Diabetes and Yeast Infections

Diabetes mellitus (DM) is a common hormonal disorder affecting millions of people worldwide, characterised by persistently high blood sugar levels. There are two main types of diabetes, type 1 DM, where the body does not produce enough insulin, and type 2 DM, which occurs when the body becomes resistant to insulin's effects.

Type 2 DM has now become a global pandemic, affecting both developed and developing nations. The number of people with diabetes in the age group of 20-79 years has risen from 415 million in 2015 with projections of it reaching 642 million by the year 2040.

One infection that can occur more frequently in people with diabetes is a yeast infection. The most common yeast infection is caused by the yeast species called Candida and is called candidiasis. Candidiasis can manifest in various forms depending on the area of the body affected. It may involve one or more sites in the body, including the oral cavity, skin and nails, gastrointestinal tract, genitourinary tract, and the foot. Individuals with diabetes may require more time to recover from infections compared to those without diabetes.1,2

Diabetes and Yeast Infections: Understanding the Connection

1. Impact of Diabetes on Yeast Infections

• Candida is a type of fungus found in humans, animals, and in certain environments such as hospitals. The ability of Candida to cause harm depends on the immune system of the host, which determines whether it remains as a harmless cohabitant or becomes a parasite in the body.
• People with diabetes are more prone to multiple organ dysfunction, which weakens their ability to fight off harmful germs and thus increases the risk of widespread infections.
• Further, the conditions for the spread of infection become more favourable due to factors like high blood sugar levels and the release of proteolytic enzymes like Sap proteins that create suitable conditions for Candida infection.
• Other factors contributing to fungal infections include liver problems, reduced gut secretions, changes in the normal bacteria of the gut, use of antibiotics or other medications, deficiencies in essential nutrients, and dietary factors.

2. Yeast Infections as a Potential Indicator for Diabetes

Recurrent candida infections are often observed in individuals with diabetes and can serve as a potential indicator of pre-diabetic conditions. Pre-diabetes or impaired glucose tolerance is suspected when fasting plasma glucose falls within the range of 100-125 mg/dL.1 Immune system impairments are exacerbated by the hyperglycaemic environment in people with diabetes.

Candida Infections in Individuals with Diabetes

Candida infections commonly seen in diabetes include:

• Oral candidiasis – This is a common infection characterised by mucosal changes, such as red or white patches and curd-like plaques in the mouth. Risk factors for oral candidiasis in individuals with diabetes include tongue lesions, tobacco smoking, wearing dentures, and immunosuppression.
• Vulvovaginal candidiasis – This is another common candida infection in individuals with diabetes, attributed to reduced immune response. Metabolic disorders such as pregnancy and aging can predispose individuals with diabetes to recurrent infections.
• Urinary tract candidiasis – Individuals with diabetes are more susceptible to this form of candidiasis, especially in hospital settings, due to factors like urinary retention (being unable to empty the bladder completely when urinating), trouble initiating urination, and kidney transplantation.
• Systemic candidiasis – This condition wherein there is infection of blood, affects multiple organs in the body, and is more prevalent in individuals with diabetes, primarily due to blood vessel disease (microvascular disease progression and diabetes vasculopathy) and compromised host defence mechanisms.
• Fungal foot ulcers – Individuals with diabetes are also prone to cutaneous fungal infections, particularly foot infections and infections of the nails (onychomycosis), which are considered predictors of diabetic foot syndrome.

Diagnosis and Management of Yeast Infections in Diabetes

1. Diagnosis

Some of the diagnostic tests for yeast infections in diabetes include:

• Visual examination and microscopic analysis: In some cases, the a yeast infection can be diagnosed by visually inspecting the affected area and examining a sample of cells under a microscope.
• Yeast infection (Vaginal): A pelvic exam is performed, and a sample of the vaginal discharge is taken for analysis.
• Oral yeast infection (Thrush): The infected area in the mouth is visually examined, and a scraping of cells may be collected for microscopic examination.
• Yeast infection (Present on the skin or nails): A small sample of skin or nail is scraped off using a blunt-edged instrument for examination.
• Fungal culture test: If the initial sample does not provide enough cells for diagnosis, a fungal culture test may be performed. The sample is sent to a laboratory to allow the yeast cells to grow, and results are generally received within a few days or weeks.
• Invasive yeast infection: If there is suspicion of a yeast infection spreading to the blood or organs, additional tests, such as fungal culture or other diagnostic procedures, may be performed on samples of blood, other fluids, or infected tissues.

2. Management

Here are some ways to manage diabetes and yeast infections:

• Individuals with diabetes with yeast infections have several management options. These options include topical therapy or systemic therapy along with medicines to keep diabetes under control.
• Systemic medications are taken by mouth and can be effective in treating infection. However, these medications can have side effects and may interact with other drugs, so it's important to be cautious, especially for individuals with diabetes.
• In some cases, oral medications may not be suitable or contraindicated. In such situations, topical therapy with a specific solution may be prescribed. It is important to use the topical medication as instructed by the doctor.
• Depending upon the site, certain specific interventions may be required such as adequate hygiene maintenance, skin care and nail removal in cases of skin/nail involvement.
• Treatment duration may vary depending on the severity of the infection and the specific medication prescribed.

Conclusion

In conclusion, the link between diabetes and yeast infections, particularly candidiasis, is well-established. Diabetes weakens the immune system, providing a conducive environment for Candida overgrowth and infection.

Effective management of yeast infections in diabetes involves oral and topical therapies, prescribed by healthcare professionals. Regular monitoring and proper diabetes management are crucial in reducing the frequency of yeast infections in diabetes.