Are People With Diabetes Immunocompromised? Here’s Why the Risk of COVID and Infections Is Higher

Diabetes can affect many different systems in the body. It can raise the risk of cardiovascular disease and affect the immune system. This means that people with diabetes have a higher risk for certain infections. When it comes to COVID-19, people with diabetes are at greater risk of serious complications. These risks are more likely if blood glucose levels (blood sugars) aren’t well controlled. 

Let’s explore how diabetes can affect the immune system.

What does it mean to be ‘immunocompromised’?

Being immunocompromised means the immune system doesn’t function appropriately. This can make you more likely to get infections that a healthy immune system would fight off quickly. When you’re immunocompromised, you’re also more likely to have complications from infections.

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Different things can make someone immunocompromised, including:

• Certain medical conditions (like cancer or diabetes)

• Medications (like prednisone)

• Infections (like HIV)

• Radiation exposure

How does diabetes affect the immune system?

Diabetes can negatively affect almost every step of the immune response. An effective immune response takes lots of coordination. Special proteins, antibodies, and white blood cells all have to work together to fight an infection. And healthy blood vessels help to get the cells and proteins where they need to be.

When blood glucose is elevated, the body tries to rid itself of excess glucose. One way it does this is by attaching the excess glucose to the proteins and cells in the blood and to the lining of blood vessels. This disrupts their normal function and impairs the body’s ability to fight infections.

Is diabetes an autoimmune condition?

Yes and no. It depends on the type of diabetes you have. 

Type 1 diabetes is an autoimmune condition. With Type 1 diabetes, the body makes antibodies against the beta cells of the pancreas. When the beta cells are destroyed, the body can no longer make the insulin it needs. This allows blood glucose to rise to dangerous levels. And there’s no cure — the only treatment is insulin replacement.

Type 2 diabetes is not an autoimmune process. People with Type 2 diabetes still make insulin, but they’re resistant to insulin. This means the body can’t properly use the insulin it has. As a result, the pancreas has to make much more insulin to keep glucose levels in a safe range. 

If you have Type 2 diabetes, you may be able to improve your insulin resistance with:

• Medications

• Dietary changes

• A healthy weight

• Exercise

Are people with diabetes at a higher risk of developing COVID?

Although people with diabetes might be at risk for more infections in general, there isn’t enough evidence to say people with diabetes are more likely to get COVID. But diabetes brings a higher risk for severe COVID. And you’re more likely to have complications — sometimes very serious ones.

Here are some good ways to reduce your chance of catching COVID:

• Wear a mask in public.

• Avoid crowds.

• Get vaccinated.

What complications can people with diabetes have from COVID?

People with diabetes have the same symptoms of COVID as people without diabetes, but the symptoms are likely to be more severe. Fever, cough, and shortness of breath are the most common symptoms.

People with diabetes also face more serious complications from COVID. This is especially true if your glucose runs high. Some dangerous complications can include:

• Respiratory failure that requires a ventilator to breathe

• Secondary infections (like pneumonia)

• Sepsis

• Two times the risk of death

Overall, you’re at much greater risk from COVID infection if you have diabetes. In fact, almost 40% of people hospitalized with COVID have diabetes.

Are people with Type 1 diabetes more at risk for COVID than people with Type 2 diabetes?

Both Type 1 and Type 2 diabetes put you at high risk for serious complications. There’s no evidence that having one type puts you at greater risk from COVID than the other. 

It’s also important to consider your COVID risk if you have other conditions associated with diabetes. Conditions linked to diabetes that may also increase your risk of serious COVID complications include:

• High blood pressure

• Cardiovascular disease

• Kidney disease

• Heavier body weight

How can you boost your immune system if you have diabetes?

The best way to boost your immune system if you have diabetes is to keep your glucose under good control. You can do this by:

• Taking all medications as prescribed

• Eating a healthy diet 

• Exercising (to improve your insulin sensitivity)

• Limiting sugar intake 

Supplementing with vitamins may also be helpful. Vitamins C and D are important in generating a healthy immune response. But make sure to talk to your healthcare provider before taking any supplements. High doses of some vitamins can have adverse effects. And some may interact with prescription medications.

Why trust our experts?

Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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