The Phone Call That Changed Margaret’s Summer
Margaret was 67, a retired school librarian from outside Atlanta, and one of the most disciplined patients I’d ever worked with. She showed up to every physical therapy appointment five minutes early. She did her home exercises without fail. Her Type 2 diabetes was well-managed, her A1C hovering around 6.8%. By every measure, she was doing everything right.
Then one Thursday in late June, she called my clinic in tears. A searing, burning pain had erupted along the left side of her ribcage overnight. She thought she’d pulled a muscle gardening. By the time she saw her primary care physician two days later, the telltale blistering rash had appeared. The diagnosis: herpes zoster — shingles.
What followed was eight weeks of agony that derailed her strength training, disrupted her blood sugar control, and left her with lingering nerve pain that persisted for months. The worst part? She’d been meaning to get the shingles vaccine for seniors for over a year but kept putting it off. “I figured I had time,” she told me. In my 18 years of treating older adults, I’ve heard that sentence more times than I can count.
Shingles Is Not Just a Rash — It’s a Systemic Event
Most people think of shingles as an unpleasant skin condition. They picture a rash, maybe some itching, and assume it clears up like a bad case of poison ivy. That misunderstanding is dangerous, especially for adults over 50.
Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you recover from chickenpox (often in childhood), the virus doesn’t leave your body. It retreats into nerve tissue near the spinal cord and brain, where it lies dormant for decades. When your immune system weakens — from aging, stress, illness, or certain medications — the virus can reactivate.
According to the CDC, about 1 in 3 Americans will develop shingles in their lifetime, and the risk rises sharply after age 50. Each year, roughly 1 million cases occur in the United States alone, with the highest incidence among adults aged 60 and older.
But here’s what people don’t realize: shingles triggers a full inflammatory cascade. It’s not just local. The virus travels along nerve fibers, causing deep neurological pain. It can affect the eyes (herpes zoster ophthalmicus), leading to vision loss. And in patients I treat with conditions like diabetes, the downstream effects on metabolic stability can be severe.
The Blood Sugar Connection Most Seniors Don’t Know About
This is where Margaret’s story gets instructive — and where recent medical attention has sharpened the conversation around the shingles vaccine for seniors who manage chronic conditions like diabetes.
When shingles strikes, your body mounts a significant immune and inflammatory response. Cortisol — the stress hormone — surges. For someone with Type 2 diabetes, that cortisol spike does something very specific: it drives blood glucose levels up, sometimes dramatically. Margaret’s fasting glucose, which had been stable around 120 mg/dL, shot up to 210 mg/dL during the worst of her outbreak.
Research published in the journal Diabetes Care has shown that acute infections and inflammatory events can worsen insulin resistance for weeks or even months after the initial illness resolves. What I see most often in my geriatric patients is a cascading effect: the pain from shingles limits physical activity, reduced movement further impairs glucose regulation, and the resulting fatigue and malaise make it harder to return to exercise routines.
For Margaret, that meant three months of setbacks. Her hemoglobin A1C climbed to 7.4% at her next quarterly check. Her lower-body strength, which we’d spent a year building through progressive resistance training, declined measurably. If you’re working hard to overcome the myths around resistance training as a senior, an avoidable illness like shingles can erase months of progress virtually overnight.
Shingrix: What the Evidence Actually Shows
The good news is that we have an exceptionally effective vaccine. Shingrix (recombinant zoster vaccine) was approved by the FDA in 2017 and is recommended by the CDC for all adults aged 50 and older, regardless of whether they remember having chickenpox or previously received the older Zostavax vaccine (which was discontinued in the U.S. in November 2020).
The numbers are striking. In clinical trials, Shingrix was over 97% effective at preventing shingles in adults aged 50–69, and about 91% effective in adults 70 and older. Protection remained above 85% for at least four years after vaccination, according to data from the National Institute on Aging.
Shingrix is administered as a two-dose series, with the second dose given two to six months after the first. Both doses are necessary for full protection.
How Shingrix Compares to the Old Zostavax Vaccine
| Feature | Shingrix (Current) | Zostavax (Discontinued) |
|---|---|---|
| Type | Recombinant (non-live) | Live attenuated |
| Doses Required | 2 doses (2–6 months apart) | 1 dose |
| Effectiveness (50–69) | 97%+ | ~51% |
| Effectiveness (70+) | ~91% | ~38% |
| Duration of Protection | 85%+ at 4 years; ongoing studies | Declined significantly after 5 years |
| Safe for Immunocompromised | Yes (non-live vaccine) | No (live virus concerns) |
| Cost (with Medicare Part D) | $0 copay under most plans since 2023 | N/A (no longer available) |
| Common Side Effects | Sore arm, fatigue, muscle pain (2–3 days) | Sore arm, headache |
I often tell my patients that the side effects of the vaccine — a sore arm and maybe a day of feeling tired — are a minor inconvenience compared to weeks of debilitating nerve pain. The math isn’t close.
Postherpetic Neuralgia: The Complication That Lingers
If shingles itself is bad, postherpetic neuralgia (PHN) is worse. PHN is nerve pain that persists long after the rash heals — sometimes for months, sometimes for years. According to the Mayo Clinic, about 10–18% of people who get shingles will develop PHN, and the risk increases significantly with age.
In my practice, PHN is one of the most frustrating conditions to manage. The pain is often described as burning, stabbing, or electric-shock-like. It can be triggered by something as light as clothing brushing against the skin. For seniors, this kind of chronic pain leads to:
- Sleep disruption, which worsens cognitive function and mood
- Reduced physical activity, accelerating muscle loss and fall risk
- Depression and social withdrawal — a topic I find deeply intertwined with physical decline (supporting aging parents with depression is something families should proactively address)
- Increased reliance on pain medications, including opioids in severe cases
- Loss of independence, particularly if pain limits the ability to drive, cook, or manage self-care
Margaret developed mild PHN that lasted about four months. She was one of the lucky ones. I’ve had patients whose PHN persisted for over two years.
