Wednesday, June 12, 2024

Diabetes And Urinary Tract Infections

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Diabetes And Utis: What You Should Know

Do UTIs Occur More in Diabetics?

More than 50% of women will have a urinary tract infection at some point in their lives. Women with type 2 diabetes may be at an even higher risk of UTI. According to the National Center for Biotechnology Information , patients with type 2 diabetes experience more frequent and more severe UTIs. They also tend to have worse outcomes: the UTIs in diabetes patients are more often caused by resistant pathogens, meaning the infections are more difficult to treat.

Most important for people with diabetestype 1 or 2is to catch the UTI early. Diabetes patients can have a harder time fighting infection and are already at risk for kidney damage, which can become worse if the infection spreads.

Why Diabetes Poses A Risk

, or UTIs, occur when bacteria or other bugs invade your bodys drainage system. Normally, your immune defenses banish these bugs before they can grow and multiply. But if you have diabetes, the following factors interfere:

  • Diabetes impairs some parts of your immune response. You have fewer white blood cells and T cells to fight off invading bacteria, viruses, and fungi. For the same reason, diabetics often develop UTIs caused by less commonly encountered germs. Routine may be ineffective.

  • Nerve damage can keep your bladder from emptying, either by weakening muscles or scrambling the signals between your brain and urinary system. Urine that remains in your body too long poses a greater infection risk.

  • Sugar in your blood and urine can also contribute to a greater risk for UTI.

Besides pain and urgency related to urination, UTIs can cause back or , pressure above your pubic bone or in your rectum, weakness, , nausea, and . These symptoms often mean the infection has spread upstream to your kidneys. Hospitalization may be necessary to aggressively manage this serious problem.

Urinary Tract Infection In Patients With Diabetes Mellitus

Abstract Urinary tract infection occurs with increased frequency and severity in patients with diabetes mellitus. General host factors enhancing risk for urinary tract infection in diabetics include age, metabolic control, and long term complications, primarily diabetic nephropathy and cystopathy. Alterations in the innate immune system have been described and may also contribute. Treatment of asymptomatic bacteriuria in diabetic patients is not indicated. Early diagnosis and prompt intervention is recommended to limit morbidity of symptomatic infection. Clinical studies comparing management of urinary tract infection in persons with diabetes compared to those without as well as diabetic patients with good or poor glucose control will be necessary to improve care of urinary infection in persons with diabetes mellitus.Continue reading > >

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Head And Neck Infections

The two most serious head and neck infections in diabetic persons are invasive external otitis and rhinocerebral mucormycosis.

Invasive external otitis

Invasive external otitis is an infection of the external auditory canal that can extend to the skull base and adjacent regions. It often affects elderly diabetic individuals and the etiologic agent is usually Pseudomonas aeruginosa.

Excruciating pain, otorrhea, and hearing loss are the characteristics. Skull base osteomyelitis and cranial nerve involvement may occur. Facial paralysis occurs in 50% of the cases. The best diagnostic method is the magnetic resonance imaging.

Rhinocerebral mucormycosis

Mucormycosis is a rare opportunistic and invasive infection caused by fungi of the class Zygomycetes. The genus most commonly associated with human infections is the Rhizopus, followed by Mucor and Cunninghamella.

This infection occurs in approximately 50% of the cases in individuals with DM due to the greater availability of glucose to the pathogen that causes mucormycosis, the decrease in serum inhibitory activity against the Rhizopus in lower pH, and the increased expression of some host receptors that mediate the invasion and damage to human epithelial cells by Rhizopus.


What Are The Symptoms Of A Uti

Diabetes and Urinary Tract Infections

Let me just start by saying, if you have ever had a urinary tract infection, you certainly know the symptoms. They are not easily forgotten even if it has been years since your last one! Here is a list of the classic symptoms some you may or may not experience:

  • Burning with urination
  • Strong odor to the urine
  • Suprapubic pain
  • In people with diabetes: High or Low blood sugars

It is very important to note here that older people or people with autonomic neuropathy may not show any of the classic symptoms. The first symptom you may notice in an older person can be confusion and maybe a low grade fever.

