Fungal infections and diabetes

======================= Diabetes, one of the most common chronic diseases of this century, is not only a disorder of blood sugar regulation; Rather, it creates a series of physiological changes in the body that affect various aspects of a person's health. One of the less noticed but very important consequences of diabetes is the increased risk of **fungal infections**; Infections that sometimes appear with simple symptoms such as itching or redness, but if neglected, can become chronic and even dangerous problems. Diabetic people are more prone to the growth of fungi due to various reasons, including weakening of the immune system, increased sugar in body fluids and disruption of the microbial balance of the skin and membranes. These infections may involve the mouth, skin, genitals, feet, and nails, and if not treated in time, can cause chronic ulcers or widespread infections. Why do diabetics get more fungal infections? People with diabetes are at higher risk for fungal infections for several reasons. This risk is not only related to high blood sugar levels, but also to a series of changes in the immune system, the body's environment, and the natural microbial balance in the skin and body tissues. ### 1. The effect of high blood sugar on the function of the immune system: High blood sugar, or hyperglycemia, is one of the most important reasons for weakening the immune system in diabetic patients. When blood glucose increases, white blood cells, which are responsible for defending the body against pathogens, malfunction. As a result, their ability to identify and destroy fungi is reduced. On the other hand, inflammatory responses are also altered in diabetics. Sometimes the body shows excessive or inappropriate reactions to the presence of fungi, which not only does not help the treatment, but also causes damage to healthy tissues. This makes the healing process slower and fungal infections last longer or become chronic. ### 2. The role of the sugar environment of the body in the growth and reproduction of fungi: Fungi, especially species such as Candida albicans, grow very quickly in warm, moist, and sugary environments. The body of diabetics, especially when blood sugar remains uncontrolled, provides such an environment for the growth of fungi. For example, when the blood sugar level is high, some of this sugar is excreted through **urine**. This causes the genital area (especially in women) to have a moist, warm and glucose-rich environment, which is a very suitable place for fungi to grow. This is one of the common causes of fungal infections of the genital tract in diabetic women. Also, the skin of diabetics is more sensitive to sweat, wounds and scratches, and if there is constant moisture (for example, in the areas between the fingers, groin or armpit), fungi can easily grow and spread. ### 3. Disturbance in the balance of bacteria and fungi in the body (microbial flora): Our body naturally has a complex community of microorganisms, which are called normal flora or natural microbiome. These microbes, which include harmless bacteria, fungi and viruses, exist in a delicate balance and live symbiotically with each other. This balance plays a very important role in maintaining the health of the skin, mouth, intestines and other tissues. In diabetic patients, especially in conditions where blood sugar is not properly controlled, this balance is disrupted. Beneficial bacteria that normally inhibit fungal growth are reduced, allowing the fungi to grow without competition. This phenomenon can lead to **fungal overgrowth** in the mouth (oral thrush), vagina or skin. Frequent use of antibiotics in diabetic patients who get other infections is another reason for disrupting this natural balance. In addition to destroying harmful bacteria, these drugs also destroy beneficial bacteria in the body and open the field for the growth of fungi. Common types of fungal infections in diabetics In diabetic patients, due to the special conditions that the disease creates in the body, the possibility of fungal infections is much higher than normal people. High blood sugar level, weakening of the immune system and constant moisture in some areas of the body are all factors that provide a suitable environment for the growth of fungi, especially species such as *Candida albicans*. In the following, we will learn about four common types of these infections in diabetics. ### oral thrush (oral candidiasis): Oral thrush is one of the most common fungal infections in diabetics, which usually appears on the tongue, gums, roof of the mouth, and inside the cheeks. This infection is caused by the overgrowth of Candida fungus in the mouth, a fungus that naturally exists in the body but loses control of its growth in conditions such as high blood sugar or dry mouth. Common symptoms of this disease include white or cream-colored spots in the mouth, burning or dryness, metallic taste, and cracks in the corners of the lips. The use of artificial teeth, diabetic drugs that reduce saliva and weak immune system are important