Why Seniors Keep Delaying — and How to Stop
If Shingrix is this effective and now covered with zero copay under most Medicare Part D plans (thanks to the Inflation Reduction Act provisions that took effect in 2023), why are so many older adults still unvaccinated?
CDC data from early 2024 showed that only about 36% of adults aged 50 and older had received at least one dose of Shingrix. That means nearly two-thirds of eligible Americans remain unprotected.
From conversations with my own patients, the barriers tend to fall into a few categories:
- “I never had chickenpox.” — Over 99% of Americans born before 1980 have been infected with varicella-zoster, even if they don’t remember symptoms. The virus is almost certainly in your body.
- “I already had shingles, so I’m immune now.” — Shingles can recur. The CDC recommends vaccination even after a previous episode, once the rash has fully resolved.
- “I heard the side effects are terrible.” — Side effects are real but temporary. Most people experience arm soreness and fatigue lasting one to three days. Compare that to weeks of shingles pain.
- “I have too many other health things to worry about.” — This is actually the strongest argument for getting vaccinated. If you’re managing diabetes, heart disease, or another chronic condition, a shingles episode can destabilize everything.
A Practical Vaccination Plan for This Summer
Summer is actually an ideal time to get your shingles vaccine for seniors, and here’s my reasoning from a rehabilitation perspective. If you experience the common side effects (sore arm, mild fatigue), you can rest comfortably without the complications of flu season or holiday travel schedules.
Steps to Take This Week
- Call your primary care physician or pharmacist and ask specifically about Shingrix availability — most major pharmacies (CVS, Walgreens, Rite Aid) stock it and can administer it without a doctor’s visit
- Verify your Medicare Part D or private insurance coverage — under current law, recommended vaccines for adults should have no out-of-pocket cost
- Schedule both doses now — book the second appointment two to six months out at the same time you book the first, so you don’t forget
- If you manage diabetes, plan the vaccine for a day when you can monitor your blood sugar more closely, as any immune response can cause minor fluctuations
The Bigger Picture: Protecting the Body You’ve Built
I think about Margaret often because her story illustrates something I try to impress on every patient: preventive care isn’t separate from your fitness and strength goals — it’s foundational to them.
You can spend a year building functional strength, improving your balance, and getting your A1C into a healthy range. One preventable illness can set you back significantly. And for seniors, setbacks are harder to recover from. A 2022 study in The Journals of Gerontology found that adults over 65 who experienced a period of bed rest or immobility lost muscle mass at roughly twice the rate of younger adults in similar circumstances.
That’s why I view vaccination as part of a comprehensive approach to aging well. It sits alongside strength training, fall prevention, home safety modifications (and if you haven’t assessed your living space yet, making your home safer for aging in place is a critical step), and regular health screenings.
What I Tell My Patients Before They Leave
At the end of every initial evaluation with a new patient over 50, I ask three questions that have nothing to do with physical therapy: Are you up to date on your flu and COVID vaccines? Have you had your Shingrix doses? And when was your last comprehensive eye exam?
These aren’t my clinical lane, strictly speaking. But in geriatric care, everything connects. A shingles outbreak affects mobility. Vision loss increases fall risk. An untreated infection disrupts metabolic health. You can’t treat the body in isolated compartments.
Margaret got her Shingrix vaccine three months after her shingles resolved. She’s back to her twice-weekly strength sessions. Her A1C is 6.9% and trending in the right direction. She told me recently that she’s become an evangelist among her friends at church — practically dragging them to the pharmacy.
“I tell them what you told me,” she said. “You don’t get the vaccine because you’re scared. You get it because you’ve worked too hard to let something preventable take it all away.”
I couldn’t have said it better myself.
Frequently Asked Questions
At what age should seniors get the shingles vaccine?
The CDC recommends Shingrix for all adults aged 50 and older, regardless of whether they recall having chickenpox. The vaccine is given as a two-dose series, with the second dose administered two to six months after the first.
Is the shingles vaccine free for seniors on Medicare?
Yes, under the Inflation Reduction Act provisions that took effect in 2023, most Medicare Part D plans now cover Shingrix with a $0 copay. Many private insurance plans for adults over 50 also cover the vaccine at no cost.
Can shingles affect blood sugar levels in people with diabetes?
Yes. The inflammatory and stress response triggered by a shingles infection can significantly raise cortisol levels, which in turn increases blood glucose. This can destabilize diabetes management for weeks or even months after the initial outbreak.
Should I get the shingles vaccine if I already had shingles?
Yes. Shingles can recur, and the CDC recommends getting Shingrix even after a previous shingles episode. You should wait until the rash has completely resolved and you're feeling well before receiving the vaccine.
What are the common side effects of the Shingrix vaccine?
The most common side effects include soreness or redness at the injection site, fatigue, muscle pain, headache, and occasionally mild fever. These typically last one to three days and are far milder than an actual shingles infection.
About Michael Torres, DPT, Board-Certified Geriatric Specialist
Michael Torres is a Doctor of Physical Therapy and board-certified geriatric clinical specialist with 18 years of experience working with older adults. He has treated thousands of seniors recovering from hip replacements, managing arthritis, rebuilding strength after hospitalizations, and preventing dangerous falls. At Daily Trends Now, Michael writes practical guides on exercises, mobility, pain management, and the physical strategies that help seniors stay strong and independent.