In my years nursing, I have cared for so many elderly women who were unable to either feel the symptoms of their urinary tract infections or had dementia and were unable to communicate the symptoms to a caregiver. The first indication the caregiver had was worsening confusion and by then, the infection was severe enough to require hospitalization. Most of these patients also had diabetes, which put them at a much higher risk as well.

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If You Have Diabetes It Is Twice As Likely You Will Develop A Utiwhy

There are many factors that elevate the risk for UTIs for people with diabetes. Common sense would tell us that higher blood sugars increase the risk for all infections.

Well, believe it or not, the jury is still out on that theory for some odd reason. I could not find any recent research anywhere on this theory or for that matter on urinary tract infections in people with diabetes. My hope is more research will be considered since the complications associated with these infections can be life threatening.

According to a study by Nitzan et al Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis and management, UTIs are most common and severe with complicated outcomes in people with type 2 diabetes. The study presents the reasons people with diabetes are at a greater risk for urinary tract infections which I will outline here:

Likely Causes of Urinary Tract Infections in People with Diabetes:

  • Poor metabolic control
  • Use of catheters
  • Hospitalizations

Poor metabolic control is not completely understood as a cause of utis yet, so this is a great opportunity for researchers. The extra sugar in the urine builds up, causing the growth of extra bacteria which leads to the infection in the bladder.

We have already discussed a few of these, but lets discuss the ones we havent.

Diagnosis Of Uti In Women Patients

All women with recurrent UTI should undergo a physical examination to evaluate urogenital anatomy and vaginal tissues estrogenization. Postvoid residual urine volume also should be measured. Diabetes screening is indicated in patients with other risk factors like family history and obesity. Most women do not need extensive urologic investigations. However, women who suffer infection with organisms which is not common causes of UTI, such as Proteus, Klebsiella, Enterobacter, and Pseudomonas, may have structural abnormalities or renal calculi. They would benefit from imaging studies of the upper urinary tract and cystoscopy. Women who have persistent hematuria after recovery of their infection also require a complete urologic workup. Although empirical therapy based on symptoms is generally accurate and cost-effective, women who are thought to be in the early stages of a problem with recurrent UTI should have documented cultures. Urine culture serves as the gold standard for diagnostic accuracy. The standard definition of a UTI on culture is > 100,000 colony forming units per HPF. This value has excellent specificity but a sensitivity of only 50% .

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Diabetes And Urinary Tract Infections Things You Need To Know

By Tammy Shifflett RN, BSN, CDE, CPT

In this article we will cover everything you need to know about diabetes and your risk for Urinary Tract Infections. Do you have an increased risk of Urinary Tract Infections now that you have diabetes?

We will cover what a Urinary Tract Infection is, symptoms, diagnosis and treatment guidelines, as well as why they are more common in people with diabetes.

More importantly, we will discuss steps you can take to prevent them!

How Can Urinary Tract Infections Be Prevented

Urinary Tract Infection Prevention for Diabetics | Dr. Mark Stengler, NMD
  • Maintain normal blood sugar level as too much glucose in the urine would encourage bacterial growth in the urinary tract.
  • Try and keep the genital area clean and dry. Do not use a scented soap or intimate wash products as they can irritate the genital region.
  • Carefully clean and wipe the genital area from front to back after urinating or passing stool.
  • Drink plenty of water so that any bacteria in the tract gets flushed on passing the urine.
  • Wash the genitals with water , before and after sexual intercourse.
  • Urinate after sexual intercourse.

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How Does Diabetes Cause Infections

If you have type 1 or type 2 diabetes, it means that your blood sugar levels are too high. Fortunately, its possible to bring your blood sugar down to normal levels by exercising regularly, eating well, and taking any prescribed diabetes medications consistently. But if your blood sugar levels remain uncontrolled, they can keep your bodys immune system from working the way that it should.

