Today is World Health Day, celebrated on April 7th each year. The focus this year is on diabetes, with the theme “halt the rise, beat diabetes.”
According the the World Health Organization’s first “Global report on diabetes”, the number of diabetes cases has nearly quadrupled since 1980, to 422 million adults. Sadly, most of these people are living in developing countries, where limited resources result in inadequate care and treatment for too many of those affected. Though the aging population accounts for some of this increase in diabetes, it is mostly related to the increase in obesity. In support of World Health Day, today’s blog post will address some of the ways in which diabetes increases the risk for infection.
I practice medicine in Mississippi, which has the unfortunate distinction of being the diabetes capital of the United States. On any given day, at least half of the patients I see in consultation for infectious diseases, are diabetic. Yesterday, I saw 17 patients and all, but 2, were diabetic! They had a variety of infectious problems, including Staphylococcus (staph) in the blood caused by an infected dialysis catheter, staph in the blood caused by a bone infection, Streptococcus in the blood caused by a gangrenous foot (the leg had to be amputated above the knee), pneumonia, infected bed sore, staph infection in the blood which spread to the spine, causing partial paralysis (fortunately improving), liver abscess, leg cellulitis (severe skin and soft tissue infection), and necrotizing fasciitis (loosely called “flesh eating bacteria” by the public). Most of the staph cases were MRSA.
Related post: 10 strategies for preventing diabetic foot infections
It is well known that diabetes increases the risk of infection in general, because of it’s effect on weakening the immune system. I have alluded to this in multiple past posts. What is it about diabetes, that causes it to increase the risk for infections?
Below I discuss 5 ways in which diabetes increases the risk for infection.
1 – Lazy white blood cells (WBCs) – WBCs are the police of the immune system. They don’t work as efficiently when blood sugar levels are high. They become ‘lazy’ and are more sluggish in getting to the site of infection. When they finally get there, they are not efficient in destroying whatever germ is trying to invade. Therefore, infection is able to take hold.
2 – Sugar is food for germs – most patients are very surprised when I tell them this. It is known that high blood sugar environments cause some microorganisms to be more efficient in causing infection. For example, the yeast Candida sticks better to cells when blood sugar levels are high, causing more yeast infections. The bacterium E. coli is more abundant in the genital and urinary tract when blood sugar levels are high, and urinary tract infections become more frequent.
3 – Poor circulation – because diabetes slowly damages the blood vessels causing them to be blocked, eventually there is not enough blood flowing to the feet, and sometimes hands (among other tissues of the body). If there is infection in these areas, there is insufficient blood flow to carry immune cells to “wash away” the infection. That is what happened to the patient with the gangrenous foot mentioned above.
4 – Damaged nerves – this is called diabetic neuropathy. Persistently high blood sugar levels over time eventually poisons the nerves. Like the damage to the circulation, the damaged nerves are usually in the feet and hands, but ultimately, nerves throughout the body become affected as well. When nerves get damaged, there is decreased and eventually absent sensation to the areas they supply. Affected persons are not able to feel pain when there is inflammation from cuts/wounds. These wounds become infected and when involving the feet, it is usually only when there is a foul odor, or soiling of the surroundings from pus, that the patient realizes there is a problem.
5 – Gastroparesis and increased pneumonia risk – gastroparesis refers to weakening of the stomach muscles, causing sluggish emptying of the contents. Damage of the nerves supplying the stomach causes this. Because this condition causes the stomach to remain full for prolonged periods, an affected person is at risk for having stomach contents back up into their throat when they lie flat. When asleep, they can accidentally breath some of these stomach contents from their throat into their lungs, and pneumonia can arise. Further complicating this situation, is the fact that affected persons tend to be on acid suppressing medications. Less stomach acid, means more germs surviving in the stomach. (See here for more on this concept.)
Fortunately, all is not lost in diabetes. When blood sugar levels are controlled, the risk of infection (and other complications) is greatly reduced. Having a physician with whom you feel comfortable, and educating yourself about diabetes, are two of the first steps to take in getting your diabetes under control. Sticking to the recommended diet and lifestyle, along with any medications prescribed, will take great self discipline, especially in the beginning. A supportive network of family and friends will go a long way in making a tremendous positive difference.
What do you think? Do you or someone you know have diabetes? Has it been a struggle to get blood sugar levels under control? Have you had to deal with frequent infections? Please comment below! And if you find this post useful, I invite you to share it with your family and friends.