reasons for this type of infection. Treatment of this infection is done with antifungal mouthwashes such as nystatin or oral antifungal drugs, but blood sugar control and oral hygiene are necessary to prevent the disease from returning. ### Fungal infection of the genital tract: Genital yeast infection is very common in diabetics, especially women, and is often accompanied by severe itching, abnormal discharge, and burning. In women, this type of infection occurs as fungal vaginitis, which is accompanied by white, thick and odorless secretions, while in men, inflammation of the head of the penis (balanitis) is observed with redness, itching and sometimes peeling. The main reason for the prevalence of this infection in diabetics is the presence of high sugar in body secretions, which provides a suitable environment for the growth of fungus. Solutions to deal with this problem include the use of antifungal creams and suppositories such as Clotrimazole, personal hygiene, keeping the area dry and wearing loose cotton clothes. In case of chronic or continuous recurrence, there is a need to take oral medications prescribed by a doctor. ### Skin fungal infections: The skin of diabetics is one of the most vulnerable places against fungal infections, because many areas of the body, such as armpits, groin, under the breasts and between the fingers, are exposed to constant moisture and high heat. In these areas, fungi grow rapidly and are usually accompanied by symptoms such as itching, inflammation, redness, scaling, and even an unpleasant odor. Sweating a lot, using plastic and tight clothes, and not drying the body after bathing are factors that encourage the growth of this type of infection. To prevent fungal skin infections in diabetic patients, it is necessary to wash the body daily, especially the sensitive areas, with unscented soaps and then dry completely, and the use of antifungal powders or creams such as ketoconazole or terbinafine is also effective in treating these infections. Wearing cotton clothes, airing the skin and maintaining hygiene play an important role in preventing this type of infection. ### Fungal infection of feet and nails: Feet are one of the most important areas of the body in the care of diabetic patients, because the occurrence of a fungal infection in this area can lead to more serious problems such as diabetic ulcers or even secondary bacterial infections. The most common type of fungal foot infection in diabetics is tinea pedis, or fungus between the toes, which is accompanied by itching, cracking, unpleasant odor, and scaling. In addition, nail fungus or onychomycosis is also very common in diabetics and causes thickening, discoloration, brittleness and deformity of nails. People with diabetic neuropathy may not notice these symptoms and delay treatment, which increases the risk of spreading the infection. For treatment, the use of topical creams, medicated antifungal varnishes, or oral antifungal drugs such as fluconazole is recommended. Also, daily foot care, keeping dry between the toes, using cotton socks, proper ventilation of shoes and visiting the doctor periodically are essential measures to prevent and manage this type of infection in diabetic patients. Warning signs that should not be ignored In diabetic patients, fungal infections can progress quickly and, if left untreated, can cause ulcers, tissue damage, or even more widespread infections. Early recognition of warning signs is the key to preventing serious complications. Many of the early symptoms seem simple or ordinary, but in people with diabetes, these symptoms should be taken seriously. In this section, we examine the most important signs that should not be ignored: ### Itching, redness and inflammation: One of the most common early signs of a fungal infection is **severe and persistent itching in the affected area**. This itching usually occurs in moist and warm areas of the body such as the groin, armpits, under the breasts or between the fingers. Along with itching, **skin redness** and **inflammation** are also seen, which indicate the body's response to the presence of fungi. Inflammation may also manifest itself as swelling, local heat or sensitivity to touch. In diabetics who may have a reduced sense of touch due to neuropathy, even mild itching or redness should be taken as a serious warning, as it may be the start of a deeper infection. ### Abnormal secretions: Another warning sign is **abnormal secretions from different parts of the body**, especially the genital area. In diabetic women, a thick, white, odorless discharge that resembles curds can indicate a vaginal yeast infection. In men, similar secretions with inflammation and itching may appear in the genital area. These secretions are usually caused by the overgrowth of Candida fungus in the sugary environment of the body. If these secretions are accompanied by burning during urination or sexual intercourse, they are a sign of the spread of infection. Paying attention to the change in color, smell, volume and texture of secretions can help in early