Diabetes Forecast

Embarrassing Body Problems You Need to Know About

Got bad breath? Toenail fungus? Problems in the bedroom? You're not alone—and these could be signs of more serious issues

By Tracey Neithercott , , ,

Let's talk about gas. Yeah, you heard that right: gas. Everyone has it—on average, humans pass it about 14 times a day. But some people with diabetes find themselves suddenly having an excess of flatulence that can be upsetting—and embarrassing. So embarrassing, in fact, that they might not even want to talk to their health care provider about it. That's a mistake. Because problems like this are usually treatable. And some "yuck factors"—for example, chronic yeast infections—are actually symptoms of poor blood glucose control or complications of diabetes, which need medical attention, pronto. Read on for some of the more common ailments associated with diabetes, and then let your doctor know if you've got 'em.

PROBLEM: I have morning breath … all day long.

The cause of bad breath may be as simple as that garlicky salad dressing you ate at lunch, but breath that reeks consistently can indicate a bigger problem. "Diabetes is a big risk factor for periodontal disease," says Robert Eber, DDS, MS, clinical professor of dentistry and associate chair of periodontics and oral medicine at the University of Michigan School of Dentistry. Periodontal disease occurs when plaque and bacteria in the mouth cause gum inflammation, tissue damage, and even loss of bone beneath the teeth. Since periodontal disease is an infection, it can raise your blood glucose levels by increasing insulin resistance. Untreated, it will lead to tooth loss.

Periodontal disease is usually painless; no throbbing toothache will spur you to seek treatment. Bleeding whenever you brush or floss is a warning sign, but by the time you have other symptoms—swollen or red gums, loosening teeth, plaque buildup, bad breath, or widening spaces between your teeth—the disease is in its later stages. Periodontal treatment focuses on stopping progression, not reversing damage, so it's important to get frequent checks to prevent problems in the first place. "After you initially get diagnosed with diabetes, it would be a good idea to get screened by a dentist or periodontist," says Eber. Then, aside from regular dental checkups, prevention is up to you. Brush twice a day, floss daily (flossing is the only way you'll scrape plaque and bacteria from your teeth and gums between regular cleanings), and keep your blood glucose in control; poor glucose control puts you at greater risk for periodontal disease.

PROBLEM: I can't keep my food down.

Having diabetes (particularly type 1) is a major risk factor for gastroparesis, a condition in which delayed stomach emptying causes nausea, bloating, extreme fullness after a meal, vomiting, unwanted weight loss, and pain in the upper abdomen. The disease itself can be debilitating, but it can also make diabetes management seem impossible. Because it takes extra time for the stomach to empty and glucose levels to rise, premeal insulin can lead to hypoglycemia. Then, an hour or two later, when the stomach finally releases food, blood glucose levels can spike.

The solution? "You have to get the stomach to work better or change the consistency of food," says Michael Camilleri, MD, a gastroenterologist at the Mayo Clinic. Since liquids move through the stomach faster than solids, Camilleri puts patients on a diet of pureed food to regain weight and add much-needed nutrients. Many people can go on to eat solid foods again, with modifications (nix the fiber and fat, and eat small meals often). "It's manageable with a change of diet," Camilleri says, noting that medications to treat the disease may have side effects and typically are not effective in the long run. If you've been diagnosed with gastroparesis, you'll need to work with a registered dietitian to reshape your diet. You'll also need to work with your doctor on ways to adjust your insulin. Since high blood glucose can delay stomach emptying even in people without gastroparesis, good control is key.

PROBLEM: My skin is thick and waxy-looking.

Ten to 15 percent of people with diabetes will experience the skin condition known as scleredema (not to be confused with the autoimmune disease scleroderma). Over time, high blood glucose can change the structure of the skin's collagen, a fibrous protein, causing skin on the neck, upper back, and shoulders to thicken and become tough. If you catch it early, you can treat scleredema before a new collagen structure permanently reduces your skin's elasticity, says Intekhab Ahmed, MD, an endocrinologist at Jefferson Medical College in Philadelphia who studies skin diseases in people with diabetes. Prevention is key. "[People with diabetes] are more prone to develop skin conditions," says Ahmed. "The moment they see something they should consult their doctor—before things get out of hand."

PROBLEM: I can't have—or keep—an erection.

