Solving Diabetes Infections Problems
Common Health Issues

Solving Diabetes Infections Problems

Everywhere you go, everything you do, microorganisms are on the prowl, trying to get into your body. They would like nothing better than to use you as a cheap hotel, complete with free food and drink. Fortunately, your body has a sophisticated security system of sorts—your immune system. Your immune system has both surveillance and search-and-destroy units that work together to keep unwanted invaders out and to destroy those that make it in.


Your primary defense against invaders is your skin and the mucous membranes of your intestinal and genitourinary tracts. Your skin and mucous membranes serve as natural barriers to unwanted microorganisms such as viruses, bacteria and fungi. Some microorganisms are allowed to live in your body and may actually help you. Your intestinal tract, for example, contains millions of E. coli bacteria that actually help break down waste products. Some helpful microorganisms also protect against infection by other, more harmful, pathogens.


When microorganism that can do you harm enter your body, your immune system springs into action. White blood cells produced in your bone marrow are dispatched to your bloodstream where they seek out and destroy foreign matter. For most people, the immune system does a fairly good job of keeping harmful microorganisms at bay. But every now and then, a disease-causing microorganism, or pathogen, makes it past your body’s defenses and proliferates out of control. When this happens, you have an infection.

Unfortunately, if you have diabetes, you are more likely to develop infections than the general population. The reasons aren’t exactly clear, but people with diabetes do have more glucose in their blood. This provides an excellent food source for microorganisms and encourage their growth in your body. Also, if you have diabetes, there are defects in how your body produces and dispatched infection-fighting cells. The ability of the immune system cells to target and move toward the site of an infection is impaired. Also, people with diabetes are more likely to have problems with circulation. 


This means that as your immune cells travel through the bloodstream to their targets, they have a harder time getting to where they need to be. A further complication in people with diabetes occurs because of neuropathy. If you have damage to your nerves, you may be less likely to sense the pain that accompanies an infection. By the time you sense there is a problem, the infection may be out of control and more difficult to treat.


Infections can be especially dangerous to someone with diabetes. That is because your blood glucose levels can rise unexpectedly and be difficult to control when you have an infection. When your body is trying to fight off an infection, it becomes stressed. To deal with stress, your body releases an array of stress hormones, including cortisol and glucagon, which trigger the release of glucose from the liver and can cause insulin resistance. This causes your blood glucose level to go up. 


The good news is that most infections are treatable. You can help your body fight infection by taking steps to prevent infections from occurring, being on the lookout for any signs of infections and taking prompt action when they occur.




People with diabetes are at an increased risk for developing urinary tract infections compared to the general population. This is partly because the urinary tract serves as a rich glucose-containing medium for the growth of microorganisms in people with diabetes. The risk is even greater if you are a woman, if you are elderly, if you have any abnormalities in your genital or urinary structures, or if you have had diabetes for a long time. The most common urinary tract infections are bacteriuria, cystitis and pyelonephritis.


Normally, urine is sterile. That means there are no bacteria or other microorganisms growing in it. Bacteria typically enter the urinary tract from the urinary tract from the intestinal tract and from the vagina in women. Usually these microbes are washed out by the flushing action of urine when you urinate. But sometimes bacteria grow in urine. When you have more than 100,000 bacteria per milliliter growing in your urine, you have a condition known as bacteriuria.


Bacteriuria Symptoms

Bacteriuria itself is symptomless. It causes no symptoms, pain or discomfort. The only way to know for sure that you have a high concentration of bacteria is to have a urine culture performed.


