Diabetics and yeast infections

Thrush is a yeast infection (candida albicans) which tends to affect warm, moist areas of the body such as the vagina, penis, mouth and certain areas of skin

Thrush is more common in people with diabetes as high sugar levels lead to better conditions for the yeast to grow.

A dry mouth coupled with a higher amount of glucose in the saliva can also make for favourable conditions for thrush.

What causes thrush?

High blood sugar levels is one of the main causes of thrush and so is an weakened immune system, which is also common in people with diabetes.

Damaged or irritated skin also promotes the growth of thrush.

Smoking increases the chance of oral thrush and certain oral contraceptives may cause vaginal thrush.

Symptoms of thrush

Vaginal thrush (vulvovaginal candidiasis) symptoms include:

  • Soreness and irritation
  • White curd appearance on the skin
  • Pain during sexual intercourse
  • White vaginal discharge
  • Reddening of the vulva (the outer parts of the vagina)
  • Itching around the vagina (infectious vaginitis)

Oral thrush (oral candidiasis) symptoms include:

  • A nasty or bitter taste
  • Redness or bleeding inside the mouth
  • Creamy white coloured patches (lesions) in the mouth (cheeks, lips, tongue or the back of the mouth)
  • Painful and sore mouth (can include the throat)
  • Cracks at the corners of the lips (angular cheilitis)

Thrush in men (candida balanitis)

Symptoms of thrush in men include:

  • Reddening or swelling or soreness of the glans (head) of the penis
  • Itching around the tip of the penis
  • Discharge beneath the foreskin
  • Nasty odour
  • Pain during urination
  • White curd-like appearance on the skin
  • Painful experience during sex

Candidal skin infections can also occur around folds of skin such as armpits and the groin.

Is thrush a common problem?

Thrush is a common problem and particularly for people with diabetes. Higher levels of glucose in the blood make candida all the more likely, so diabetics who have difficulty controlling their blood sugar may find themselves particularly prone to yeast infections.

Is thrush serious?

Occasional periods of thrush may not be a cause to worry.

However, regular episodes which go untreated can lead to more serious infections. Thrush is an uncomfortable problem and it is possible to pass on to a partner.

What treatments are available for thrush (candida)?

Thrush may be treated by anti-fungal creams or by orally taken thrush treatments.

Typically used thrush treatments include:

  • Topical imidazole
  • Fluconazole
  • Itraconazole
  • Clotrimazole
  • Ketoconazole

How can I prevent thrush from occurring?

For people with diabetes, keeping blood sugar levels under control will certainly help to reduce the frequency and severity of outbreaks of yeast infections.

Genital infections can be reduced by wearing looser fitting clothing (particularly underwear), washing your genitals regularly but avoiding the use of scented soaps and shampoos.

Oral candidiasis can be prevented by:

  • Maintaining good dental hygiene
  • Brushing twice a day
  • Rinsing your mouth after eating
  • Flossing regularly
  • Using mouthwash
  • Maintaining clean dentures
  • Regularly visiting a dentist

Can Your Sugar Habit Explain Your Chronic Yeast Infections?

As any woman who’s had a yeast infection knows (and statistics show that three out of four of us will experience at least one in our lifetimes), once you spot those tell-tale symptoms such as itching and burning, you’ll do pretty much anything to get rid of it, STAT. Actress Gabrielle Union went so far as to suggest women stick yogurt-covered tampons in their vaginas to be free of a yeast infection, which, uh, don’t do that.

It’s not exactly wrong to look to the kitchen when it comes to yeast infections, though—except, instead of looking for a cure, you should be looking for a culprit.

RELATED: How to Ease Your Withdrawal Symptoms When You Quit Sugar, According to a Nutritionist

There’s actually a link between recurring yeast infections and the amount of sugar in your diet, says Jessica Shepherd, MD, an assistant professor of clinical obstetrics and gynecology and director of minimally invasive gynecology at the University of Illinois College of Medicine at Chicago. “When there’s too much sugar in the body, the immune system becomes suppressed and unable to ward off any bad bacteria; that can lead to an overgrowth of yeast in the vagina,” she explains.

The key word is overgrowth. All women have yeast, or candida albicans, in their vaginal area; it exists symbiotically with lactobacilli, a type of bacteria. “When those are both maintained, you’re fine,” says Lakeisha Richardson, MD, an ob-gyn in Greenville, MS. “But when one grows more quickly than the other, that’s when you typically develop a yeast or bacterial infection.”

