**13. Oxidative burst**

Chemiluminescence (CL) corresponds to the emission of light directly or indirectly produced in the course of a chemical reaction. This phenomenon is often used to evaluate the oxidative potential of PMNs, a process during which free radicals are synthesised early in the phagocytotic process [31, 38]. CL correlates well with antimicrobial activity [39] and may be used as a measure of phagocytotic capacity [38]. Compared to controls, CL at baseline was higher [31] or the same [36, 39] in PMNs of diabetic patients. These studies [31, 36, 39] also showed that, after stimulation, the CL of diabetic PMNs was lower than that of control PMNs. It is possible that the reaction of diabetic PMNs to stimuli is quenched as a result of the higher resting CL.

lower age and a higher HbA1c level (poor regulation of DM). Continuous wearing of dentures and the presence of glucosuria (also an indication of a poor DM regulation) increased the risk of *Candida* carriage in DM type 2 patients, the mean number of cigarettes smoked per day was correlated with *Candida* carriage in DM type 1 and type 2 grouped together [42]. Cameron et al. extracted lipids from human buccal epithelial cells and found, using chromatogram overlay assays, that some *C. albicans* strains bind to fucose-containing and other *C. albicans* strains to *N*-acetylgalactosamine-containing lipids extracted from human buccal cells. The authors conclude that the existence of several adhesin-receptor systems contributes to the virulence of *C. albicans* [43]. The carbohydrate composition of receptors probably plays an important role in the susceptibility to infections. It has been shown that severely ill patients have a decreased amount of galactose and sialic acid on their buccal cells, compared with minimally ill patients and healthy controls. The investigators mentioned that these receptor changes possibly lead to an increased adherence of microorganisms and play a role in the high prevalence of Gram-negative bacterial colonisation in the respiratory tract of these patients [44]. This mechanism of increased adherence, due to an altered receptor carbohydrate composition, is possibly also present in diabetic patients. Buccal cells from 50 diabetic patients (DM type 1 and type 2) showed an increased in vitro adherence of *C. albicans* compared to buccal cells from controls [45]. A significantly higher incidence of *Candida* infection, but not *Candida* carriage, was also found in this patient group (12% versus 0%) [45]. No relationships, however, were found between the frequency or quantity of *Candida* and age, duration, regulation or type of DM [45]. This increased adherence to diabetic cells might also play a role for other microorganisms, for example the adherence of *E. coli* to uroepithelial cells,

Insulin – Overview, Infections and Benefits of Immunization and Insurance

http://dx.doi.org/10.5772/intechopen.81346

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which would explain the increased prevalence of infections in patients with DM.

more virulent in a high-glucose environment.

**17. Types of infections from diabetes**

Diabetes could cause the following infections:

• Bladder infections

**17.1. Bladder infections**

• Skin infections • Foot infections • Oral infections

includes:

In conclusion, disturbances in cellular innate immunity play a role in the pathogenesis of the increased prevalence of infections in DM patients. In general, a better regulation of the DM leads to an improvement of cellular function. A second important mechanism is the increased adherence of the microorganism to diabetic cells. Furthermore, some microorganisms become

People with diabetes are more likely to get these infections than those without diabetes. It involves the kidney, ureter, bladder and urethra. Major complaint from such infection