Despite those omnipresent Viagra, Cialis, and Levitra commercials, "a lot of physicians never ask if a patient has erectile dysfunction," says Ronald Tamler, MD, PhD, MBA, CNSP, an assistant professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Medical Center in New York, whose research focuses on erectile dysfunction in people with diabetes. The connection between erectile dysfunction and diabetes is strong: Men with diabetes are three times as likely to experience the problem as those without diabetes. The link is similar to the diabetes–heart attack connection: Blocked arteries in the heart can lead to heart attack, but smaller arteries typically clog up first, such as those in the penis. "That's one of the reasons why erectile dysfunction is not just more complications of diabetes but also precedes other complications like coronary artery disease," says Tamler. Other risk factors for erectile dysfunction include old age, obesity, and low testosterone, a problem common to men with diabetes.

Now here's the good news: Most of the time, the problem can be alleviated. If a man is overweight or obese, losing weight may do the trick. Exercising may help, too. Controlling blood glucose can stop erectile dysfunction. And medications can also be effective. If you think erectile dysfunction is just an embarrassing annoyance, it's time to start taking it seriously. "See this as a potential warning sign of complications [like heart attack or stroke]," says Tamler. "Force or initiate changes that will benefit [your] cardiovascular system."

PROBLEM: I itch … down there.

Most women at some point will experience a vaginal yeast infection. Women with diabetes, however, are much more likely to get annoying and painful infections with the candida yeast. Since candida basically feeds off glucose, it's easy to see why diabetes is a risk factor. Not sure if you have a yeast infection? Look for a white, cottage cheese–like discharge, itchiness, and a foul odor. Over-the-counter medications for treating yeast infections abound, but Carolyn Alexander, MD, a gynecologist at Cedars-Sinai Medical Center in Los Angeles, suggests visiting your doctor instead of self-treating. To prevent yeast infections, maintain good blood glucose control, skip scented soaps, avoid douches, and keep your vaginal area dry by wearing cotton underwear and avoiding tightly fitted pants.

PROBLEM: My toenails are thick, crumbly, and yellow.

Here's the thing about toenail fungus: You don't have to be on a high school wrestling team to contract it. "You can pick it up on gymnasium floors or pool surfaces. You can get it from the beach. You can get it from your home," says Crystal Holmes, DPM, CWS, a podiatrist and certified wound specialist at the University of Michigan Medical School. People with diabetes aren't necessarily more likely to get toenail fungus (though having a weakened immune system plays a role, as does being over age 65), but having it puts people at diabetes at risk for infections, especially those with neuropathy. Fungus can turn a toenail into a hard, thick, and—when part of the nail peels or crumbles off—sharp weapon that can cut into the skin around the toe and create a gateway for infection. "Fungus cohabitates with bacteria that can feed off your skin," says Holmes.

If you notice any yellow or white spots or general discoloration in your toenails, make an appointment with your podiatrist. While some over-the-counter ointments treat nail fungus, your doctor will be able to determine if you're really infected with fungus and whether treatment (like oral medications or prescription creams) is needed. You'll most likely use medication for a matter of months, but it can take up to a year for the infection to fully disappear. Once you've been infected with a fungus, you're more susceptible to getting it again, and you're also more likely to contract athlete's foot, says Holmes. To prevent infections, keep nails clean, trimmed, and dry; always wear shoes in public places; and use antifungal powder.

PROBLEM: Sex isn't what it used to be.

When sex is more ow than wow, pay a visit to your gynecologist. Your pain may be due to vaginal dryness, a problem that isn't dinner party conversation fodder but is common nonetheless. "It's a really hush-hush kind of thing," says Alexander, noting that the limited research on the topic suggests it's more common in women with diabetes. In fact, a 2002 study in the journal Diabetes Care found that the only significant difference in sexual dysfunction between women with diabetes and those without was decreased vaginal lubrication. The reason, says Alexander, may be that poorly controlled diabetes causes vascular damage that decreases vaginal blood flow.

Even women without diabetes are more likely to experience dryness when they reach menopause, as lower estrogen levels reduce the amount of moisture in the vagina. For dryness caused by menopause, your doctor may prescribe estrogen rings or pills that are inserted directly into your vagina; since the estrogen in these isn't absorbed throughout your body, you're at less of a risk for heart disease, cancer, and stroke, which may result from typical hormone replacement therapy. Over-the-counter lubricants can also make sex more comfortable.

PROBLEM: I have constant diarrhea.

If your medication is causing diarrhea, you'll experience more than one night of misery; the problem could last as long as you take the drug. That's why it's important to know that metformin, the common type 2 diabetes medication, is the top cause of chronic diarrhea in people with diabetes. (Autonomic neuropathy and "diabetic diarrhea" may also be to blame.) "One in 10 people with diabetes on metformin will have diarrhea," says Paresh Dandona, MD, PhD, chief of endocrinology in the Department of Medicine at the University at Buffalo and lead researcher of a landmark study that noted the metformin-diarrhea connection.

