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.

Infections – Part 1

Infections can happen at any time, but are more common when diabetes is not well managed. Below are some of the types of infection with a brief discussion of each.

Streptococcus is a type of bacteria. There are two types: group A and group B.

Group A strep causes

• Strep throat - a sore, red throat, sometimes with white spots on the tonsils
• Scarlet fever - an illness that follows strep throat. It causes a red rash on the body.
• Impetigo - a skin infection
• Toxic shock syndrome
• Cellulitis and necrotizing fasciitis (flesh-eating disease)

Group B strep can cause blood infections, pneumonia, and meningitis in newborns. A screening test during pregnancy can tell if you have it. If you do, IV antibiotics during labor can save your baby's life. Adults can also get group B strep infections, especially if they are elderly or already have health problems. Strep B can cause urinary tract infections, blood infections, skin infections, and pneumonia in adults.

Antibiotics are used to treat strep infections.

E. coli is the name of a type of bacteria that lives in your intestines. Most types of E. coli are harmless. However, some types can make you sick and cause diarrhea. One type causes travelers' diarrhea. The worst type of E. coli causes bloody diarrhea, and can sometimes cause kidney failure and even death. These problems are most likely to occur in children and in adults with weak immune systems.

You can get E. coli infections by eating foods containing the bacteria. Symptoms of infection include

• Nausea or vomiting
• Severe abdominal cramps
• Watery or very bloody diarrhea
• Fatigue
• Fever

To help avoid food poisoning and prevent infection, handle food safely. Cook meat well, wash fruits and vegetables before eating or cooking them, and avoid unpasteurized milk and juices. You can also get the infection by swallowing water in a swimming pool contaminated with human waste.

Most cases of E. coli infection get better without treatment in 5 to 10 days.

Staphylococcus is a type of bacteria. There are over 30 types, but Staphylococcus aureus causes most staph infections (pronounced "staff infections"), including

• Skin infections
• Pneumonia
• Food poisoning
• Toxic shock syndrome
• Blood poisoning (bacteremia)

Skin infections are the most common. They can look like pimples or boils. They may be red, swollen, and painful, and sometimes have pus or other drainage. They can turn into impetigo, which turns into a crust on the skin, or cellulitis, a swollen, red area of skin that feels hot.

Anyone can get a staph skin infection. You are more likely to get one if you have a cut or scratch, or have contact with a person or surface that has staph bacteria. The best way to prevent staph is to keep hands and wounds clean. Most staph skin infections are easily treated with antibiotics or by draining the infection. Some staph bacteria such as MRSA (methicillin-resistant Staphylococcus aureus) are resistant to certain antibiotics, making infections harder to treat.

Next, we must visit the fungal infections. Yeast is a fungus that normally lives in the vagina in small numbers. A vaginal yeast infection means that too many yeast cells are growing in the vagina. These infections are very common. Although they can bother you a lot, they are not usually serious. And treatment is simple.

Most yeast infections are caused by a type of yeast called Candida albicans. A healthy vagina has many bacteria and a small number of yeast cells. The most common bacteria, Lactobacillus acidophilus, help keep other organisms, like the yeast, under control.

When something happens to change the balance of these organisms, yeast can grow too much and cause symptoms. Taking antibiotics sometimes causes this imbalance. The high estrogen levels caused by pregnancy or hormone therapy can also cause it. So can certain health problems, like diabetes.

Skin infections can involve bacteria, fungus and yeast infections. Several kinds of bacterial infections occur in people with diabetes:

• 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

Inflamed tissues are usually hot, swollen, red, and painful. Several different organisms can cause infections, the most common being Staphylococcus bacteria, also called staph.

Once, bacterial infections were life threatening, especially for people with diabetes. Today, death is rare, thanks to antibiotics and better methods of blood glucose management.

But even today, people with diabetes have more bacterial infections than other people do. Doctors believe people with diabetes can reduce their chances of these infections by practicing good skin care. If you think you have a bacterial infection, see your doctor.

The culprit in fungal infections of people with diabetes is often Candida albicans. This yeast-like fungus can create itchy rashes of moist, red areas surrounded by tiny blisters and scales. These infections often occur in warm, moist folds of the skin. Problem areas are under the breasts, around the nails, between fingers and toes, in the corners of the mouth, under the foreskin (in uncircumcised men), and in the armpits and groin.

Common fungal infections include jock itch, athlete's foot, ringworm (a ring-shaped itchy patch), and vaginal infection that causes itching. If you think you have a yeast or fungal infection, call your doctor.

Localized itching is often caused by diabetes. It can be caused by a yeast infection, dry skin, or poor circulation. When poor circulation is the cause of itching, the itchiest areas may be the lower parts of the legs.

You may be able to treat itching yourself. Limit how often you bathe, particularly when the humidity is low. Use mild soap with moisturizer and apply skin cream after bathing.