But what exactly does the food you put in your mouth have to do with what’s going on in your vagina? Whatever we eat is broken down and ends up in our bloodstream so we can either use it or excrete it, explains Dr. Richardson.

RELATED: Can Stress Give You a Yeast Infection?

“When you’ve had too much sugar and you’re body can’t get rid of it, it can end up in your blood, running throughout your body—including to the vagina, where there’s a significant amount of blood vessels,” she says. “When you have normal glucose control, the yeast in your vagina doesn’t get enough sugar to grow. But when that excess sugar passes through the area, you create an environment where yeast has more than enough nutrients to overgrow.”

Before you freak out about that Friday night ice cream binge, know that it’s unlikely that eating too much sugar is to blame for that one yeast infection you got one time or even the annual yeast infection you typically find yourself suffering through, says Dr. Shepherd. “More likely causes are spending too much time in sweaty gym clothes; wearing tight, synthetic underwear that doesn’t allow the vagina to breath; or even stress,” she says.

But if you’re suffering four or more yeast infections a year, which doctors consider a recurring issue, then you might want to look to your diet. “If someone comes in with recurring yeast infections and tells me that they don’t have any other health issues but they drink soda, eat candy, and love ice cream, then I would definitely tell them to cut their sugar intake in half,” says Dr. Richardson.

RELATED: The Best and Worst Foods for Your Vagina

It’s not just junk food that dumps dietary sugar into your system, says Dr. Shepherd. Hidden sugars can be found in refined carbohydrates (like baked goods and packaged cereals), sweetened drinks (like the sports drink you refuel with after a workout), and bottled sauces, dressings, and condiments. “People are always like, ‘Oh, I don’t have a high-sugar diet’ because they don’t add sugar to their food, but they don’t think about the sugars that are already in what they do eat,” she explains.

In this case, your vaginal health may just be a wake-up call for your overall health. “If you’re starting to have chronic yeast infections, look at the bigger picture,” says Dr. Shepherd. Yeast infections on their own may not be a major cause for alarm; as soon as you’re aware of it, you can treat it and be done with it. Yet “the vagina may not be the main source of the problem, but it could indicate a problem with your gut health, your stress levels, or another internal issue,” she adds.

RELATED: 6 Sneaky Ingredients That Are Really Just Added Sugar

Even if you recognize the symptoms and are old hat when it comes to treating yeast infections, it’s worth making a call to your ob-gyn, walking through your history, and making sure there isn’t a larger issue at play. Whatever you do, don’t put yogurt on a tampon. Please.

Diabetes Forecast

Haleigh Eason/Mittera (illustrations); Thinkstock (patterns)

Yeast infections rate anywhere from annoying to unbearable, yet many people avoid broaching the topic with their doctor. But don’t let embarrassment stop you from raising the issue with your health care provider, particularly if you’re getting these infections frequently.

Spotting Symptoms

Yeast infections occur when the fungus Candida albicans grows out of control, says Deena Adimoolam, MD, assistant professor of diabetes, endocrinology, and bone disease at the Icahn School of Medicine at Mount Sinai in New York. The overgrowth of yeast can occur anywhere on the body, though for women, these infections typically affect the vagina. It’s less common, but men can develop yeast infections, too. “You can even have yeast infections that affect certain areas of the skin, especially in skin folds, where it’s very moist and warm,” she says.

The symptoms of a vaginal yeast infection include itching, burning, pain, and a cottage cheese–like discharge. Signs of a skin yeast infection are a bit different. “It can appear as a slight discoloration of the skin or a red or pink scaly rash,” says Adimoolam, who notes that such infections may be itchy.

Risky Business

Women with poorly controlled diabetes are at high risk for yeast infections because candida thrives on higher-than-normal glucose levels, says Pauline Camacho, MD, FACE, professor of medicine at Loyola University Medical Center in Chicago. Women on SGLT-2 inhibitors are also at increased risk. Men with elevated glucose have a greater risk than people without diabetes for developing yeast infections.

Looking Inward

While it’s clear that high blood glucose allows yeast to thrive, researchers are still looking at why this is the case. The answer may lie with the immune system (uncontrolled diabetes hinders the body’s ability to fight infection) or the medications you take.

Immune Evasion

One theory for why yeast infections come back is that candida produces a protein that allows it to adhere better than other fungi and bacteria to the vaginal lining and evade the immune system, says Adimoolam. The result? Recurrent infections when blood glucose is high.

