Look closer at the slight discolouration on your skin as it could be the first warning bell to monitor your blood glucose levels. It is pointed out that your skin reflects our inner health and any sudden manifestation on the skin could often hint at an undetected internal health issue. That’s why experts suggest that any superficial skin infection should be timely probed to rule out or address any undiagnosed condition like diabetes.
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On the other hand, if you are aware that you are prediabetic or diabetic, you need to watch out not only for your sugar levels but also for any visible signs of dermal irritation or condition before it progresses into something severe.
Dr Mahesh DM, consultant, endocrinology department, Aster CMI Hospital, Bengaluru, said that diabetics often experience some skin condition which may be due to prolonged diabetes and high insulin levels. In an interaction with Happiest Health, he estimated this could even be as high as 40 to 60 per cent of the cases he has come across.
Happiest Health also spoke to multiple dermatologists and diabetologists, who also confirmed the same and pointed out that certain recurring skin infections could be an indicator of diabetes.
With blood sugar control and medication, some of these conditions may go away but need timely attention and care before they escalate into something irreparable.
Some people may not even know that they are prediabetic or diabetic unless they consult a dermatologist who, after observation and blood tests, would be able to conclude that.
Dr Shireen Furtado, consultant, medical and cosmetic dermatology, Aster CMI Hospital says, “skin conditions and diabetes are intricately linked, and many times dermatologists are quick in spotting diabetes-related skin issues even when the patient may be unaware of being a diabetic. So, it is advisable to visit a doctor if you notice any changes in your skin.”
The s-kinship between diabetes and skin conditions
Dr Mahesh explains that people with diabetes are more prone to skin infections because high sugar levels in the blood make the organisms or the infection grow faster and prevent the immune system from fighting it, even if it is a minor skin trauma. “While the infection will spread at a fast rate, healing takes a longer time,” he says.
Secondly, frequent urination in people with diabetes makes them lose a lot of water and thus, the skin tends to become dry. “The dry skin tends to crack which makes it a good breeding ground for organisms to grow,” he reasons.
Some other serious skin conditions in people with diabetes occur because of damage to the peripheral nerves (all the nerves of the central nervous system) due to high sugar levels. When the nerves get damaged, the affected person may feel increased sensitivity (pin and needles pain) or numbness in the feet.
There are several kinds of bacterial and fungal skin infections a diabetic may develop because of the constant glucose spike. Experts explain these are usually seen in people with prolonged diabetes and those who are unable to keep their sugar under control.
Bacterial skin infections
Necrobiosis lipoidica (necrobiosis lipoidica diabeticorum)
Dr Furtado explains in this condition, reddish brown waxy patches appear in the front bony part of the legs.
This condition is strongly associated with type 1 diabetes and is more common in women, says Dr Mahesh. “This condition usually targets the lower legs or shins and causes reddish and brown patches in roundish and irregular shapes,” he explains. It comes with a risk of ulceration and needs prompt medical attention.
Lipohypertrophy
People who inject insulin frequently around the same area of the skin tend to get fat and protein deposits there. These bulged areas or scar tissues can be fixed by changing the site of injection and using ice packs on them.
Diabetic cheiroarthropathy
This condition is also known as diabetic stiff hand syndrome or limited joint mobility syndrome. “The skin becomes thick and tight which makes it difficult for the person to flex or bend the fingers,” explains Dr Furtado. Apart from glucose monitoring, this condition is treated with anti-inflammatory medication and skin stretching exercises.
Diabetic bullae
In this condition, fluid-filled blisters appear spontaneously on the hands, feet, legs and forearms. These blisters usually heal in a few weeks, but sometimes may reappear. While these are painless, care should be taken to avoid secondary infection.
Diabetic foot
This condition is seen in people affected with diabetic neuropathy or nerve damage due to prolonged or uncontrolled diabetes. “People with diabetic foot gradually feel no sensation in their feet; so even a small injury or ulcer if unattended can blow up into severe infection,” explains Dr Furtado.
She insists that diabetics with nerve damage need to be cautious because it doesn’t take much time for an injury on the periphery of the foot to turn into a condition requiring amputation.
