4.        Immunizations and Skin Tests       

Flu Vaccine - Yearly in people with diabetes at all ages.  Influenza vaccine can reduce diabetes-related
            hospitalizations by up to 79% during influenza epidemics.

Pneumovax - Immunize everyone at the time of diagnosis. Re-immunization should be strongly considered five (5) years after the first dose for those patients at highest risk of fatal pneumococcal infection (e.g., asplenic patients) or those at highest risk of rapid decline in antibody levels (e.g., those with chronic renal failure, nephrotic syndrome, or transplanted organs). Re-immunize all patients > age 65 years if it has been >5 years since initial immunization.

Td - Every 10 years.

Hepatitis B - Immunize persons whose renal disease is likely to lead to dialysis or transplantation (estimated GFR < 60 ml/min/1.73m²).

PPD - Once after diagnosis unless known positive. PPD-positive people with diabetes, including AI/AN with Type 2 diabetes, have 5 times the risk of reactivating TB. All diabetic patients with positive PPD including those over age 35 should be given INH chemoprophylaxis according to current guidelines (see Section 9).