Blunt Response

Immune cells called neutrophils defend the body against disease, but they’re compromised in people with poorly controlled diabetes. Some studies show that these cells have defects in movement and show altered chemical processes involved in destroying infections—such as candida. T cells are another infection-fighting heavyweight in our immune system, but high blood glucose may weaken their ability to attack. Adimoolam says the reason is not yet clear.

Side Effects

Yeast infections can thrive for reasons unrelated to diabetes. Prolonged or repeated antibiotic use can disrupt the balance of good bacteria and yeast in the vaginal area (also known as normal flora) that suppress the growth of bad bacteria and yeast. As the bacteria that keep candida in check die, the yeast spreads out of control, says Adimoolam. Older, postmenopausal women are at increased risk for yeast infections because they produce less estrogen. Women using certain contraceptives, such as vaginal sponges and diaphragms, also have a higher risk. These have been shown to disrupt vaginal flora and boost yeast growth. People taking immunosuppressive medications—such as those that prevent rejection of organ transplants—are more likely to get infections.

Treating Infections

Over-the-counter creams for vaginal infections and infections of the skin can help treat a yeast infection early on, says Camacho. But if it doesn’t clear up after a few days or if you’ve had several yeast infections in a short time, Camacho recommends that you talk with your health care provider. An oral antifungal medication will probably be prescribed.

Keeping your blood glucose within target range can prevent a recurrence. “These organisms tend to thrive when sugars are the highest,” Adimoolam says.

Yeast Prevention

Four simple lifestyle changes can help you fend off yeast infections.

  1. Wear breathable fabrics. Yeast thrives in warm environments, so make sure your vaginal area has enough airflow. Opt for cotton underwear and avoid tight-fitting undergarments and panty hose. “Allow for as much airflow as possible,” says Deena Adimoolam, MD, assistant professor of diabetes, endocrinology, and bone disease at the Icahn School of Medicine at Mount Sinai in New York.
  2. Follow proper hygiene. After going to the bathroom, wipe front to back. Wash yourself frequently. Keep your genitals and the area under skin folds dry and clean. “It’s all about controlling moisture,” says Pauline Camacho, MD, FACE, president of the American Association of Clinical Endocrinologists.
  3. Choose condoms wisely. Those with spermicide can lead to yeast infections in some women.
  4. Avoid douches and scented sanitary products. They can change the pH of the vagina, which can upset the healthy balance of vaginal bacteria and make yeast infections more likely.

High blood sugars affect nearly every part of your body. When it comes to the health of your genitalia as a person with diabetes, high blood sugars can also lead to the growth of yeast.

Yeast infections are very treatable — but they are extremely uncomfortable, stressful, and inevitably recurring if your blood sugars continue to be high.

In this article, we’ll discuss how diabetes can cause frequent yeast infections, how yeast infections are treated, and what you can do to prevent them in the future.

Table of Contents

What is a yeast infection?

A yeast infection develops within the vagina — and is also referred to as “vulvovaginal candidiasis,” explains Planned Parenthood.

Yeast is an important part of a healthy vagina, but too much is a big problem. When the healthy amount of yeast in your vagina grows out of control it leads to extremely uncomfortable symptoms.

Yeast is technically a fungus, and most yeast infections are considered a “fungal infection.”

Some yeast infections can be a “bacterial” infection but these are less common.

Yeast infections can develop in other parts of the body — your mouth, tongue, and throat — but this is referred to medically as “thrush.”

Symptoms of a yeast infection

The earliest signs of a yeast infection are easy to ignore or dismiss. Within a few days, those symptoms will escalate quickly as the amount of yeast grows. Some of those symptoms can become unbearable if left untreated.

  • Itching in and around the vagina
  • Burning in and around the vagina
  • White, clumpy cottage cheese-like substance inside and around the vagina
  • White discharge
  • Inflammation
  • Redness
  • If any odor, it is mild
  • A stinging sensation when you urinate
  • Burning pain during intercourse

Do your best not to scratch and aggressively rub the affected area. Excessive manual irritation of the area can create small cuts in the very tender skin within your vaginal area, making the infection worse.

If your symptoms include any of the following, you should contact your doctor immediately

  • Yellow discharge
  • Strong, foul-smelling odor
  • Fever
  • Vomiting
  • Bloody discharge
  • Increase urination
  • Stomach or back pain

Causes of yeast infection

Some women are simply prone to yeast infections. Most women will experience at least one or two during their adult life.