Bacteriuria Risks

Bacteriuria often develops in women following sexual intercourse. It is also quite common in people with diabetes because of the high glucose content of urine, especially in people with neurogenic bladder. If have neurogenic bladder, you may have a problem emptying your bladder. This allows bacteria to spend more time in your urine and increases the chance of infection. Bacteriuria commonly occurs in people with neurogenic bladder who have to use a catheter to empty the bladder. Bacteriuria has no symptoms and is not problematic in itself. The danger of bacteriuria is that it can progress to cystitis, infection of the bladder, and to pyelonephritis, infection of the kidneys


Bacteriuria Treatment

Most bacterial infections can be treated with antibiotics, drugs that kill bacteria. If you have Bacteriuria and no symptoms of pain or discomfort, there is little benefit to be gained in taking antibiotics. That is because the overuse of antibiotics can lead to drug-resistant strains of microorganisms that can be more dangerous and more difficult to get rid of. However, if you have any sort of obstruction to urinary flow or bladder dysfunction, are pregnant, have immune system problems, or are having a bladder catheterization or other sort of invasive procedure of the urinary tract, your doctor may suggest that you take a course of antibiotics.


If you do use a catheter for emptying the bladder and develop Bacteriuria, the catheter should be removed before treating with antibiotics, if at all possible. If the catheter is kept in, you or your caregiver should remove it frequently. Your doctor will probably prescribe an antibiotic only if you are experiencing symptoms of infection. Bacteriuria itself does not usually produce symptoms unless it has progressed to cystitis



Bacteriuria can often progress to the point where the tissue of your bladder becomes inflamed. When this happens, you have cystitis. Most bladder infections are caused by an overgrowth of bacteria. However, sometimes people with diabetes develop fungal infections of the bladder, which require a different drug therapy.


Diabetes Cystitis Symptoms

Symptoms of bladder infection include a feeling that you always have to urinate and a burning, painful sensation when you do urinate. You may feel pain over the bladder, which lies above the pubic area. Occasionally you may also develop a fever. Your urine may be cloudy and have a foul odor. You may even notice blood in your urine.


What You Should Do

If you have frequent, painful urination, contact your doctor. You may need to have a urinalysis performed to confirm the infection and identify the organism responsible. This will dictate the course of treatment. In the meantime, you can start some self-help steps to begin to clear up the infection. Drink plenty of fluids. The more liquid that moves through your bladder, the greater the chance that your urine will flush out your bladder. Some people find that drinking cranberry juice helps but check with your dietitian and make sure to make allowances for the sugar from the juice in your meal plan.


Diabetes Cystitis Treatment

If your infection is bacterial, your doctor will prescribe one of several antibiotic drugs, depending on what type of bacteria are responsible. Usually the condition clears up within a few days. However, if you are prescribed an antibiotic, it is important that you take the drug for the entire course of treatment (usually 10 days) to prevent reinfection. If your infection is due to fungus, your doctor will prescribe a different type of drug, an antifungal agent. Sometimes fungi form a large mass called a fungus ball in the bladder or anywhere else in the urinary tract. If this occurs, you may have to have it surgically removed.



Sometimes infected urine can travel from the bladder and up the ureters (the tubes that connect the bladder to the kidneys) to the kidneys. When this happens, one or both of your kidneys can become infected. If you have neurogenic bladder, you are at a greatly increased risk of developing pyelonephritis



Pyelonephritis can be quite painful. You may experience fever, chills, nausea, vomiting, and severe pain in your side or upper back. If you have pyelonephritis, these symptoms can occur along with the symptoms of cystitis or shortly thereafter. You may also find that your blood glucose levels are very high.

What You Should Do

If you have recently had a bladder infection or suspect that you have one and develop any of the symptoms of pyelonephritis, contact your doctor or health care professional right away. If you are vomiting, have a high fever, have blood glucose levels over 400mg/dl, or have positive urine ketones (with type 1 diabetes), you may require hospitalization



If your symptoms are severe, you will be treated in a hospital setting where you will probably receive intravenous therapy for several days. If your symptoms are less severe, you may be treated on an outpatient basis. You will probably need to take antibiotics for 2 full weeks.