Your immune system consists of white blood cells that protect your body from unknown substances like germs. Since white blood cells are a part of your blood, they rely on your blood vessels to transport blood throughout the body to get where they need to go. But because diabetes can cause blood vessel disease, your white blood cells cant always get where they need to be to fight off germs. This allows germs like bacteria, viruses, and fungi to invade your body and cause infections that make you sick.

In addition to suppressing your bodys immune system, diabetes also makes it more likely that you will have slow-healing wounds and nerve pain . Neuropathy makes it harder to notice open cuts and sores. Together, both of these complications can increase the risk of infection.

Now that you understand how diabetes can increase your risk of certain infections, lets learn what some of those infections are.

Understanding The Correlation Between Diabetes And Recurrent Utis

Weak Immune System: Type 1 diabetes is an autoimmune disease, which means it causes the immune system to attack itself. People with autoimmune diseases have weaker immune systems, making them more prone to infections than a non-diabetic person.

Poor Circulation: Along with this, they also suffer from poor circulation. Poor circulation makes it harder for the white blood cells to travel through the body and fight infections. This, in turn, increases the risk of infections and thus UTI.

Extra sugar in the urine: Another correlation between diabetes and UTI is that in case of diabetics, there is an extra sugar build up in their urine. This high level of glucose in the urine gives rise to bacteria which causes recurrent UTIs.

Autonomic neuropathy: UTIs also occur due to urine build up in the bladder and not emptying it completely. Diabetics suffer from autonomic neuropathy quite often, which is a nerve damage affecting the bladder, intestinal tract and genitals. Autonomic neuropathy makes it harder for the bladder to respond to pressure, hence not being able to empty the bladder completely. Urine in the bladder for long eventually leads to UTIs.

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Major Infections Associated With Diabetes Mellitus

Some investigators claim that the differences in the risk factors for infection between diabetic and non-diabetic patients result either from non-controlled studies or biased studies . However, most researchers conclude that there is clinical evidence pointing to the higher prevalence of infectious diseases among individuals with DM. summarizes the major infections associated with DM.

Management Of Utis With Diabetes

Diabetes and Urinary Tract Infections  Things You Need To ...

Management of utis in people with diabetes is exactly the same, except you will be monitoring your blood sugars much more closely because you have an infection. As with any infection, we recommend that you check your blood sugar more frequently and contact the physician who manages your diabetes to let them know about your infection. You may need a temporary adjustment of your diabetes medications while you are sick.

If your blood sugars are very high, you run the risk of complications related to those high blood sugars even if you do not have Type 1 diabetes. Yes, people with Type 2 diabetes can be hospitalized for high blood sugars too!

If your blood sugar is over 250mg/dL this is considered too high and is at a dangerous level. Believe it or not, research shows you are actively doing damage to your body when your blood sugar is sustained at 150mg/dL 24 hours per day. Please contact your physician if your blood sugars start to rise if you get a UTI.

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Symptoms Of A Uti Include

  • A frequent urge to urinate
  • A painful, burning feeling in the area of the bladder or urethra during urination
  • A feeling of being tired, shaky, washed out
  • A feeling of pain even when not urinating
  • Women may feel an uncomfortable pressure above the pubic bone
  • Men experience a fullness in the rectum
  • Despite the urge to urinate, often only a small amount of urine is passed
  • The urine itself may look milky or cloudy, even reddish if blood is present
  • A fever may mean that the infection has reached the kidneys
  • Pain in the back or side below the ribs
  • Nausea
  • Vomiting

A UTI is generally diagnosed through a simple urine test conducted at a clinic. Treatment is generally through the use of antibacterial drugs. In severe cases a patient may require hospitalization.

If you are diabetic and experience repeat UTIs your doctor may prescribe medications that can help correct deficiencies and alter the environment that allows UTIs to form.