Women with diabetes, on the other hand, will likely experience yeast infections more often due to short-term or long-term high blood sugar levels.

  • High blood sugar levels
  • Normal changes in hormone levels (during your menstrual cycle or period)
  • Birth-control
  • Antibiotics
  • Cortisone injections
  • Weakened immune system
  • Chemotherapy
  • HIV/Aids treatments
  • Anabolic steroids
  • Douching
  • Too much moisture in the vaginal area from tight underwear, damp panty liners, damp menstrual pads, sweat, wet swimsuit, etc.
  • Reaction to sexual partner’s genital chemistry
  • Reaction to sexual partner’s semen
  • Intercourse with a person who has a yeast infection

Men can develop a yeast infection in their testicles or penis if they have intercourse with a woman who has one, but it’s rare.

Diagnosing a yeast infection

While the symptoms of a yeast infection are generally obvious and hard to confuse with another medical condition, it is recommended that you contact your healthcare team to get a proper diagnosis.

They will take a swab sample of the discharge to confirm it is a yeast infection. This will also determine whether it’s fungal or bacterial.

Why diabetes increases your risk of a yeast infection

Yeast loves sugar. Much like the chemistry of yeast in a loaf of bread, yeast consumes sugar and this encourages its growth.

When your blood sugar is high for a prolonged period of time — or it’s spiking severely high repeatedly over the course of a few days — you can easily trigger out of control yeast growth.

250 mg/dL is the general threshold when your body begins to struggle with normal tasks — like exercise, for example. Persistently “hanging out” above this level is an ideal environment for the growth of yeast.

When levels are well over 300 mg/dL, the development of yeast is almost inevitable if blood sugars aren’t improved quickly.

While every vagina has a normal and healthy amount of yeast in it at all times, an infection develops when the amount of yeast grows too much or too fast.

It’s said that most women (even those without diabetes) will experience at least one yeast infection in their lifetime, but people with diabetes are likely going to experience far more.

The excess glucose in your bloodstream when your blood sugar levels are running higher for a prolonged period of time (even just one week) actually feeds the growth of that fungus.

While there are treatment options easily available for yeast infections, a person with diabetes will continue to develop them until blood sugar levels are brought back down into a healthier range.

Women struggling with diabulimia — which entails persistently high blood sugar levels — will likely face chronic yeast infections until they achieve recovery from their eating disorder.

Treatment options for yeast infections

There are several treatment options for yeast infections depending on the severity of the infection and how your body responds to one type of antifungal versus another.

Do keep in mind that your yeast infection will come back — sometimes immediately — if your blood sugars continue to persist above 250 mg/dL. No antifungal will cure your yeast infection fully if you don’t lower your blood sugar levels.

Over-the-counter antifungal medications

These medications are either a pill-shape or a cream. Both come with a plastic applicator tube similar to a tampon, that pushes the capsule or cream into the vagina where the yeast is growing.

You’ll see options for a “3-day,” “5-day,” or “7-day” treatment. A 3-day treatment should work for the average yeast infection.

In the United States, the available brands are:

If miconazole doesn’t cure your infection, you may find tioconazole does — and vice versa. Most people respond better to one over the other.

Prescription antifungal medication

If over-the-counter remedies don’t bring you relief within a few days, it’s worth a call to your doctor and as about prescription-strength medications.

The most common brand in the United States is Fluconazole (Diflucan)

If your yeast infection is persistent or frequent, you should absolutely contact your healthcare team. Chronic yeast infections can be a sign of something else.

Itch-relief

These medications cannot cure your yeast infection but they can help reduce the exterior burning and itching while you treat the infection with another medication.

In the United States, the available brands are:

  • Vagisil (wipes or cream)
  • Vagicaine
  • AZO

Preventing yeast infections

In addition to keeping your blood sugar levels in a mostly healthy range, Planned Parenthood recommends the following to reduce your risk of developing a yeast infection:

