**17. Types of infections from diabetes**

Diabetes could cause the following infections:


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

Data about the bactericidal activity of diabetic PMNs have yielded conflicting results [25, 26, 33, 37]. An impaired killing function of diabetic PMNs was found in all studies using *Staphylococcus aureus* as the microorganism [25, 26, 37], but not in the studies in which the killing of *C. albicans* [33] was used as the measure. Killing was impaired in one study that used non-diabetic serum for opsonisation [37], but not in another [33]. Thus, based on these studies, any conclusions about the effect of non-diabetic serum on the killing of diabetic cells cannot be drawn. No correlation was found with glycaemic level [25, 26, 37], although some studies have shown that bactericidal activity improved, but did not normalise after achieving normoglycaemia [6, 37].

Both impaired chemotaxis and phagocytosis of the monocytes of diabetic patients have been described [1, 40]. Since plasma from healthy controls does not cause any significant change in the phagocytotic capacity of diabetic monocytes [40], it seems that this impaired function is

A lower immune response in children with DM type 1 compared to controls was found after intradermal (instead of intramuscular) administration of the hepatitis B vaccine [5]. It has been suggested that this lower response is probably partly the result of an impaired macro-

In combination with the earlier mentioned decreased production of pro-inflammatory cytokines after LPS stimulation in DM type 1 patients, it seemed that monocyte/macrophage func-

Adherence of a microorganism to mucosal or epithelial cells is an important step in the pathogenesis of infections. Host-related factors may influence this adherence. For example, women with recurrent urinary tract infections have a greater adherence of *E. coli* to their vaginal and

*C. albicans* infection is frequently found in diabetic patients. Since infection mostly is preceded by colonisation, Aly et al. investigated which risk factors increased the risk of *Candida* carriage in diabetic patients [42]. Risk factors for oral *Candida* carriage in patients with DM type 1 were a

reaction of diabetic PMNs to stimuli is quenched as a result of the higher resting CL.

**15. Cellular innate immunity: monocytes/macrophages**

caused by an intrinsic defect in the monocytes themselves.

phage function in this patient group [5].

tions are impaired in DM type 1 patients.

buccal cells compared to controls [41].

**16. Adherence**

**14. Killing**

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#### **17.1. Bladder infections**

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 includes:


• Carbuncles (deep infections of the skin and the tissue underneath)

Diabetics are more likely to develop overgrowth of yeast-like-fungus, *Candida albicans*. The patient comes with complaints of itchy rashes, moist red areas, surrounded by tiny blisters and scales. Common sights are areas of warm, moist folds of skin. Identifying in the early

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Like already mentioned, foot infections occur due to reduced blood supply to the extremities.

Elevated blood sugar leads to elevated sugar levels in the saliva, leading to increased growth

Proper care of feet must be done by methods that will be later mentioned.

Here, the gums are unhealthy, swollen, bleed easily and appear red.

This is a mild to severe gum disease. Symptoms are:

• Long-lasting infection between teeth and gums

• Presence of pus between teeth and gums

• Red and swollen bleeding gums

• Gums pulled away from the teeth

• Infections around the nails

For fungal infections it may be:

stages is the key for successful treatment.

of bacteria in the mouth. This predisposes to:

• Vaginal yeast infection

• Ringworm

• Athlete's foot

**17.3. Foot infections**

**17.4. Oral infections**

• Plaque on the teeth

• Gum disease

• Breath odour

*17.4.1. Gingivitis*

*17.4.2. Periodontitis*


Additionally, if it is an infection in the kidney:


If it is an infection in the bladder:


If it is an infection in the urethra:


#### **17.2. Skin infections**

There is increased risk of bacterial and fungal infections. The best way to avoid this is to take care of skin and look out for early symptoms.

For bacterial infections,

you have to look out for:


For fungal infections it may be:

• Ringworm

• Burning micturition

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• Blood in the urine

• Strong smelly urine

• High fever

• Nausea • Vomiting

• Shaking and chills

• Pelvic pressure

• Blood in urine

• Discharge

• Cloudy appearance of urine

• Upper back and side (flank) pain

If it is an infection in the bladder:

• Lower abdomen discomfort • Frequent, painful urination

If it is an infection in the urethra:

care of skin and look out for early symptoms.

• Stye (infection of the glands of the eyelid)

• Boils folliculitis (infections of the hair follicles)

There is increased risk of bacterial and fungal infections. The best way to avoid this is to take

• Burning on urination

**17.2. Skin infections**

For bacterial infections, you have to look out for:

• Urinary urgency (a sudden compelling urge to urinate)

• Nocturia (waking up at night for voiding urine)

Additionally, if it is an infection in the kidney:

• Urinary incontinence(uncontrolled leakage of urine)

• Polyuria (producing abnormally large volumes of dilute urine)


Diabetics are more likely to develop overgrowth of yeast-like-fungus, *Candida albicans*. The patient comes with complaints of itchy rashes, moist red areas, surrounded by tiny blisters and scales. Common sights are areas of warm, moist folds of skin. Identifying in the early stages is the key for successful treatment.