Such people tend to get a lot of ulcers on their feet and are asked to be alert and check their soles regularly. They are advised to wear comfortable and airy shoes in and outside the house.
Fungal skin infections
Some of the common fungal infections in people with diabetes come from the fungus species candida albicans. Candida is a kind of fungus which leads to fungal infections due to flora imbalance and overgrowth. Candida infections could be genital, oral or even urinary yeast infections.
Then there are infections like tinea unguium (nail infection) and tinea corporis (ringworm) which also affect people with poor insulin control. It is caused by the fungus, dermatophyte, which can grow on body surfaces such as the skin and scalp. When tinea unguium affects the nails, they become dry, brittle and thick while ringworm infection or tinea corporis can affect any part of the skin. “Repeated tinea raises suspicions of diabetes,” says Furtado. This infection causes reddening on the arms and legs and should be treated timely.
Dr Furtado says many of her clients discover they are prediabetic or diabetic when the infection doesn’t go away despite medication. “That’s when we get a blood test done and invariably, they turn out to have high blood sugar,” she explains.
Another kind of fungal infection found in men is candida balanoposthitis. Dr Furtado explains that most diabetic men tend to get this when they over-indulge in sweets and snacks, especially during festivities. “This fungal infection appears around the penile outlet because of the high sugar levels in the urine,” explains Furtado.
Candida albicans can also cause oral thrush in the mouth. This infection or thrush can manifest in two ways – while one condition causes redness, burning and lesions in the tongue which leads to a low tolerance of spicy food, the other one causes a thick curdy white deposit inside the mouth and on the tongue in advanced cases.
Diabetic dermopathy or shin spots
Dr Mahesh explains that diabetic dermopathy indicates early symptoms of diabetes when the skin around the shins shows reddish-brownish patchy spots because of the damage to the nerves and minor blood vessels. “These nerve vessels get blocked because the blood supply is reduced and the skin becomes dark or hyperpigmented usually around the shin area,” he says. People with this condition need to take care not to hurt their lower legs so that it doesn’t lead to ulceration.
According to Dr Furtado, this is the most common skin pigmentation disorder in people with diabetes. In this condition, the skin, usually behind the neck gets very hard and turns dark. “Basically, the skin gets layered over again and again because of high insulin levels in the body,” she explains.
Dr Mahesh says that out of the different types of cells in the skin, because of high glucose levels, the production of one type of cell is reduced and the other cells start proliferation; this results in the darkening of the skin.
Generally, people who are obese and have a family history of diabetes are more prone to this condition. This also indicates that the person is prediabetic. “These people observe blackening of the skin and realise that despite scrubbing the skin, they are unable to clean off the dark area and that’s when they consult a skin specialist,” explains Dr Furtado.
Dr Mahesh explains that acanthosis nigricans is seen especially around skin folds. Areas like the elbows, underarms and sometimes the area under the breasts or groin can also get affected.
Apart from controlling blood glucose levels people with this condition are advised topical creams, oral medications, laser therapy and weight loss.
Treatment for diabetes related skin infections
Dr Mahesh explains that the treatments for most of these bacterial infections include administering antibiotics while fungal infections require antifungal medication and topical creams.
The affected person should be in constant touch with both the endocrinologist and the dermatologist to monitor the sugar levels and check the skin. “Sometimes, apart from the endocrinologist, the dermatologist also recommends sugar control as it is the key factor in controlling the condition; it works like a reinforcement,” says Dr Mahesh.
Dr Furtado says taking good care of the skin is equally important. She says that people with diabetes should take care of their skin by moisturising it well after a quick warm water bath so that there are fewer chances of it cracking due to dryness.
Tips to keep diabetic skin conditions at bay
- Take part in regular physical activities
- Restrict the intake of simple carbohydrates
- Diet should include 50 per cent carbohydrates, 30 per cent good fats and 20 per cent proteins
- Maintain good hygiene
- Wear comfortable and airy footwear
- Undergo regular check-ups with dermatologists and endocrinologists