diagnosis and prevent the infection from progressing to chronic stages. ### Foul smell: The presence of **unusual and unpleasant odor** in parts of the body, especially moist and closed areas such as between the toes, groin or armpits, can be an important sign of the beginning of a fungal infection. This odor is usually caused by a combination of excessive sweating, dead skin, fungal growth, and sometimes secondary bacterial infections. In diabetic people, because sweating may be more and blood sugar control is poor, a suitable environment is provided for the growth of fungi and the production of unpleasant odors. If the body odor suddenly changes, becomes intense, or is accompanied by itching and redness, it should be considered as a warning sign. Observing daily hygiene, keeping wet areas dry and using antifungal sprays or powders can prevent the aggravation of this symptom. ### Change in nail or skin color: Another obvious and visible symptom of fungal infections is **color change in the skin or nails**. Nail fungus causes nails to turn yellow, brown, or even green, thicken, and become brittle or misshapen over time. In some cases, the nail completely separates from its bed, which is a sign of an advanced and severe infection. Red or brown spots may appear on the skin, which are usually accompanied by itching and peeling. These spots are more common in diabetic women, especially in the groin, abdomen and under the breasts. These discolorations, if accompanied by an unpleasant odor or skin cracks, can indicate an active fungal infection and require immediate treatment. Ways to prevent fungal infections in diabetics Prevention of fungal infections in diabetic patients is one of the important principles in their health management. Considering that diabetes provides a suitable environment for the growth and spread of fungi, following preventive measures can largely prevent the occurrence of skin, oral, vaginal or nail problems. In the following, we examine the most important effective and scientific solutions to prevent these types of infections: ### Effective blood sugar control: The first and most basic way to prevent fungal infections in diabetics is to control blood sugar carefully and continuously. The high level of glucose in the blood not only disrupts the function of the immune system, but also provides a sugary and favorable environment for the growth of fungi such as *Candida albicans*. When blood glucose is high, the skin and mucous membranes become weaker and their defense power decreases; For this reason, the body cannot resist fungi well. Studies have shown that diabetic patients with uncontrolled blood sugar are several times more prone to fungal infections than patients with regulated sugar. Therefore, regular use of a glucometer, following a suitable diabetic diet, regular physical activity and timely consumption of diabetes medications play a key role in maintaining skin health and reducing the possibility of infection. ### Personal hygiene: Personal hygiene is the second pillar in the prevention of fungal infections in diabetic patients. Many fungi grow in warm, moist, and dark areas of the body such as the groin, armpits, under the breasts, between the toes, and under the abdomen. Therefore, it is very important to keep these areas dry after bathing, exercising, or sweating profusely. Using a clean and dedicated towel, drying the body completely before wearing clothes and avoiding long-term use of wet or tight clothes are important points. Also, wearing cotton, loose and breathable clothes helps to reduce sweating and better evaporation of moisture. Tight clothes and plastic materials trap heat in the body and facilitate the growth of fungus. Changing underwear daily, washing them regularly with hot water and maintaining hygiene in the genital and leg areas, especially between the toes, is highly recommended. ### Strengthening the immune system: The immune system of diabetics may work weaker than normal, and for this reason, strengthening it is very necessary to prevent fungal infections. A healthy, balanced diet rich in vitamins and minerals such as vitamin C, vitamin D, zinc and selenium helps to improve the function of immune cells. Consuming fresh fruits and vegetables, whole grains, nuts and healthy proteins such as fish and eggs are the main foundations of healthy nutrition for diabetic patients. Also, nutritional supplements such as probiotics and vitamin D can be helpful in some people who are immunocompromised or vitamin deficient. However, the use of any type of supplement must be prescribed and supervised by a doctor, because arbitrary use may cause drug interactions or increase blood sugar. ### Use of antifungal products: For people who are prone to excessive sweating or moist areas of the skin, regular use of topical antifungal products such as powders, creams, or sprays can be an effective way to prevent fungal growth. These products can be used especially in sensitive areas such as between the toes, groin, or under the breasts. Topical creams can also prevent the progress of infection