How Do UTIs Affect Diabetic Patients? What is the Link Between Diabetes & UTI?

What are Urinary Tract Infections?

As the name suggests, a urinary tract infection or UTI is an infection that affects any component of the urinary tract. Your urinary tract is made up of the upper urinary tract (kidneys and ureters) and the lower urinary tract (bladder and urethra). 

UTIs occur when pathogens (usually bacteria) enter your urine and start growing in the lining of your urinary tract. This leads to inflammation in your urinary tract, which causes most of the symptoms like pain, burning, pus and blood in urine, etc.

What Causes UTIs in Diabetics?

Urinary Tract Infections (UTIs) manifest when bacteria or other organisms enter and propagate in your urinary system. In diabetes, UTIs are complicated by the following factors:

• High Blood and Urine Sugar Levels

Type 1 and Type 2 Diabetes are characterised by elevated blood and urine glucose (sugar) levels. High urine sugar levels provide a hospitable condition for infection-causing bacteria to grow, as bacteria feed on sugar. This is one of the most important reasons for recurrent UTIs in diabetic patients.

• Autonomic Neuropathy

Persistently high blood sugar levels caused by diabetes can damage the autonomous nerves that control your bladder. Nerve injury can prevent your bladder from emptying as the muscles in your bladder do not respond well to nerve signals. This causes urine to stay in your bladder for a long time. Any amount of urine that stays in your body for an extended period increases your chance of infection.

• Weakened Immune System

Diabetes weakens various aspects of your immune system. As a result, you have fewer white blood cells and T-cells left to fight off invading bacteria, viruses, and fungi. Due to this, people with diabetes are prone to recurrent UTIs caused by bacteria. Antibiotics, when used regularly in such cases, may also become ineffective due to the bacteria developing antibiotic resistance.

What are the Symptoms of UTIs in Diabetes?

If you or someone you care about has diabetes, call a doctor if you notice any of the following symptoms:

• Frequent urination (polyuria) and an intense urge to urinate
• Pain, a burning sensation, or discomfort when urinating
• Urine with a strong odour 
• Urine that is cloudy, dark, or bloody
• Lower back pain or abdomen pain
• Chills or a feverish feeling

It is important to note that you do not have to have all the symptoms of UTIs, and the symptoms might vary from person to person. Some diabetics, particularly those with diabetic neuropathy, may not feel pain in the abdomen or back when they have a UTI.

Symptoms may also vary with age. Diabetes and UTIs in the elderly can manifest as confusion or behavioural changes, or cause agitation in some older adults with Alzheimer’s or dementia. 

It is also important to note the difference between UTI and diabetes symptoms. Both often cause frequent urination, cloudy urine, and strong-smelling urine. However, frequent urination in diabetes is not accompanied by pain or a burning sensation like in a UTI. 

Similarly, the cause of cloudy urine in diabetes is the accumulation of glucose, whereas in a UTI, your urine may appear cloudy due to the discharge of pus or blood. Further, in diabetes, your urine is often sweet-smelling, which is different from the strong, foul smell caused by UTIs.

How Do UTIs Affect Diabetic Patients?

Due to frequent urination in diabetes and reduced bladder emptying caused by nerve damage, diabetic patients are more likely to come in contact with bacteria and develop urinary tract infections. These bacteria benefit from elevated sugar levels that provide them with a favourable environment for development. Therefore, it is essential that urinary tract infections in people with diabetes are diagnosed at the earliest, and appropriate treatment is provided. Urine culture reports are used to diagnose urinary tract infections.

Diabetics are also more likely to experience recurrent infections, as high blood sugar levels weaken your immune system, and slow down your body’s ability to heal and fight off infections. This can prolong the time the bacteria stays in your body, which makes it more likely to spread to other parts of your urinary tract, like your kidneys. 

This can lead to a condition called pyelonephritis, where recurrent UTIs can cause infection and inflammation in the kidneys. Having diabetes puts you at a higher risk of developing pyelonephritis.

How are UTIs in Diabetic Patients Treated?

In general, the treatment of UTIs is comparable in diabetic and non-diabetic individuals, but the choice of antibiotics in diabetic UTI patients is a crucial issue in therapeutic management.

The interaction of antimicrobial medications with anti-hyperglycemic medications may result in altered glucose control. Studies have found that some antibiotics used to treat UTIs and respiratory tract infections can cause blood sugar fluctuations which can lead to poor glycaemic control and worsening of your UTI. Some antibiotics can also cause an imbalance in your gut bacteria and microbiome, leading to altered insulin sensitivity in your cells.

The management of urinary tract infections (UTIs) in diabetics is influenced by a number of factors, including the following:

• The symptoms present
• Severity of symptoms
• Location of the infection: lower urinary tract (bladder) or upper urinary tract (also involves kidney)
• Renal function
• Urological abnormalities

Furthermore, the treatment of UTIs differs depending on the patient's age, gender, infectious agent, and other underlying conditions involved. Diabetes and UTI in the elderly cannot be treated with the same medication or dosage as healthy individuals under the age of 60, as many other factors like kidney and liver function, and the presence of other underlying conditions must be considered before treatment.

How Can You Prevent Diabetes-Induced UTIs?

Managing your diabetes effectively will help you avoid UTIs. High blood glucose levels, for example, can increase your risk of contracting a UTI, so keeping blood sugar levels in check is critical. When you urinate, make sure you empty your bladder. Emptying the bladder can be a problem for people with diabetes, which promotes bacterial growth, leading to further illnesses.

Other UTI prevention tips apply, irrespective of whether you have diabetes. They are:

• Stay hydrated; drink plenty of water. 
• If you feel the urge to urinate, do not hold it in. 
• Always wipe front to back after urinating. 
• Wear underwear made of a breathable material, such as cotton.

When to See a Doctor?

Consult your doctor if you experience any of the symptoms listed above or face other urinary issues. Prompt treatment can relieve your symptoms and prevent the spread of the infection. Untreated UTIs can cause major problems, such as renal damage or, in rare situations, even kidney failure.

Your doctor will take a urine sample and test it for bacteria and pus to diagnose a UTI. Typically, you will be given an antibiotic. Usually, you will start to feel better within a few days of beginning treatment. 

However, you must continue the medication for the entire course prescribed by your doctor. Treatment may take several weeks if the infection has progressed to your kidneys.