  • Avoid scented tampons, vaginal deodorants or other products intended for your vagina that contain perfume or artificial scents.
  • Avoid using perfumed and scented bath products including soap, laundry detergent, bubble bath, bath bombs, or colored toilet paper.
  • Absolutely do not “douche.” The practice of douching actually washes away the healthy, organic fluid in your vagina which disturbs its natural balance. Your vagina is a “self-cleaning” organism. Avoid interfering with its natural process unless you’re treating a clear condition.
  • Avoid sitting in damp underwear or swimsuits for lengthy periods of time.
  • Change your underwear after exercising to avoid sitting in sweaty, damp underwear.
  • Change tampons, pads, menstrual cups, and liners regularly.
  • Wash your vagina with water and mild unscented soap.
  • Avoid transferring bacteria from your anus into your vagina by wiping “front to back.”
  • Consider that the lubricant or spermicide you’re using may be a source of infection — and consider switching if you are developing recurring infections.
  • Look at your vagina with a mirror when it’s healthy so you know what it looks like when it’s not.
  • Contact your healthcare team (primary care or gynecologist)
  • Strive to keep your blood sugar levels in your goal range and your HbA1c at or below 8.0 percent, and ideally below 7.0 percent.

Yeast infections are no picnic! As people with diabetes, they can be just another motivation to manage our blood sugars as well as possible!

Suggested next posts:

  • Diabetes and Periods: Everything You Need to Know
  • Diabetes and Sleep Problems: Causes and Treatment Options

If you found this guide to yeast infection & diabetes useful, please sign up for our newsletter (and get a free chapter from the Fit With Diabetes eBook) using the form below. We send out a weekly newsletter with the latest posts and recipes from Diabetes Strong.

How Women With Diabetes Can Reduce Risk of Yeast Infections

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Diabetes poses a host of problems for women’s health, and among the most common are yeast infections. In fact, it’s such a telltale sign that doctors often will test a woman who has recurring infections for diabetes if she doesn’t already know she has the disease.

Diabetes—particularly the occurrence of high blood glucose levels—can cause a bodily imbalance that can lead to an overgrowth of yeast, which thrive in warm, moist places, like your vagina. Diabetic women who have difficulty controlling their blood sugar are more susceptible to yeast infections, but there are steps you can take to stave off infections.

How can you prevent yeast infections?

It’s essential for women with diabetes to keep their blood sugar levels under control. Yeast eat sugar, and with all that extra glucose in your system, you’ll only fuel the problem. In addition to keeping your blood sugar in the normal range, adopt these habits to keep yeast infections at bay.

Do:

  • Change tampons or pads frequently.
  • Make sure your underwear has a cotton liner, which helps keep you cool and dry.
  • Dry yourself thoroughly after bathing or swimming.
  • Eat some unsweetened yogurt with live cultures—the good bacteria that help keep yeast in check. Alternatively, you can get these good bacteria, called probiotics, as a capsule in a nutrition store, but talk to your doctor before adding supplements to your diet.

  • When using the bathroom, wipe front to back, which helps prevent germs from spreading.

Don’t:

  • Wear tight-fitting underwear or pants, which can trap body heat. Instead, choose looser clothes made of nature fibers so you’ll stay dryer.

  • Sit around in a wet bathing suit or workout gear, which creates the moist environment yeast love.

  • Take long, hot baths. That goes for soaking in a hot tub, too.
  • Use bubble bath or scented tampons, which can irritate the vagina. Printed toilet paper is also a big no-no. Steer clear of anything with perfumes or dyes.

  • Douche, which washes away the good bacteria that prevent an overgrowth of yeast.
  • Take unneeded antibiotics, such as to treat a common cold. Antibiotics kill the good bacteria along with the bad, and it’s the good bacteria that help keep yeast under control.

How can you treat a yeast infection?

If you do develop a yeast infection, you can try an over-the-counter medication to treat it. Creams and suppositories are usually effective for mild to moderate symptoms, and they’re safe for pregnant women. A few things to know about these types of short-course vaginal therapies: You might feel some burning as a side effect, and the treatment might reduce the effectiveness of condoms or birth control. If this is a consideration, talk to your doctor about other methods of preventing pregnancy.

Oral medications must be prescribed by your doctor. Single-dose and multi-dose medication might be needed to treat more severe symptoms.

As a non-medicinal way to help get rid of a yeast infection, change your underwear often to stay dryer.

If left untreated, a yeast infection may go away on its own, often when menstruation begins. But for women with diabetes, yeast infections may return frequently. A small percentage of women suffer four or more yeast infections a year, a sign of recurrent vulvovaginal candidiasis (RVVC), which is more common in women with diabetes. If you believe you have RVVC, talk to your doctor about treatment options for you. You might need to begin a medication regimen, possibly up to six months of treatment, to prevent future infections.

Men can get yeast infections, too.