Stomach woes that result from metformin typically start right away, though a 1999 study published in The American Journal of Gastroenterology found that some people had new-onset diarrhea after years on the drug. Though experts don't know exactly why metformin sometimes triggers diarrhea, Dandona says many of his patients switch meds (or try slow-release metformin, which can be less aggravating) because of the side effect. The good news? "Once you stop the drug," he says, "it will disappear."

PROBLEM: Sometimes I don't make it to the bathroom.

If you've gotta go all the time, you may have urinary incontinence. There are two common types: Stress incontinence happens when a cough or sneeze releases urine. Urge incontinence, which is more common in people with diabetes, brings on a need to urinate so quickly and unexpectedly that one is unable to make it to a toilet in time. Why is unclear, but researchers suspect microvascular damage, which also causes retinopathy, nephropathy, and neuropathy. Suzanne Phelan, PhD, a researcher at California Polytechnic State University in San Luis Obispo, Calif., found in a recent study that abdominal fat plays a major role, too. In the study of overweight women with type 2 diabetes, Phelan and colleagues learned that abdominal fat in particular, in addition to overall obesity, may place added pressure on the bladder, leading to incontinence.

Whether lowering A1C or losing weight can suppress incontinence in people with diabetes is a subject for future study, says Phelan. For now, treatment consists of medication, surgery, weight loss, adult diapers or pads, pelvic floor exercises called Kegels, and a technique called "double voiding," in which you urinate, wait a few minutes, and go again. Phelan says it's important for people with diabetes to know they're not alone. Her study found that incontinence at least once a week is far more prevalent in people with diabetes (about 27 percent) than retinopathy (7.5 percent) and neuropathy (1.5 percent) combined.

PROBLEM: Going to the bathroom hurts.

Women who have had a urinary tract infection understand the pain and frustration: There's a constant urge to urinate, but little comes out. That, and there's pain in your stomach and a burning sensation when you do go. There are plenty of ways you can get an infection, but it all stems from bacteria entering your urinary tract (including the bladder and kidneys) through the urethra. Most urinary tract infections are bladder infections, though you should see a doctor immediately if you experience a fever, chills, and back pain, additional symptoms that may signify a more dangerous kidney infection.

"Anybody with diabetes is more prone to get any kind of infection," says Alexander, so preventive measures are important. She recommends going to the bathroom at least every four hours, wiping from front to back after urinating, going to the bathroom right after sex, and maintaining general hygiene. When you start feeling the symptoms of an infection, see your doctor, who will determine the exact antibiotic needed. And yes, says Alexander, cranberry juice may fight infection, though people on the drug warfarin should skip the juice because of a potentially harmful interaction.

PROBLEM: I've got gas.

Gas is common, but if you have an excess, the result can be uncomfortable and embarrassing. Gas can be caused by a number of things, from that spicy bean burrito you had for lunch to certain medications. The type 2 medications miglitol (Glyset) and acarbose (Precose) may lead to an upset stomach and gas during their first few weeks of use. If you experience this side effect, don't sweat it. It often goes away once your body adjusts to the medication.

Another reason you could be gassy is excess glucose in the blood. According to Steven V. Edelman, MD, a professor of medicine at the University of California–San Diego School of Medicine and founder of the nonprofit Taking Control of Your Diabetes, people with poorly controlled diabetes are likely to have more gas because the normal bacterial flora in the gut form gas in the presence of high blood glucose. The solution: Strive for good glucose control.

PROBLEM: I have facial hair—but I'm a woman.

A stray whisker here and there is no big deal. But excess hair on the face and body as well as acne, weight gain, hair loss on the head, infertility, and irregular periods all point to polycystic ovary syndrome (PCOS), which shows up in many reproductive-age women. For reasons still not understood, hormones get out of balance and, in about half of all women with the condition, result in insulin resistance that leads to type 2 diabetes. The research doesn't suggest that diabetes causes PCOS, but if you have PCOS, high levels of insulin due to insulin resistance can worsen your symptoms. Complications include infertility, miscarriages, and endometrial cancer. While there's no cure, weight loss, healthy eating, exercise, and stopping smoking can help control PCOS. Your doctor may also prescribe hormones or diabetes medications.

If broaching these topics with your doc fills you with anxiety, take heart. Millions of people have these conditions. Talking with your doctor will offer a more well-rounded view of your health—and the info needed to treat problems before they become serious. If you won't raise the issue for fear of your doctor's reaction, it may be time to consult with someone else. After all, tackling these pesky or painful conditions is much more satisfying than suffering in silence.



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