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Diabetes significantly increases the risk of infections. If you have diabetes, your body is more likely to get infected in the first place, and infections will grow more quickly and require medical care more rapidly.
Infections in a person with diabetes can range from annoying to life-threatening. This article will discuss why infections are more likely to happen, how to help prevent them, and how to handle specific types of infections common in patients with diabetes.
If you have an infection in a sore or open wound, you should seek medical help immediately.
Why Infections Happen
The biology of infections is very complex, and people with diabetes tend to have many types of dysfunction that combine to slow down the healing process and make infections more resistant to treatment:
- A sugary body environment, which increases the virulence of many pathogens
- Immune system dysfunction
- Increased inflammation
- Micro- and macro-angiopathies (blood vessel disease)
- Neuropathy, which masks pain signals of an injury
- Decrease in the antibacterial activity of urine
- Gastrointestinal and urinary function impairment
- Frequent medical interventions due to other health issues
There’s one root cause for most of these issues, as well as virtually every other complication of diabetes: high blood sugar.
Therefore, the first line of defense against infections is getting your blood sugar levels as close to your target range as possible. Healthy glucose levels are the best way to make sure that your body can fight infections the way it’s built to.
Foot Infections (Sores and Wounds)
There are at least two diabetic complications that make the feet far more likely to develop infections:
In short, the feet of a person with diabetes can have both lost sensation and poor circulation, both of which can result in hard-to-treat bacterial and fungal infections. It is extremely common for patients with diabetes to have some measure of neuropathy and poor circulation in their lower extremities, which makes the body’s defenses against foot infections much less effective.
Issues like nerve damage and poor circulation can certainly affect other parts of the body, but it is generally the legs and feet that suffer first. And reduced sensation in the foot can allow you to sustain injuries without your knowledge, allowing wounds to fester before the problem is even discovered.
Infected sores and wounds on the feet are a very big deal. Amputations are something like 10 to 40 times more likely in people with diabetes.
For all of these reasons, people with diabetes need to take especially good care of their feet. Many authorities have published foot care checklists like this one (PDF) from the Canadian Diabetes Association. Here are some highlights:
Foot Care Checklist:
- Check your feet every day. Use a mirror if necessary.
- Wash your feet every day
- Keep the skin soft and smooth
- Smooth corns and calluses gently
- If possible, trim your toenails regularly
- Don’t walk barefoot
- Protect your feet from hot and cold
- Keep the blood flowing to your feet
- Be more active
- Talk to your health care team, they may be able to direct you to a specialist to help in case you are not able to perform these tasks.
Some of the above tips will be more relevant for those who have lost some sensation in their feet due to nerve damage. The key is to take your individual situation into account and be proactive about foot care. See your healthcare provider at the first sign of infection to get it treated before it becomes more of a problem.
Bladder Infections
People with diabetes are much more likely than people without diabetes to have a bladder infection, according to the Urology Care Foundation. These infections are also known as urinary tract infections (UTI).
UTIs may involve the ureters, urethra, kidneys, or bladder and you may experience pain, tiredness, nausea, and fever. If you have a UTI, it is crucial to treat the infection because if not, the bacteria may spread to your kidneys and cause a dangerous kidney infection.
The American Diabetes Association (ADA) states that more than 50 percent of men and women with diabetes live with some type of bladder dysfunction, which involves symptoms like “urinary urgency, frequency, nocturia, and incontinence.”
Early detection and treatment of bladder infections is key.
Take note of symptoms and report them to a healthcare provider as soon as possible.
Symptoms of a Bladder Infection
According to the Mayo Clinic, symptoms include:
- A strong, persistent urge to urinate
- A burning sensation when urinating
- Passing frequent, small amounts of urine
- Urine that appears cloudy
- Urine that appears red, bright pink, or cola-colored—a sign of blood in the urine
- Strong-smelling urine
- Pelvic pain, in women—especially in the center of the pelvis and around the area of the pubic bone
It’s also important to note that UTIs present with different symptoms in the elderly. Older patients, with or without diabetes, are less likely to feel pain or physical discomfort — more commonly a UTI presents as “delirium or confusion in the absence of a fever.”
If you have any of these symptoms, please call your healthcare provider.
Skin Infections
Diabetes also increases the risk for a huge number of skin complications, including bacterial and fungal skin infections. As with other infections, the best defense is to take care of the skin, look out for early symptoms, and get early treatment before the infection gets worse.
