Similar to any individual living with a weakened immune system or compromised body systems due to chronic disease, those with diabetes-related complications may be susceptible to increased risk and impact of foodborne illnesses. One reason those with diabetes may suffer increased impact of a foodborne illness is because diabetes-related complications may delay an individual’s natural response to infection. It can also lengthen the process of recovering from a foodborne illness compared to someone without diabetes. The most well-known complications of diabetes are related to vascular disease and frequently impact the eyes, kidneys and blood flow to the extremities. Gastrointestinal problems are also fairly common and may impact digestion by keeping food in the stomach longer. “When those types of things happen, that’s when they’re going to be at a higher risk,” said Dr. Christopher Braden, director of the Division of Foodborne, Waterborne and Environmental Diseases at the Centers for Disease Control and Prevention. The immune system of someone with diabetes may not appropriately recognize harmful bacteria or pathogens, which can increase the risk of developing infection. Likewise, gastrointestinal and kidney problems may lead to a longer illness duration and healing process if the individual does develop an infection. High glucose levels can directly affect the immune system through suppressing the functioning of white blood cells, so a person having difficulty regulating glucose levels may have a higher risk of contracting a foodborne illness. “Someone with a very hard time controlling their glucose levels could have a higher risk because of the direct effect of the glucose on the blood cells,” Braden said. It is important to keep in mind that, even among those with diabetes, the risk of foodborne illness lies on a spectrum. A person living with diabetes for quite a long time and who is on dialysis will be at a much greater risk for a foodborne illness than another individual who does not have this level of diabetes-related complications, Braden said. For someone with diabetes, the presence of a foodborne illness may have a huge impact on blood glucose levels due to the way the illness impacts what an individual can or cannot eat at the time. Thus, it is important for those with diabetes to prepare a sick-day plan for reacting appropriately upon becoming ill, said Matt Petersen, managing director of medical information at the American Diabetes Association. This plan includes basic but important factors such as having electrolytes on hand, checking glucose levels more frequently, and knowing when to call the doctor. For example, when diarrhea and a fever are both present or if dehydration sets in. “If people with diabetes are ill, they have a lot of issues to factor in,” Petersen said. “Especially if they are using insulin.” Many of the same food-safety considerations for individuals without diabetes apply to those with diabetes such as handling, cooking and cleaning food properly. But those with diabetes should be more cognizant of these ideas and ready to call a doctor when they become sick, said Dawn Sherr, practice manager at the American Association of Diabetes Educators. “The big thing is making sure to prevent foodborne illness and doing whatever you can to avoid contracting a foodborne illness,” Sherr said.