The Root Cause Of Uti

The urinary tract system, the very system which is known to safeguard the body gets infected with the bacteria which results in the UTI. These bacteria originate mostly from bowel region. That severally affects the normal functioning of the urinary tract system.

As for a little insight, heres how Urinary Tract system functions normally. The urinary system is it ureters, carries the urine from the kidney to the bladder region. The ureters have a valve system that stops any urine from staying back in the kidney for long. The bladder then empties the content out via urination and keeps the body free of bacterial particles.

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The Definition Of A Positive Urine Culture

The definition of a positive urine culture depends on the presence of symptoms and the method of urinary specimen collection, as follows and as depicted in . For the diagnosis of cystitis or pyelonephritis in women, a midstream urine count 105 cfu/mL is considered diagnostic of UTI. However, in diabetic women with good metabolic control and without long-term complications who present with acute uncomplicated cystitis, quantitative counts < 105 colony-forming units /mL are isolated from 20%25% of premenopausal women and about 10% of postmenopausal women. Only 5% of patients with acute pyelonephritis have lower quantitative counts isolated. Lower bacterial counts are more often encountered in patients already on antimicrobials and are thought to result from impaired renal concentrating ability or diuresis, which limits the dwell time of urine in the bladder., Thus, in symptomatic women with pyuria and lower midstream urine counts , a diagnosis of UTI should be suspected.

Flow chart for the diagnosis of urinary tract infection in patients with type 2 diabetes mellitus.

Abbreviations: cfu, colony-forming units UTI, urinary tract infection.

For the diagnosis of UTI in men, a midstream urine colony count of 104 cfu/mL is indicative. However, when coli-form bacteria are isolated, lower colony counts might also represent significant bacteriuria.

The Excretory System And Diabetes

One Easy Way To Prevent Urinary Tract Infections (UTI) In Women With Diabetes

The excretory system consists of the kidneys and urinary tract, which together, filter and eliminate waste from the body. As blood circulates throughout the body, nutrients are extracted for energy. Once blood reaches the kidneys, any remaining waste products are extracted to maintain blood homeostasis. These filtered waste products are compiled into urine, which passes from the kidneys through the ureters to the bladder, from where it is eventually expelled.

Type 2 diabetes mellitus is a metabolic disease in which insulin resistance is a key causative factor. When carbohydrates are broken down after eating a meal, levels of glucose in the blood rise. In response to increased blood glucose, the pancreas secretes insulin, a hormone that circulates in the blood and binds to the insulin receptor on the surface of cells throughout the body. Once activated, the IR induces a signaling cascade that culminates in that cell taking up glucose, the breakdown of which generates cellular energy. Insulin resistance arises when the cells of the body do not respond well to insulin and do not take up glucose from the blood.

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Urinary Tract Infections More Common In Diabetics

Its not easy being a diabetic. In addition to having to monitor and control their sugar levels, they also have to be careful of other troubles, such as problems with their feet, eye damage and even susceptibility to strokes and heart attacks. And in the last decade, urinary tract infections have been added to the list of woes of a diabetic.

Certainly many women have had the occasion, young and more aged, to be afflicted with this infection. However, research from the Scientific Sessions of he American Diabetes Association seems to indicate that diabetics are more prone.

Why do people with diabetes get urinary tract infections?

White blood cells

The problem centers around a diabetics ability to send those strong white blood cells, which are infection fighters, to places in the body that are prone to bacteria. One of the characteristics of diabetes is poor circulation, so that means those white blood cells cant always get where they need to be before an infection sets in, especially in the bladder and its surrounding system.

Diabetes also seems to make the white blood cells weaker, which means when they do get to the places in the body to fight infection, they arent as effective in killing the bacteria.

Impaired bladders

In addition, people affected by diabetes tend to have impaired bladders. What this means is that urine may sit in the bladder longer than it should, which in turn provides a breeding pond for bacteria.

The bottom line

Treatment and prevention

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