There are two families of skin infections: fungal and bacterial.
Bacterial Infections:
- Styes (infections of the glands of the eyelid)
- Boils Folliculitis (infections of the hair follicles)
- Carbuncles (deep infections of the skin and the tissue underneath)
- Infections around the nails
Bacterial infections usually present with redness, swelling, pain, tenderness, or warmth at the site of the infection, frequently around the nails, scalp, and eyes. Bacterial infections generally require antibiotics as a treatment.
Fungal Infections
Fungi may find the body of a patient with diabetes to be especially hospitable, because they can literally feed on the excess sugar. The organisms that cause these infections usually prefer warm, moist parts of the body. These infections are likely to be itchy rashes, characterized by dry scaly skin or blisters.
People with diabetes may be more prone to several common fungal infections:
- Ringworm
- Jock Itch
- Vaginal yeast infection
- Athlete’s Foot
Fungal infections require special treatment. Again, catching the infection in the early stages leads to faster and more successful treatment. Many targeted antifungal remedies are available.
Yeast Infections
Women with type 1 and type 2 diabetes are more likely to develop vaginal yeast infections. It’s one of the lesser-known diabetes complications – and one that can be tough to talk about.
Yeast infections are caused by a microscopic yeast named Candida albicans.
It’s natural and common to have these tiny organisms living in and on our bodies. But too much growth can turn into an uncomfortable (and occasionally dangerous) problem. Most of the time our body effectively keeps the growth of Candida yeast in check, but diabetes throws the equilibrium out of whack in several ways.
First, high blood sugar levels also increase the sugar concentrations in other bodily fluids, including the mucus that lines the vagina and vulva. Because yeast and other fungi thrive on sugar, this makes the diabetic body an unusually hospitable place for these microorganisms. Second, people with diabetes often have compromised immune systems and a reduced ability to fight off infections once they’ve taken hold.
Vaginal yeast infections can result in multiple uncomfortable symptoms:
- Moist red rash and/or swelling
- Itchiness
- White vaginal discharge, sometimes compared to cottage cheese
- Tiny blisters and scales
- Pain, discomfort, or burning feeling while urinating or during sexual intercourse
Symptoms may be mild at first, hardly noticeable. Early application of an over-the-counter antifungal treatment can be effective, but people with diabetes may be wise to seek a doctor sooner rather than later.
The earlier you begin to treat a yeast infection, the more effective the treatment is likely to be. If an infection doesn’t get better with over-the-counter treatments, or if it keeps coming back, it’s definitely time to see a doctor, who will be able to recommend and prescribe more powerful antifungal agents.
Oral Infections
Living with diabetes means that taking care of your oral health is even more important than it is for the average person. Diabetes also makes a variety of mouth and gum infections more likely to occur. Tooth loss is more common in people with diabetes, especially in people with higher blood sugar levels.
Remarkably, taking care of your teeth seems to have a positive metabolic effect. Studies have suggested that brushing your teeth more often could even result in a lower A1C level.
Gingivitis and periodontitis
Gingivitis is inflammation of the gums — it usually precedes the development of periodontitis (gum disease). These are among the most common oral complications for people living with diabetes. As many as 22 percent of people living with diabetes have some measure of periodontitis.
These issues occur for several reasons:
- Immune system dysfunction
- Blood vessel thickening, which restricts nutrient supply
- High sugar levels provide fuel for bacteria.
These issues can sneak up on you — examine your mouth for red, puffy, swollen gums, and take note if brushing or flossing causes much bleeding. If not treated early, the gums can begin to recede from the teeth, a more serious situation.
Poor healing of sores and cuts
Infections in the mouth are slower to heal for the same reason as infections in the legs, feet, and elsewhere — high blood sugars inhibit the ability of the body’s immune system to fight off viruses and bacteria. If you have a wound that will not heal, please seek medical care.
Thrush
Thrush is a yeast infection, caused by a fungus named candida that is normally innocuous — small, harmless amounts are found in the mouths of many perfectly healthy people. The large amounts of sugar in the saliva, however, allow candida to grow more quickly, and it may begin to cause problems; a weakened immune system is not as good at fighting it off, either.
Thrush can cause dry mouth, discomfort, and pain. It can affect the tongue, cheeks, roof of the mouth, or lips. It may result in white patches or spots. Antibiotics can also increase the risk of infection.
