April 2, 2015

Infections – Part 2

People with diabetes need to be more aware of infections, their causes, and the problems infections can cause. Everyone can have infections, but people with unmanaged diabetes are more susceptible to infections because of higher blood glucose levels. The higher blood glucose levels can furnish the bacteria, fungus, and E coli food to thrive.

People with diabetes are more susceptible to developing infections, as high blood glucose levels can weaken the patient's immune system defenses. In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body's vulnerability to infection.

People with diabetes are especially prone to foot infections, yeast infections, urinary tract infections and surgical site infections. A diabetic's insulin injection sight can be a possible infection source. Injections provide a potential gateway for certain immune-suppressing agents to enter the blood. For example, common bacteria such as Staphylococcus aureus can enter the blood system and cause what is known as a staph infection.

A lot of people have no problems with insulin injections and some recommend using alcohol wipes over the area in which insulin is to be injected.

In addition, yeast cells (Candida albicans) that occur naturally in the mucous membranes (e.g., mouth, vagina, nose) can enter the blood system at the injection sight. These Candida cells then interfere with the normal infection-fighting action of white blood cells. With white blood cells impaired, Candida can replicate unchecked, causing yeast infections. High blood glucose levels contribute to this process.

Diabetic neuropathy (nerve damage) causes problems with sensation, particularly in the feet. This lack of sensation sometimes means foot injuries go unnoticed. Untreated injuries can lead to infection. Some types of neuropathy can also lead to dry, cracked skin, which allows a convenient entry point for infection into the body. People with diabetes often have low blood flow to the extremities. With less blood flow, the body is less able to mobilize normal immune defenses and nutrients that promote the body's ability to fight infection and promote healing.

People with diabetes are more adversely affected when they get an infection than someone without diabetes, because diabetics have weakened immune defenses. Studies have shown that diabetics (even those who have minimally elevated blood sugar levels) experience worse outcomes with infections. Diabetic patients in hospitals do not necessarily have a higher mortality rate due to infections, but they do face longer hospitalization and recovery times. I have been fortunate in the few times that I have been in the hospital that I have healed with no problems.

Good urinary hygiene, especially for women, can help minimize the possibility of developing urinary tract infections. This includes proper toilet hygiene, prompt urination after sexual intercourse, regular emptying of the bladder and ample fluid intake.

Some examples of body changes that diabetics should be alerted to can include a rise in body temperature or change in blood glucose levels; pain with urination, or cloudy, bloody or foul-smelling urine; difficulty or painful swallowing; changes in bowel habits; and warmth or redness at any cut or scrape, including minor trauma locations and surgical sites. Any of these symptoms should be noted and mentioned to the patient's healthcare team.

Care should be taken visually to inspect your feet and lower legs on a daily basis (using a mirror if necessary). This is important if you have neuropathy.

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