not affect vaccine effectiveness. However, people who are significantly immunocompromised (such as those on high-dose steroids) may have reduced antibody response. Talk to your healthcare provider if you have concerns.
People with diabetes should generally follow the same vaccine schedule as adults without diabetes, with certain vaccines prioritized. Live vaccines (like the nasal spray flu vaccine) should be avoided. Those who are severely immunocompromised should avoid live vaccines and discuss options with their provider.
Sources:
- American Diabetes Association. Standards of Care in Diabetes—2025. Diabetes Care 2025; 48(Suppl 1): S245-S250 (Section 11: Immunization)
- Centers for Disease Control and Prevention. Recommended Adult Immunization Schedule, 2025
This article is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before making decisions about your health, treatment, or care. Individual circumstances vary, and what is appropriate for one person may not be appropriate for another.
If you are experiencing a medical emergency, call 911 (or your local emergency number) immediately.