While it’s less common, men can develop yeast infections on the penis, and men with diabetes are at higher risk. Yeast infections aren’t usually spread through sexual contact, but if you have a yeast infection, it is possible to pass it to your sex partner, who then can reinfect you. Your partner won’t always need to be tested or treated for a yeast infection, but if you suffer frequent infections, you may both need to be treated. Talk to your doctor if this is a concern.

Uncontrolled blood sugar isn’t the only cause of yeast infections—three out of every four women will get one in their life—but it contributes to frequent, recurring infections. Bottom line? Do everything you can to keep your diabetes under control to reduce your risk for yeast infections.

Yeast Infections and Diabetes

Dr. Greene’s Answer

Timbo, I’m so glad you have raised this issue. There are indeed early ways to detect diabetes, but most children with type 1 diabetes are not diagnosed until the situation has become desperate. The diabetes symptoms that most people are familiar with (increased thirst and increased urination) are very late warning signs. By then, the child is dangerously close to the end, unless she receives prompt treatment.

Diabetes is a slow process that may have begun as long as nine years earlier – with no one suspecting.

In healthy children a hormone called insulin pushes sugar from the blood into the body’s cells, where it can be used for fuel. This insulin is produced in the pancreas. Diabetes is an attack on the pancreas.

People who get type 1 diabetes were born with a genetic predisposition to it. Not everyone born with this predisposition gets diabetes, however. In fact, if an identical twin has diabetes, the other twin only gets diabetes about half the time. Some predisposed individuals are exposed to something in the environment that triggers the diabetes. This is usually a viral infection. The virus misleads the body’s immune system into making antibodies that attack its own pancreas cells. Type 1 diabetes is what we call an autoimmune disease.

When diabetes first begins, the insulin-producing cells of the pancreas are destroyed gradually over months or years. The remaining cells are able to compensate for this by increasing their insulin production. The body can still make enough insulin to keep the concentration of sugar in the blood within a fairly narrow range.

Not until 90% of the insulin-producing cells are destroyed is the sugar no longer pushed effectively from the blood into the cells. The blood sugar level begins to rise. Without sugar in the cells, muscle and fat begin to be burned for fuel (evidence of this — ketones — shows up in the urine). The person feels hungry all the time, but loses weight in spite of increased eating.The person is literally starving.

Meanwhile, the concentration of sugar in the blood begins to increase. We call it diabetes when the fasting blood sugar is higher than 126 mg/dL. When the level reaches around 180 mg/dL, the sugar begins to spill over into the urine. This causes the person to make more urine and then to get thirstier, creating an accelerating cycle.

Thus, insulin-dependent diabetes generally brews for years, but appears abruptly. Then it rarely goes undiagnosed for more than a few weeks. The classic symptoms at diagnosis are increased urination (polyuria), increased thirst (polydipsia), increased eating (polyphagia) and weight loss. Anyone with the classic symptoms should have a blood sugar test as well as a urine test. Occasionally people also report fatigue, blurred vision, vomiting, or abdominal pain. If the disease remains undiagnosed, symptoms progress to include labored breathing, coma, and death.

How much better it would be to diagnose diabetes long before everything is out of control! As you have pointed out, Timbo, chronic yeast infections (or other skin infections) can be an early warning sign. Healthy kids in diapers commonly get yeast diaper rashes. But if these infections are very frequent, or not easy to clear up with appropriate treatment, I get concerned. If a child who is out of diapers develops even one yeast infection, the child should be checked for diabetes. In the pediatrician’s office, a blood sugar test can be performed to check for diabetes. Checking for diabetes is especially important if there is a family history of diabetes.

Other tests are available for even earlier detection of the diabetes process. People with type 1 diabetes have measurable antibodies in their blood that reveal their autoimmune condition. One autoantibody found in people with type 1 diabetes is the islet cell antibody. This antibody is often detectable months or years before symptoms appear. Other antibodies include the ICA 512 antibody and the GAD (or 64-K) antibody. The presence of these antibodies is a sign that the body is attacking its own insulin-producing cells. I expect that testing for autoantibodies will get less expensive and more common over the next several years.

An intriguing study released in October 1999 1 showed that by measuring the number of autoantibodies in siblings of children with diabetes, they were able to predict the risk each of these siblings had for going on to develop diabetes. They were even able to predict how long it would be likely to take.

Clearly this is useful information. It will become especially powerful when we find ways to prevent the autoantibodies from completing their destructive actions.

