“It can be difficult for people to discuss some of the more embarrassing symptoms related to type 2 diabetes,” says Susan Spratt, MD, an endocrinologist with Duke University Health System and associate professor with the Duke University School of Medicine. But in order to design a customized plan for your overall health, your doctor needs to know about every little ache, pain, or itch you’re feeling. Still a bit shy about sharing? Here are explanations for some of the most common embarrassing type 2 diabetes symptoms.
1. Why do I itch … down there?
The likely culprit is a yeast infection, which is caused by an overgrowth of the Candida albicans fungus. Up to 75 percent of women experience at least one in their lifetime, according to the Mayo Clinic, making it very common. But having more than four yeast infections in a year is considered recurrent and may require more aggressive treatment. Women with immune-suppressing diseases, including type 2 diabetes, have a greater risk for developing yeast infections, especially if their diabetes is uncontrolled. Excess sugar can appear in the mucus of the vagina, feeding the fungus. “Yeasts like moist places, and glucose is a nutrient source for them,” explains Dr. Spratt. The combination of extra blood sugar and an ideal environment can lead to an overgrowth of yeast and more frequent infections. You may also be at higher risk if you’re taking antibiotics, are pregnant, or have a weakened immune system, according to the U.S. Department of Health and Human Services. WHAT TO DO: Getting your A1C level in the target range set by your doctor is the first step. To treat the yeast infection, your doctor will prescribe the most effective dose and duration of antifungal medications to alleviate symptoms. This may include both topical creams and prescription oral medication, which is why it’s important to check in with your doctor instead of simply picking up over-the-counter medication at the pharmacy. WHAT TO DO: The good news is, a study published in March 2014 in the journal Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy found that regulating blood sugar levels and adopting a healthier lifestyle — exercising regularly, losing weight, quitting smoking, maintaining a healthy diet — can help you reduce your ED symptoms and maintain a healthy sex life. You can also talk to your doctor about treatment options for ED, including medications.
3. Why can’t I make it to the bathroom?
The persistent urge to urinate and urinary incontinence — a sudden, strong urge to urinate or urinary leakage — can be two of the most embarrassing symptoms for people with type 2 diabetes. But they’re very common. Some research has found that at least 89 percent of people with diabetes experience some form of bladder dysfunction. Other research suggests that women with diabetes are up to 2.5 times more likely to have urinary incontinence than those without diabetes. When you have uncontrolled blood sugar, your kidneys have to work harder to remove the excess glucose in your blood. If your kidneys can’t keep up, the excess sugar is flushed out, along with fluids from your tissues, through your urine, “which leads to the urge to urinate more frequently,” says Spratt. It’s commonly accompanied by dehydration due to fluid loss, causing excessive thirst. Bladder dysfunction also occurs due to damage to the nerves that control the bladder. It can cause frequent and urgent urination, urinary retention, urine leakage, and bladder infections. WHAT TO DO: A heightened blood sugar level is a likely cause of your incontinence, which is why your doctor may have you see a dietitian to create a meal plan and make other healthy lifestyle changes to address your elevated A1C. Your doctor may also recommend a weight loss program, since excess weight can also put pressure on the bladder, leading to problems. Other treatment options depend on the specific bladder problem you’re experiencing.
4. Why are my toenails thick and yellow?
That discoloration on your big toe shouldn’t be ignored. In fact, toenail fungus, or onychomycosis, is common, affecting an estimated one in three people with diabetes. “When your glucose is not well controlled, it creates environments where fungus likes to grow, such as [on] your toenails,” explains Spratt. “It also creates an environment where your white blood cells don’t fight off infection as easily and the fungus can easily grow.” WHAT TO DO: Toenail fungus is not something to take lightly. Poor circulation to your feet due to diabetes can make it harder for your body to fight off infections. This can lead to osteomyelitis, a bone infection usually caused by bacteria, mycobacteria, or fungi. A study published in July 2017 in International Wound Journal found that patients with osteomyelitis were at higher risk for amputation, which is why treatment of toenail fungus is necessary. Spratt recommends getting foot exams by your family doctor or a podiatrist at least once a year. Your doctor will examine your toenails and look for other signs of abnormalities, including infection and injury. As with many other diabetes symptoms, working with your doctor to keep your blood sugar under control is crucial to keeping toenail infections in check. If you have an infection, topical or oral medication may also be prescribed.
5. Why does my breath smell?
A major cause of bad breath is periodontal disease, common signs of which include red, tender, or bleeding gums; sensitive teeth; and receding gums. An estimated one in three people with diabetes have periodontal disease, according a report published in May 2013 in the IOSR Journal of Dental and Medical Sciences. Perhaps more surprising, periodontitis can also raise blood sugar levels in people with or without diabetes. That may be because germs in infected gums leak into the bloodstream, causing harmful effects throughout the body, including raising blood sugar. But it’s not just the health of your teeth and gums that complicates things in your mouth. When your body doesn’t get enough glucose for energy, it begins to burn fat instead, which produces ketones that can build up in the blood. Certain chemicals released during this process can cause a fruity odor on the breath, explains Spratt. WHAT TO DO: High levels of ketones can lead to a serious condition known as diabetic ketoacidosis (DKA), which can cause diabetic coma or even death. Fortunately, DKA is rare in people with type 2 diabetes. If you think you might have DKA, it’s essential to see your doctor or head to the emergency room right away, as treatment usually takes place in the hospital. Other symptoms include high blood glucose levels and high levels of ketones in the urine. You can prevent DKA by keeping your blood sugar in your target range. You should talk to your doctor about when to check urine ketones and what to do if your ketones are elevated. To keep your mouth healthy, it’s crucial to go to the dentist for a checkup twice a year, says Spratt. You should also follow a good oral care routine daily that includes brushing twice daily and flossing at least once. Additional reporting by Colleen de Bellefonds
