For diabetic patients, no symptom is too insignificant to ignore. Given a short period of time, what starts as a small untreated wound or blister on the foot can develop into a condition severe enough to have to undergo foot or above the knee amputation. A study concluded that diabetics who acquire infections are 55 times more likely to get hospitalized and 154 times more likely to undergo an amputation.

The stunning finding is enough to put infection, and its effect on the lives of diabetic patients, in the limelight. Diabetes-related foot infection is just one of several kinds of complications caused by bacteria and fungi (collectively known as pathogens) that enter and dwell in the body.

Dr. Vilma Co, head of the Infectious Diseases Department of Makati Medical Center, mentioned six areas commonly afflicted with an infection: lungs, urinary tract, genitals, gums, skin or soft tissue, and feet. Inflammation and perennial wounds, among others, are tell-tale signs that pathogens have already inhabited and wreaked havoc in the area.

There’s such a close association between diabetes and infectious diseases which include, but are not limited to pneumonia, urinary tract infection, yeast infection, and gingivitis that endocrinologists and infectious disease consultants actually share the same patients.

A complex disease, diabetes mellitus is a health condition conducive to acquiring infections. According to Dr. Ma. Teresa Plata-Que, Philippine Diabetes Association (PDA) president, “Diabetics are more prone to infection because hyperglycemia (high blood sugar) decreases the normal functioning of white blood cells, known as the soldiers of our immune defense system, making infection even worse and take longer to heal.”

Needless to say, infections among diabetic patients tend to be harsher than in those who don’t have the disease. When the body has impaired the infection-fighting mechanism, the person lacks protection against bacteria. Dr. Co likewise believes infections among diabetics are relatively more difficult to treat because in order to fight an infection, we not only depend on antibiotics but also on the patient’s own immune system to work.

Furthermore, the recovery period for a person with diabetes and infection usually takes longer since poorly managed blood sugar gets in the way. In pointing out the hazards of infectious diseases among people with diabetes, Dr. Co said that in general, any respiratory infection in diabetic patients is associated with higher mortality rate. “People with diabetes are four times more likely to die from pneumonia or influenza compared with others,” she added.

Just as there are several kinds of infections diabetics can acquire, so are the causes for the onset of infection. The causes of an infection are not necessarily similar to another even if both infections only occur in the same person. “The causes of infections in a person with diabetes may vary depending on the site of infection present,” Dr. Co said. In the case of diabetic foot ulcer which progresses to amputation, the doctor explained that poor blood circulation in the peripheral extremities and neuropathy (diseases related to the nervous system) common among diabetics are to be blamed for this complication.

Diabetics with foot ulcers have a hard time feeling the symptoms. According to Dr. Co, cuts and wounds on the feet area are not normally felt since diabetics have problematic sensory function. This explains why diabetics suffer leg amputations out of sheer neglect and indifference. Since causes of diabetes-related infections differ, the symptoms also vary. Though there are general signs like fever, headache and chills, a unique symptom is already a clue of the infection itself. Take yeast infection as an example. Naturally, this complication only occurs among diabetic women and is characterized by vaginal discomfort and thick, smelly discharge.

Both Dr. Que and Dr. Co mentioned the following as among the most common symptoms of infection: rashes, a wound or cut that won’t heal, sore throat, nasal congestion, cough that lasts more than two days, shortness of breath, white patches inside the mouth or on the tongue, nausea, bloody or foul-smelling urine, vomiting or diarrhea.

In treating infectious diseases, Dr. Co said that specific antibiotics and dosages are prescribed to treat particular infections. Frequent follow-up visits may be needed because minor infections can easily become serious for people with diabetes and may take longer to heal when blood sugars are high. “Good glycemic control can prevent infections while antibiotics constitute the first line of treatment for infections and the type of antibiotics given will depend on the infection that is being dealt with,” Dr. Plata-Que commented.

Dr. Co, who is a member of the Philippine Society for Microbiology and Infectious Diseases (PSMID), gave helpful tips for diabetics who want to veer away from contacting infections:

• After bathing, feet should be kept dry to prevent skin breakdown in between toes. Lotions may be used to prevent dryness of skin which can become cracked and cause microorganisms to enter the body.
• Aside from basic personal hygiene, regular brushing of teeth and dental visits are also a must. Avoid smoking because it can worsen circulation problems.
• Flu and pneumonia vaccinations are recommended. It is also important to follow a physician’s advice regarding duration of treatment with antibiotics.
• Medical professionals can also benefit from regular symposia, workshops and annual conventions organized by PSMID and PDA which may cover topics related to diabetes and infectious diseases. The armor of vigilance and knowledge can go a long way to keep infections at bay.