My hope is that in this next century, most diseases from cancer to diabetes to the common cold will no longer be thought of as beginning when we first notice the symptoms. As we are able to detect the true beginnings of these processes, we will be far more able to prevent and treat diseases before they wreak mayhem and destruction in our bodies.

Footnote References: 1 Pediatrics – 1999 Oct; 104(4 Pt 1): 925-30

So I get this e-mail from Web Editor Tara Dairman one day asking me if I’ve ever had any experience with diabetes-related yeast infections and would I like to blog about it.

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“You want me,” I zapped back, “to tell the world about my itchy hooha?”

I thought about it and, in the spirit of being up-front about what it’s like to live with diabetes, decided to go for it.

If any one thing causes me to try and keep my blood glucose under control, it’s to avoid yeast infections which, for about a three-year period back in the day, would absolutely not go away. I itched. I burned. I wriggled and scratched. I wished sandpaper was absorbent and came in a roll. I treated and treated and treated with over-the-counter creams that were formerly available only by prescription. I applied a cream that a doctor prescribed for me. It soothed the itch, but didn’t cure the infection.

It wasn’t until I switched to a female doctor that I finally got somebody who really understood what I was going through. It was a time when Diflucan (fluconazole) was new and the general wisdom was that you need only take one pill, and voila!

Not with diabetes, you don’t. Yeast loves sugar, and I was very sweet in those days. The doc prescribed two pills and a prescription vaginal cream. It took two courses of that for the yeast infection to go away.

And stop snickering, guys: You can get diabetes-related yeast infections, too. In fact, I know of one man who was diagnosed with diabetes when his “little friend,” as he called it, got a red, itchy rash that wouldn’t go away.

Now comes news from a study in India that, in women with diabetes, a 14-day course of using boric acid vaginal suppositories is better at clearing up yeast infections than one Diflucan tablet. (Heck, I coulda told ’em that one Diflucan won’t work!) At any rate, the researchers found that the cure rate was 64% for women with Candida glabrata infections (a type of yeast infection more common in women with diabetes) who used the suppositories versus a 29% cure rate in those who took one Diflucan.

With my blood glucose under control now, my main risk factor for getting yeast infections is taking antibiotics. I had a particularly bad one a couple of years ago when I got a snakebite while substituting for a fifth-grade teacher. (That’ll teach me to take dares from 10-year-olds!) The school corporation insisted that I go to a doctor, who insisted that I take some major antibiotics. The antibiotics did a number on my stomach and contributed to a raging vaginal yeast infection. I should have just nodded my head and skipped the drugs. It was only a scratch and I immediately washed and disinfected. Well, actually, I shouldn’t have taken the dare to pick up the snake, but what fun is that?

Guys, you can also pick up yeast infections from your partner, so keep away until the lady is over it. While the man may be symptom-free, he can still reinfect his partner, leading the two of you to keep passing the infection back and forth.

Also, my neighbor the med student says that many yeast infections stem from sexual relations when the man hasn’t practiced good hygiene, so wash your “little friend” off good before frolicking.

And keep that blood glucose down. Like a stray kitten or puppy, if you feed it, it’ll keep coming back.

Diabetes and Women

Women with diabetes have more to manage. Stay on track by checking your blood sugar often, eating healthy food, and being active so you can be your healthiest and feel your best.

How is diabetes different for women than it is for men? Diabetes increases the risk of heart disease (the most common diabetes complication) by about four times in women but only about two times in men, and women have worse outcomes after a heart attack. Women are also at higher risk of other diabetes-related complications such as blindness, kidney disease, and depression.

Not only is diabetes different for women, it’s different among women—African American, Hispanic/Latina, American Indian/Alaska Native, and Asian/Pacific Islander women are more likely to have diabetes than white women.

How you manage diabetes may need to change over time depending on what’s happening in your life. Here’s what to expect and what you can do to stay on track.

Yeast and Urinary Tract Infections

Many women will get a vaginal yeast infection at some point, but women with diabetes are at higher risk especially if their blood sugar levels are high.

More than 50% of women will get a urinary tract infection (UTI) in their lifetime, and your risk may be higher if you have diabetes. Causes include high blood sugar levels and poor circulation (which reduces your body’s ability to fight infections). Also, some women have bladders that don’t empty all the way because of diabetes, creating a perfect environment for bacteria to grow.

What You Can Do: To prevent yeast infections and UTIs, keep your blood sugar levels as close to your target range as possible. Other ways to prevent UTIs: drink lots of water, wear cotton underwear, and urinate often instead of waiting until your bladder is full.