#### **17.3. Foot infections**

Like already mentioned, foot infections occur due to reduced blood supply to the extremities. Proper care of feet must be done by methods that will be later mentioned.

#### **17.4. Oral infections**

Elevated blood sugar leads to elevated sugar levels in the saliva, leading to increased growth of bacteria in the mouth. This predisposes to:


#### *17.4.1. Gingivitis*

Here, the gums are unhealthy, swollen, bleed easily and appear red.

#### *17.4.2. Periodontitis*

This is a mild to severe gum disease. Symptoms are:


#### *17.4.3. Thrush*

This occurs due to candidiasis, that is, overgrowth of candida yeast as white or red patches in the mouth. This can be treated by fungal medications.

*17.5.2. Oral infections*

• Use a soft bristle toothbrush

• Use a gentle scrubbing motion • Brush your tongue and gums

*17.5.3. Urinary infections*

• Toilet hygiene

• Ample fluid intake

*17.5.4. Vaginal infections*

• Alert for:

the following has to be checked for:

• Regular emptying of bladder

• Prompt urination after sexual intercourse

Yeast infections can be avoided by the following:

• Avoidance of spermicides and douches

*17.5.5. Common symptoms of all infections*

○ An increased body temperature

○ Foul-smelling vaginal discharge

○ Change in blood sugars

○ Pain while urination

• Eating foods with active culture (yoghurt with acidophilus)

• Replace toothbrush every 3–4 months

The following should be done in case of an oral infection:

• Floss once a day, using a clean section of floss per tooth

• See your dentist regularly for check-ups and cleanings

• When flossing, scrub up and down, each side of your tooth

This has to be done mostly for women and children. In cases of urinary tract infection (UTI),

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• Angle the toothbrush towards your gum line

#### *17.4.4. Dry mouth*

Here, there is not enough saliva in the mouth. This poses a high risk for gum diseases and cavities. The patient complains of trouble in talking and difficulty in swallowing. The treatment for this is occasionally drinking sips of water and avoiding tobacco, alcohol and caffeine.

#### *17.4.5. Oral burning*

This is a sensation of burning in the mouth, dry mouth and bitter taste. Oral care must be followed, which will be mentioned later.

#### **17.5. Prevention**

"I may have diabetes, but diabetes does not have me."

The first and foremost way is to control the sugar levels in the blood.

Second most important measure is undergoing immunization which will be taken in detail in the later pages.

Prevention or early diagnosis is mostly done for foot infections and oral infections.

#### *17.5.1. Foot infections*

The following should be done, in case of foot infections:


#### *17.5.2. Oral infections*

• Persistent bad breath

the mouth. This can be treated by fungal medications.

This occurs due to candidiasis, that is, overgrowth of candida yeast as white or red patches in

Here, there is not enough saliva in the mouth. This poses a high risk for gum diseases and cavities. The patient complains of trouble in talking and difficulty in swallowing. The treatment for this is occasionally drinking sips of water and avoiding tobacco, alcohol and

This is a sensation of burning in the mouth, dry mouth and bitter taste. Oral care must be

Second most important measure is undergoing immunization which will be taken in detail

• Ensure that minor cuts do not turn into ulcerated infections which migrate to the

Prevention or early diagnosis is mostly done for foot infections and oral infections.

• Loose teeth

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*17.4.3. Thrush*

*17.4.4. Dry mouth*

*17.4.5. Oral burning*

**17.5. Prevention**

in the later pages.

*17.5.1. Foot infections*

• Wash your feet everyday

• Keep the skin soft and smooth

• Trim your toenails regularly

bloodstream

• Smoothen corns and calluses gently

• Wear shoes and socks at all times

followed, which will be mentioned later.

"I may have diabetes, but diabetes does not have me."

The following should be done, in case of foot infections:

The first and foremost way is to control the sugar levels in the blood.

caffeine.

The following should be done in case of an oral infection:


#### *17.5.3. Urinary infections*

This has to be done mostly for women and children. In cases of urinary tract infection (UTI), the following has to be checked for:


#### *17.5.4. Vaginal infections*

Yeast infections can be avoided by the following:


#### *17.5.5. Common symptoms of all infections*

	- An increased body temperature
	- Change in blood sugars
	- Foul-smelling vaginal discharge
	- Pain while urination
