If you have diabetes, you may have noticed that you get yeast infections more often than others do. It’s not just in your head; it’s factual.
Patients with diabetes are at higher risk of yeast infections. We will discuss why that is, as well as other relevant information related to yeast infections.
How common are yeast infections?
Researchers have stated that the worldwide burden of yeast infections remains “unacceptably high.” Yeast infections are increasingly reported from all over the world, including East Asia, the Middle East, Africa, Europe, and South and North America.
The overall burden of yeast infections is quite high. This is particularly true of patients at risk of opportunistic infections, such as the immunosuppressed. The number of patients at risk of opportunistic infections such as yeast infections is rising steadily. In the general population, 8.20% have had yeast infections.
Did you know that vaginal yeast infection is the most prevalent vaginal infection worldwide? They affect millions of women each year. It is a highly prevalent clinical condition in premenopausal women.
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What’s the connection?
Yeast infections are invasive. Pathogenic yeasts cause them in vulnerable populations. Pathogenic yeast causes disease in the immunocompromised.
Patients with diabetes are considered to be immunosuppressed. This is because diabetes mellitus is an autoimmune disease. In diabetes, the body attacks its own pancreatic cells. Since the body is busy inappropriately responding to its cells, it’s unable to properly fend off infections.
Yeast occurs naturally in the mouth, intestines, vagina, and skin. However, this is not in an amount that is dangerous to human health. Studies show that patients with type 1 diabetes are primarily exposed to complications related to yeast infections.
One scientific research study looked at 54 patients with Candida Auris infections. This study took place from 2012 to 2015 across Pakistan, India, South Africa, and Venezuela. 41% of the patients with this yeast infection had diabetes mellitus. Another study looked at 742 cases of Candida Auris infection from 16 countries. More than 52 cases had diabetes mellitus.
Uncontrolled diabetes is a known risk factor for vaginal yeast infections. Saccharomyces cerevisiae is a commensal yeast of the digestive, respiratory, and genitourinary tracts. A case study on a diabetic patient showed that he developed a urinary tract infection from this strain.
A substantial yeast overgrowth observed in diabetic patients might negatively affect metabolic compensation. This could lead to an increased demand for insulin. This can also lead to infections that are hard to cure. Research has shown that the weaker the immune system in patients with diabetes, the greater the risk of disease-related to yeast infections.
One study compared infection rates in people with diabetes versus those without. This was a 2014 study conducted in the United Kingdom. They recruited 34,278 people with type 2 diabetes and 613,052 without diabetes for comparison. They found that the incidence of infections was higher in those with type 2 diabetes. Worsening glycemic control was associated with an increased rate of:
- Skin and soft tissue infections
- Urinary tract infections
- Genital infections and infections of the surrounding area
Infections that were most commonly of yeast origin were more frequent in people with worse control over their diabetes.
Oral thrush is a major manifestation of uncontrolled diabetes mellitus. Numerous cofactors are associated with the development of this infection.
Yeast is commensal to the mouth and esophagus. This means that with certain predisposing systemic and local circumstances, oral thrush can occur. Patients with diabetes suffer oral thrush more frequently than healthy individuals do. This is especially true of the strain Candida albicans. The presence of diabetes is considered to be a significant risk factor for alterations of the oral mucosa.
A case-control study looked at 250 patients with type 2 diabetes and 81 controls without diabetes. Researchers collected oral rinse samples from each patient to measure candida levels.
32.8% of those with diabetes had more than 2000 colony-forming units per milliliter of yeast. This is significantly higher than the 12.3% of healthy controls. Researchers concluded that the infestation of yeast in the mouth of diabetics is significantly higher than in healthy counterparts.
Another study looked at the prevalence of oral thrush in patients with diabetes and its relationship to blood glucose levels. They took blood sugar levels from 113 patients with type 2 diabetes, 24 with type 1 diabetes, and 105 healthy controls. They took samples by swabbing their mouth to test for yeast. Then, they tested blood levels of hemoglobin A1c.
The results showed that the candida density was statistically higher in diabetics than healthy individuals. Researchers concluded that there is a significant association between poor glycemic control and higher yeast density in patients with diabetes.
An animal study done on rats found that those with diabetes actually had changed to their tongues. The rats with diabetes had thicker tongues, with hyperkeratosis and different epithelial changes visible.
Another study looked at prosthetic joint infections. They pulled out 72 cases from the literature. 14 of those with prosthetic infections also had diabetes mellitus. The most frequent species of infection was Candida albicans, followed by Candida parapsilosis. These are both types of yeast infections.
Are there other causes of yeast infections?
Some of the factors that can put you at a higher risk of a yeast infection include being female, smoking cigarettes, wearing dentures, and being HIV positive.
Conditions that seem to happen along with yeast infections include sepsis, lung diseases, kidney diseases, and of course, diabetes. Some of the patient-related risk factors for yeast infections include:
- Pregnancy (those with gestational diabetes are at even higher risk)
- Hormone replacement therapy for women’s health
- Antibiotics (taken for a previous bacterial infection)
- Glucocorticoid use
Some of the behavioral risk factors for yeast infections include:
- Birth control pills (due to high estrogen levels)
- Intrauterine device
- Spermicide use
- Condom use
- Personal hygiene
- Restrictive clothing
- Sexual practices
One study looked at Candida Auris yeast infections. Of the 54 patients evaluated, 51% had recent surgery, and 73% had a central venous catheter. This indicates that these could be risk factors for candidiasis as well, particularly of the Candida Auris variety.
A different study was conducted from April 2011 to September 2017. Of the 124 patients with yeast in their blood, 65 of them were elderly (aged 65 or older). 40 patients had some form of malignancy or cancer.
Four patients were prescribed antibiotic medications one month before the study period. This means that these are potential risk factors to be aware of as well.