Menstrual Cycle

Changes in hormone levels right before and during your period can make blood sugar levels hard to predict. You may also have longer or heavier periods, and food cravings can make managing diabetes harder. You may notice a pattern over time, or you may find that every period is different.

What You Can Do: Check your blood sugar often and keep track of the results to see if there’s a pattern. If you use insulin, you might need to take more in the days before your period. Talk to your doctor about changing your dosage if needed. Being active on most days, eating healthy food in the right amounts, and getting enough sleep can all help too.

Sex

Diabetes can lower your interest in sex and your ability to enjoy it. For some women, vaginal dryness can make intercourse uncomfortable or even painful. Causes can include nerve damage, reduced blood flow, medications, and hormonal changes, including those during pregnancy or menopause.

What You Can Do: Be sure to talk to your doctor if you’re having any sexual issues. He or she can let you know your options, from using vaginal lubricants to doing exercises that can increase sexual response.

Birth Control

It’s important to use birth control if you don’t want to become pregnant or if you want to wait until your blood sugar levels are in your target range, since high blood sugar can cause problems during pregnancy for you and your baby. There are many types of birth control methods, including intrauterine devices (IUDs), implants, injections, pills, patches, vaginal rings, and barrier methods like condoms and diaphragms. Choosing the right option for you will depend on whether you have any other medical conditions, current medicines you take, and other factors.

What You Can Do: Talk with your doctor about all your birth control optionsexternal icon and risks. Continue checking your blood sugar, track the results, and let your doctor know if your levels go up.

Make Friends With Your Numbers

Sometimes having high blood sugar can feel like a test you didn’t pass. But numbers are just numbers. Think of them instead as information. Did a certain food or activity make your levels go up or down? Armed with that knowledge, you can make adjustments and get closer to your target range more often.

You can’t go wrong with the basics: check your blood sugar regularly, eat healthy food, and be active on most days.

Getting Pregnant

If you know you want to have a baby, planning ahead is really important. Diabetes can make it harder to get pregnant, and high blood sugar can increase your risk for:

  • Preeclampsia (high blood pressure)
  • Delivery by cesarean section (C-section)
  • Miscarriage or stillbirth

A baby’s organs form during the first 2 months of pregnancy, and high blood sugar during that time can cause birth defects. High blood sugar during pregnancy can also increase the chance that your baby could:

  • Be born too early
  • Weigh too much (making delivery harder)
  • Have breathing problems or low blood sugar right after birth

What You Can Do: Work with your health care team to get your blood sugar levels in your target range and establish good habits such as eating healthy and being active. Your blood sugar levels can change quickly, so check them often and adjust your food, activity, and medicine as needed with guidance from your doctor.

During Pregnancy

Gestational diabetes—high blood sugar during pregnancy—can develop in women who don’t already have diabetes. It affects 2% to 10% of pregnancies in the United States every year. Any woman can have gestational diabetes, but some are at higher risk, including those who are overweight or have obesity, are more than 25 years old, or have a family history of type 2 diabetes. Careful management is important to ensure a healthy pregnancy and healthy baby.

What You Can Do: If you’re diagnosed with gestational diabetes, your doctor will work with you to create a treatment plan to help keep your blood sugar in your target range by eating healthy food in the right amounts and being active most days of the week. You may need diabetes medicine or insulin shots to keep you and your baby healthy.

Gestational diabetes usually goes away after your baby is born. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes. It’s important to get tested for diabetes 4 to 12 weeks after delivery and continue to get tested every 1 to 3 years to make sure your blood sugar levels are in a healthy range. Ask your doctor about participating in the CDC-led National Diabetes Prevention Program, which includes a lifestyle change program scientifically proven to prevent or delay type 2 diabetes in people at risk.

Menopause

After menopauseexternal icon, your body makes less estrogen, which can cause unpredictable ups and downs in blood sugar. You may gain weight, which increases your need for insulin or other diabetes medicines. Hot flashesexternal icon and night sweats may disrupt your sleep, making managing blood sugar harder. This is also a time when sexual problems can occur, such as vaginal dryness or nerve damage.

What You Can Do: Ask your doctor about ways you can manage menopause symptomsexternal icon. If your blood sugar levels have changed, you may need to change the dosage of any diabetes medicines you’re taking. Heart disease risk goes up after menopause, so make heart-healthy choices that also help manage your diabetes, such as eating healthy food and being active.

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