If your symptoms have persisted for several days, your doctor may take an X ray of your abdomen. This is to determine whether you have a condition known as emphysematous pyelonephritis. This is a complication that is characterized by the presence of gas in your kidneys. Although rare, most cases of emphysematous pyelonephritis occur in patients with diabetes. It may be that the bacteria or fungi that are causing the infection feed on the glucose in the urine to produce gas. If you have emphysematous pyelonephritis, you will require immediate hospitalization. If you have a kidney infection and do not treat it promptly, you risk the death not only of kidney tissue, but also of the tissues surrounding the kidney.



It is not always easy to prevent infection, especially if you have diabetes. Try to keep your blood glucose levels as close to normal as possible for both the short and long term. In the short term, the lower your glucose levels, the less hospitable a climate you provide for invading pathogens. In the long term, good glucose control can go a long way in preventing neuropathy. This can help minimize the possibility of developing neurogenic bladder, which puts you at risk for urinary tract infections.


Keep your genital region clean, especially if you are a woman. Try to avoid any contact between your vagina and fecal waste. Also, drink plenty of fluids to promote the flushing out of any bacteria by the urine flow. You are more susceptible to infection when you are overtired, overstressed, and eating poorly, so try to get enough rest, avoid or reduce stress as much as possible, and eat a balanced diet.

If you have frequent urinary tract infections that occur with pain and discomfort, your doctor may suggest a low-level daily dose of antibiotics to prevent bacteriuria from occurring. However, when you do this, reinfection often occurs when you stop taking the antibiotics, and the resultant infection may be harder to cure.


If you do develop a kidney infection, you should be thoroughly evaluated by your doctor to identify any factors that may predispose you to urinary tract infections. This exam will probably include an ultrasound examination of the kidneys, measurement of urinary flow, excretory urogram using an injected dye, or cystoscopy, a method of looking into the bladder with a special instrument.



People with diabetes are at high risk for a serious form of ear infection called malignant external otitis. In fact, malignant external otitis occurs almost exclusively in people with diabetes. The term ‘malignant’ here means only that the condition is serious. It does not mean you have cancer. This condition is caused by the Pseudomonas aeruginosa bacteria. 


The infection starts in the soft tissue and cartilage around the external auditory, or outer ear, canal. As the infection progresses, it can spread to the bones of the ear canal. If untreated, the infection can sometimes reach the cranial nerves, which extend into the brain, or into the compartments of the brain itself. In some cases, malignant external otitis can abscess or rupture into the meningeal space—the space between the brain and its membrane—and cause death. The best defense against this serious infection is early, aggressive intervention.



Symptoms of malignant external otitis include a severe, persistent headache. Often you may notice a foul-smelling discharge of pus from the outer ear. You may also experience a loss of hearing in the affected ear. If the infection progresses, you may also notice a drooping of facial muscles due to infection of the cranial nerves. You may also show signs of a systemic infection, such as high fever and chills. Your blood glucose levels may rise significantly. In clinical tests, your doctor may also find that you have a high white blood cell count.



Malignant external otitis occurs almost exclusively in people with diabetes. It typically occurs in people over the age of 65 who are male and have had diabetes for a long time.


What You Should Do

If you experience any of the symptoms of malignant external otitis, call your doctor at once. The earlier you seek treatment, the greater the chance that you can prevent the spread of infection. As with any sign of infection, make sure to monitor your blood glucose levels frequently. If you show signs of hyperglycemia, you will need to bring down your blood glucose levels. This may involve taking an extra dose of insulin or altering the timing of your meals. Ask your doctor about the best way for you to deal with hyperglycemia



The treatment of malignant external otitis will depend on an accurate diagnosis and an assessment of how far the infection has progressed. Your doctor may take an X ray or use magnetic resonance imaging or another scanning technique to see whether the infection has spread to soft tissue, bone or beyond.