Another study looked at 73 patients with fungal prosthetic joint infections. 24.6% of them had a systematic disease such as rheumatoid arthritis, Sjogren’s syndrome, or systemic lupus erythematosus. 32.8% of patients had immunosuppression due to malignant or chronic diseases. 5.4% had long term antibiotic use.
How is a yeast infection diagnosed?
Vaginal yeast infection
In order to diagnose a vaginal yeast infection, your health care provider will first ask you questions about your medical history. Be prepared to answer questions about past vaginal infections or sexually transmitted infections. Your health care provider may also perform a pelvic exam.
They will examine your external genitals for signs of infection, such as discharge, odor, redness, signs of itching, or the visible presence of yeast.
Your doctor may also place a speculum into your vaginal canal. This is to hold the walls of the vagina open to better view your vagina and cervix.
Your doctor may take a swab sample of your vaginal secretions. They will send this to a laboratory for testing. According to the Mayo Clinic, this is how they know what specific type of fungus it is and be able to prescribe more effective treatment. This way, treatment is more targeted.
Oral thrush diagnosis is usually based on symptoms alone. Your doctor may take a swab sample from your mouth or throat. This will be sent to a lab for testing under a microscope.
How are yeast infections treated?
So, how do we treat yeast infections?
Vaginal yeast infections
Typical treatment for a vaginal candida overgrowth involves an antifungal medication for three to seven days. This can be in the form of a tablet, ointment, cream, or suppository. One example is miconazole, commonly known as Monistat 3.
Another example is the terconazole. Some antifungals are over the counter, while others are by prescription only. Your doctor may recommend a single dose oral medication called fluconazole (Diflucan). However, this is not an option if you are pregnant. If your symptoms are severe, your doctor might prescribe two single doses, three days apart.
If you have severe or frequent vaginal yeast infections, your doctor may suggest long-course vaginal therapy. This is daily for up to two weeks, followed by once a week. This goes on for six months. Your doctor may give you multidose oral medication. This involves two to three doses of oral antifungal medication.
Unfortunately, this is not a safe option for pregnant women. If your yeast infections appear to be resistant to these medications, your doctor may recommend boric acid. This comes in a vaginal suppository and is only used to treat Candida yeast infections that are resistant to the common antifungal agents mentioned above.
A probiotic can be helpful in yeast infections. This is because a yeast infection occurs due to the disruption of the microbiota composition. A probiotic can help to restore a healthy microbiome. One helpful strain is Lactobacillus acidophilus.
Recent studies support the effectiveness of local and oral probiotics for the prevention of yeast infections. A study found that Saccharomyces cerevisiae lives yeast and inactivated whole yeast had positive effects on yeast infections. They did this by speeding up the rate at which yeast was cleared from the vagina. This was due to the Saccharomyces probiotic’s multiple interactions with the yeast.
Both live and inactivated probiotics prevented the yeast from sticking to epithelial cells. Usually, Candida albicans yeast can switch forms and express certain enzymes to protect itself.
However, the Saccharomyces probiotic was able to prevent the yeast from doing that. You can take a probiotic supplement, or get it from food sources such as yogurt and cottage cheese.
For oral thrush, your health care provider will likely give you an antifungal medicine. This is usually topical, and you simply apply it to the inside of your mouth for seven to fourteen days.
Common medications for this are clotrimazole, miconazole, and nystatin. If your oral thrush is severe in nature, your doctor might recommend fluconazole orally or intravenously. If this still doesn’t help, they may try a different medication.
Interestingly enough, research has found that there is less candida in the stool of people who clean their teeth more frequently. So be sure to floss and brush regularly, at least twice per day.
How can I prevent future yeast infections?
One way to help prevent yeast infections is by taking a probiotic. Research shows that probiotics stimulate the immune system.
Probiotics do this by activation of immune cells such as macrophages, natural killer cells, antigen-specific cytotoxic T lymphocytes, and cytokines. In fact, infants that are given probiotics can have less risk of immune-mediated diseases in childhood. You can take probiotics both orally and locally in the case of vaginal and oral yeast infections.
There is a novel vaccine currently being researched that is meant to help with yeast infections. Keep an eye out for more information related to that in the coming years.
Prevention is surely the most effective treatment, even more so than the use of antifungal agents.
- Certain strains, such as Candida Auris and Candida albicans, can be passed through surfaces. You can prevent the transmission of these yeast infections by disinfecting surfaces in your home and workplace.
- Wear breathable undergarments; Tight-fitting clothing holds moisture. This is especially true of manufactured materials such as nylon and polyester. The reason this is problematic is that yeast loves to grow in dark, moist places. Cotton is a great example of a breathable material that allows for airflow. Wear cotton underwear or underwear that has a cotton lining.
- Use unscented personal hygiene products. Scented pads, tampons, soaps, and even laundry detergents can be irritating to the vulva. This can lead to an imbalance in the natural bacteria of the vagina. Please note that washing your vagina actually puts you at a higher risk of a yeast infection. You do not need to wash your vagina! On that note, douching is also a bad idea for the same reasons. It kills the good bacteria that do the important job of preventing infections.
- If you have a nutritious diet and generally healthy lifestyle, this helps to support your immune system so that you are less likely to develop a yeast infection. If you wear dentures, be sure to remove them before bed. Clean them daily and ensure that they fit you properly. This will help to prevent oral thrush. If you use a corticosteroid inhaler, this increases your risk of oral thrush. To help minimize this risk, rinse your mouth, or brush your teeth after using your inhaler.
Although having high fasting blood sugar and diabetes puts you at a higher risk of yeast infections, there are many things you can do to help prevent them. If you have frequent or recurring yeast infections, be sure to talk to your health care provider about them as soon as possible.