if early symptoms such as itching or redness are observed. People who wear closed shoes and socks for a long time should wash and dry their feet after taking off the shoes and use antifungal sprays if needed. These simple but targeted actions can create an effective defense barrier against fungal infections along with blood sugar control. Methods of treating fungal infections in diabetic patients The treatment of fungal infections in diabetic patients requires a combined, precise and scientific approach. Unlike non-diabetic people, the immune system in diabetic patients is not able to fight infection properly, and their body environment - due to high sugar - is much more favorable for the growth of fungi. Therefore, treatment in these patients should not be superficial or only symptomatic. ### Topical drugs: The first line of treatment for fungal infections, especially in the early stages, is the use of topical medications such as antifungal creams, ointments, or gels. These drugs usually contain compounds such as clotrimazole, miconazole, terbinafine, ketoconazole, or nystatin. In diabetic patients, careful and regular use of these ointments can help stop the growth of fungus and repair the damaged skin. These drugs are especially useful in cases such as fungus between the toes, skin infection in the groin, or oral thrush. It is important that the patient continues the treatment until the end of the prescribed period, even if the symptoms decrease in the first days. Stopping the drug early may cause a recurrence of the infection, which is more dangerous in people with diabetes. ### Oral drugs: In cases where the infection is widespread, recurrent, or resistant to topical medications, the doctor may prescribe the use of oral antifungal medications. These drugs include fluconazole, itraconazole, oral terbinafine, or oral ketoconazole and must be taken with a prescription and under the supervision of a physician. In diabetic patients, the use of these drugs should be done more carefully, because they may interact with other diabetes drugs or heart drugs. Also, some oral antifungal drugs can affect liver function, so checking liver function before and during treatment may be necessary. Treatment follow-up, regular visits to the doctor, and periodical tests are vitally important at this stage to avoid drug side effects or fungal resistance. ### Assistive measures and care at home: Along with drug treatment, home care also plays a very important role in speeding up recovery and preventing the spread of infection. The first step is to thoroughly dry the affected areas after bathing or sweating. It is essential to use a separate, clean and completely dry towel, especially in the areas between the toes, armpits or groin. Adequate ventilation of the skin by wearing loose, cotton clothing, and frequent changes of clothing (especially underwear and socks) are other effective supportive measures. It is also recommended to use non-scented and non-greasy moisturizers, as high fat or industrial fragrances may facilitate the growth of fungi. ### Necessity to see a doctor in resistant infections: One of the biggest mistakes that some diabetic patients make is self-medication or ignoring the symptoms of fungal infection. Because of impaired circulation, weakened immune system, and the possibility of diabetic neuropathy (loss of sensation in the limbs), a simple infection may progress in a short time to open wounds, necrosis, deep tissue infections, or even gangrene. Cases that do not improve with topical treatment, recurrent infections, or sores that are oozing, foul-smelling, painful, or discolored should be reported to a doctor immediately. Also, if you have fever, severe weakness, unexplained increase in blood glucose, or general symptoms of the disease, you need to see a doctor immediately. Self-medication or using other people's prescriptions can lead to exacerbation of conditions, occurrence of drug resistance or hiding of infection symptoms. ### Mushrooms lurking in sugar; Silent alarm for diabetics Fungal infections, although they seem simple at first glance, can quickly turn into a serious crisis in people with diabetes. High blood sugar levels, a weakened immune system, and a disruption in the natural balance of the body's microorganisms create a dangerous combination that provides a breeding ground for fungi. From oral thrush to skin and nail infections, they can all be signs of a deeper threat. But the good news is that with effective blood sugar control, careful personal hygiene, preventive care and timely medical treatment, many of these infections can be prevented. Diabetes is a chronic disease, but with awareness, education and smart action, the quality of life can be dramatically improved. Finally, every small sign in the diabetic body can carry a big message; The message of attention, prevention and following scientific solutions to have a healthier body and a safer life. **To receive a visit (online or in person) with Dr. Yazdan Panah, fill out the form below**

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