According to recent studies, diabetics are three times more likely than non-diabetics to die from pneumonia and influenza.  They are also more likely to develop pneumonia, have a longer recovery period and require hospitalization for treatment.  A recent three-year study in Portugal found that diabetes more than doubled the chance of requiring hospitalization for pneumonia.  These findings support a study conducted in Denmark from 1997 to 2005 that revealed that the rate of hospitalization was significantly higher for patients with both type 1 and type 2 diabetes; the study also found that the longer the patient had been diabetic, the greater the risk of hospitalization. 
What Causes Pneumonia?
Pneumonia is an infection that inflames the alveoli, the air sacs in the lungs. The alveoli may fill with pus or phlegm, reducing the amount of space available for air and making it difficult to breathe. 
Most physicians classify pneumonia as one of four types.
• Bacterial pneumonia is the most common type developed by American adults. It results when bacteria invade the lungs and multiply. The most common bacteria resulting in pneumonia is Streptococcus pneumoniae, a cousin of the bacteria that can cause strep throat, meningitis and several other serious illnesses. Other bacteria can also cause pneumonia, such as Legionella pneumophila, Haemophilus influenzae, Mycoplasma pneumoniae and Chlamydia trachomatis. The bacteria may make their way to the lungs if the patient breathes in air droplets containing the bacteria, but the bacteria may also migrate to the lungs from another part of the body that is infected, such as the mouth or kidneys. 
• Viral pneumonia is often a complication of another virus, usually Influenza A or Influenza B. Rarely, chicken pox, measles and herpes simplex can also cause viral pneumonia. Approximately 30 percent of the pneumonia cases reported in the United States annually are viral. People can become infected with viral pneumonia in the same ways that they can be infected with the flu or cold virus. They may breathe in contaminated droplets after an infected person coughs or sneezes, or they may acquire the virus by touching a contaminated surface, such as a keyboard, counter or doorknob. 
• Aspiration pneumonia is caused by the entry of vomit, food, liquids or saliva into the lungs rather than the stomach. It most often occurs in patients who have difficulties in swallowing or who are unconscious or less alert due to illness, alcohol consumption or certain medications. Aspiration pneumonia is also a risk for surgical patients who receive general anesthesia. 
• Fungal pneumonia is relatively rare in the United States. In healthy adults, it is usually caused by the inhalation of fungal spores, including Histoplasma capsulatum, Blastomyces dermatitidis and Cryptococcus neoformans. However, in patients with an acquired or congenital condition resulting in a severely compromised immune system, the Candida, Mucor and Aspergillus species can also lead to fungal pneumonia. 
Why Does Diabetes Increase Pneumonia Risks?
The connection between diabetes and increased pneumonia-related risks is complex. Therefore, the link is best demonstrated by first discussing diabetes before explaining how the condition can cause complications that make diabetics more susceptible to pneumonia.
After eating or drinking, the level of sugar in the blood increases. If the system is functioning properly, the pancreas produces insulin, a type of hormone that converts blood sugars into glucose. Glucose is the form of sugar that the body’s cells can utilize for energy, the efficient circulation of blood and other bodily functions. In people with diabetes, little or no insulin is produced; in some instances, insulin production may be sufficient, but the body cannot utilize the insulin effectively. 
Type 1 diabetes is a disorder of the immune system in which the body attacks the cells in the pancreas that are related to insulin production. Type 2 diabetes is an acquired disorder resulting from the body’s inability to utilize insulin in a normal method; the pancreas must produce higher levels of insulin to control blood sugar. Eventually, this overproduction can cause the insulin-producing cells in the pancreas to fail. 
When the organs in the body cannot obtain the glucose needed to function, they can be damaged. Kidney disease is a common complication; when insulin is not available for the cells, the body may find alternative hormones that produce toxic chemicals. Since the kidneys filter wastes from the blood, these toxins can harm the kidneys. This affects their functionality, but it can also make them more susceptible to infections that could potentially spread throughout the body and reach the lungs, resulting in pneumonia. 
Diabetes also affects the circulatory system. Fatty deposits build up on the walls of arteries, restricting blood flow. In time, these deposits will harden and a condition known as atherosclerosis results, which elevates the blood pressure and increases stroke and heart attack risks. The restricted blood flow also means that the body’s cells have trouble getting the oxygen they need to function properly.  Although studies found that pneumonia did not increase the mortality rate due to cardiovascular problems, a history of pulmonary problems associated with diabetes increased the chances of developing pneumonia, and these patients required longer hospital stays and had a higher mortality rate. The higher mortality rate was often associated with an underlying condition attributable to complications of diabetes, such as congestive heart failure, kidney disease and cerebrovascular disease. 
Other Factors Increasing Pneumonia Risks for Diabetics
Diabetes and its complications pose significant pneumonia risks. However, there are other factors that increase risks as well, and these risks can be even greater when combined with diabetes. 
• Age: People over the age of 65 are at greater risk for pneumonia. The immune system weakens with age, decreasing the body’s ability to resist infections.
• Smoking: Tiny hairs called cilia line the body’s airways. The function of these cilia is to clean the airways of dust, germs and other contaminants. Smoking paralyz which allows germs, mucus and other toxins to accumulate in the lungs.
• Major surgery: A major surgery or a serious injury can increase the risk of pneumonia. If hospitalized, patients are at greater risk of contracting hospital-acquired pneumonia, especially if they are placed on a ventilator or are housed in the intensive care unit. Patients may be weakened by the injury or surgery, making them more susceptible to infections. Spending a great deal of time in a prone position can also increase pneumonia risks; mucus and fluids can accumulate in the lungs, providing a hospitable environment for bacteria to grow.
• Chronic obstructive pulmonary disease: This disease is commonly called COPD. In the United States, the term is used to describe patients manifesting a combination of chronic bronchitis and emphysema. Both of these conditions affect the body’s ability to obtain the necessary amount of oxygen, and the lungs have difficulty clearing the excessive mucus that accumulates. Patients with COPD are at greater risk for pneumonia, and the risk is elevated even more if they have used corticosteroid inhalers for six months or longer to treat their COPD.
Mitigating Pneumonia Risks
People with diabetes can take certain steps to reduce their risks of developing pneumonia. The National Institutes of Health recommends the following to help patients prevent pneumonia. 
• Stop smoking and avoid second-hand smoke.
• Wash the hands frequently, especially before cooking and consuming food.
• If possible, avoid contact with people who are ill. If this is impossible, wash hands frequently and disinfect hard surfaces before touching them.
• Get an annual flu vaccine. Flu viruses can spread to the lungs, but they can also leave the body weakened and more susceptible to pneumonia.
• Get the pneumonia vaccine. The pneumococcal vaccine reduces the risk of contracting the most common type of pneumonia, which is caused by Streptococcus pneumoniae.