Once it is known how far the infection has spread, your doctor will surgically remove any infected tissue or bone and then wash out the site with antibiotic solution. You will then begin an intensive course of therapy with antibiotics. Most likely you will have to take the drug for 6 weeks or more, either orally or intravenously. It is important to schedule follow-up appointments with your doctor, because this type of infection can recur.



Serious Pseudomonas infections tend to affect people with weakened immune systems. Your best bet to avoid this infection is to follow a healthy lifestyle. Eat balanced meals and keep your blood glucose levels under control. Exercise to whatever extent is possible and keep your weight under control. Try to get plenty of rest and avoid stress. Also practice good hygiene and keep your ears clean and dry. Make sure your doctor checks your ears at your routine examinations.



Whether you have diabetes or not, you are likely to develop sinus infections on occasion. Most sinus infections can be easily treated with antibiotics. But if you have diabetes, especially if you are prone to diabetic ketoacidosis, you need to be on guard against rhinocerebral mucormycosis. This is a rare infection, caused by the fungus Zygomycetes, that can infect your nasal sinuses and the palate of your mouth. 

They zygomycetes fungus can exist in your blood without causing much harm, and normal blood stops its growth. However, these organisms can grow rapidly in the presence of high concentrations of glucose and in an acid environment. Both of these conditions occur if you develop diabetic ketoacidosis. When this occurs, the infection can progress rapidly with a potentially fatal outcome.


The infection may begin in the nostrils or sinuses and spreads at an amazingly rapid rate. Within days, the zygomycetes fungus can eat through to the deep recesses of the sinuses, infecting nerves and blood vessels, until it reaches the brain.



The earliest symptoms of a rhinocerebral mucormycosis infection is often pain in your eyes or face. This is followed by a yellowish-white nasal discharge that may be tinged with blood. You may also experience swelling around the eyes, increased tearing, visual blurring and tenderness in the sinus and nasal passages.


What You Should Do

If you have any of these symptoms, especially if you have had a recent episode of diabetic ketoacidosis, hyperglycemia or ketones in the blood, call your doctor at once. This is a life-threatening condition that could cause death within days. If you cannot contact your doctor immediately, seek emergency help.



A rhinocerebral mucormycosis infection must be treated quickly and aggressively. Your doctor will examine you physically to determine whether you have rhinocerebral mucormycosis. If you do, your doctor will notice a darkening or ulceration in the nasal passages or palate of your mouth. You will also be examined by X ray or other imaging technique to confirm the diagnosis and evaluate the extent of disease.


If you have rhinocerebral mucormycosis, you will require immediate surgery. Your doctor or surgeon will remove all dead and infected tissue and surrounding tissue. This procedure may have to be repeated. This will be followed by an aggressive course of antifungal medication to kill the fungus that is causing the infection. If your condition is accompanied by diabetic ketoacidosis and/or hyperglycemia, these conditions will have to brought under immediate control.



The greatest risk factor for rhinocerebral mucormycosis is diabetic ketoacidosis. To prevent rhinocerebral mucormycosis and diabetic ketoacidosis, it is essential to keep your blood glucose levels under control. You, your doctor and your dietitian should together develop an eating and insulin schedule you can follow. Never skip a dose of insulin, even if you are not feeling well. Monitor your blood glucose level frequently, especially if you are feeling sick, are under stress, have an infection or have changed your daily routine.


Sources and References

The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

Infections in diabetes by H M Calvet and T T Yoshikawa 

Urinary tract infection in patients with diabetes mellitus by Lindsay Nicolle, Kurt Naber et al 

Asymptomatic bacteriuria in patients with diabetes mellitus by G G Zhanel, G K Harding and L E Nicolle 

Phenotyping of interstitial cystitis/bladder pain syndrome by Y Akiyama and P Hanno 

Emphysematous pyelonephritis by S Ubee, L McGlynn and M Fordham

Otitis Externa by Susanne Wiegand, Reinhard Berner et al



Rich Health Editorial Team

Health Research

Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner