Frequency, impact and prevention of urologic complications of type 1 diabetes.
There are some very widely talked about and avoided complications of Type 1 diabetes (T1D) such as retinopathy, neuropathy, nephropathy and cardiovascular disease. However there are other complications that get relatively little notice but have major impacts on not just our health, but our quality of life.
Urological complications such as urinary tract infections (UTI) sexual dysfunction, dysuria and urinary incontinence are some of the most commonly reported diabetes related issues reported among both men and women. In a recent analysis of data from the Diabetes Control and Complications Trial it was found that 65% of women and 68% of men reported urologic complication symptoms. Most common among women being UTI and most common among men and women being sexual dysfunction and difficulty urinating.
Urinary Tract Infections and Type 1 Diabetes:
UTI has been directly correlated to elevated A1C with women with an A1C above 7.38 being twice as likely to report having experienced UTI symptoms than those with an A1C of 7.3 or lower. It is clear that reducing blood glucose levels and increasing time in target range greatly reduces UTI occurrences. When blood sugar levels are over 160 we pass glucose in our urine. When we have glucose in our urine it feeds genital bacteria and this easily triggers infection. These infections move from the external genitalia to the urinary tract, and if left untreated can progress to bladder and kidney infection.
Sexual Dysfunction and Type 1 Diabetes:
Sexual dysfunction is tied most closely to age but also to other diabetes complications. Those who experience one diabetes related complication have been shown to be at increased risk of a second complication. Urinary difficulties in men are also most closely linked to age and possible development of prostate enlargement as opposed to A1C, however inability to urinate and urinary incontinence are both symptoms of neurogenic bladder. Neurogenic bladder is a secondary form of neuropathy. Urinary incontinence is most closely linked to elevated BMI rather than A1C.
Conversely frequent infections and other complication are also linked to reduced quality of life as well as contributing to elevated A1C. Preventing urological complications can improve our quality of life and our A1C, which in turn reduces our risk for complications.
How to Prevent Urologic Issues:
- Maintaining a healthy blood sugar target and maximizing time in range is the first line of defense against all complications including urologic complications.
- A second vitally important preventative measure is maintaining good hydration. When we are dehydrated our urine carries more sugar per ounce and so we are more likely to generate an infection. Water moving through our urinary system also helps flush out any bacteria before they can adhere to the lining of the urinary tract to cause infection. For insulin users maintaining hydration is also key to maintaining even timely absorption of insulin into the blood stream to maintain stable blood sugar control.
- Drinking cranberry juice has long been recommended for maintaining urinary tract health. However cranberry juice is high in sugar so cranberry tablets are often recommended for people with diabetes to reduce UTI risk. Cranberry contains a compound that is believed to prevent bacteria from adhering to the urinary tract lining. Tests of this effect have been split, however it is clear that this supplement use does not treat an active UTI.
- Seeking treatment swiftly for UTI is important to preventing further complications. It is also important that treatment be thorough, finishing all prescribed antibiotics and requesting a culture and sensitivity (C&S) from your prescriber can ensure that you are taking the correct antibiotic. It may also take a longer than typical course of antibiotics to treat a UTI for patients with elevated blood sugars.
Maintaining a healthy BMI also helps reduce urologic complications as well as improving blood sugar control with less medication, which reduces complication and side effect risk.
Maintaining good hygiene is also important to reduce infection risks. Maintaining routine health screenings with your prescriber is important to screen for complications and other health risks that can exacerbate issues and catch complications before they are problematic and while treatments can reduce or reverse the impact.
Managing diabetes effects a lot more than just our blood sugar. Every one of the body’s systems are interconnected and blood sugar management is an important piece of maintaining health. However, maintaining health is not an ends unto itself. Quality of life is the driving force behind maintaining wellness for most people.
Assisting our clients with heir diabetes management within the framework of an enjoyable quality of life is our goal and passion at Integrated Diabetes Services. From managing blood sugars to reduce complication risk, to managing diabetes along side additional complications and health concerns, our staff of educators and advanced health professionals are here to assist you in reaching your goals.