Posts Tagged ‘diabetes mellitus’

Diabetes And Urological Health

August 12, 2017

Andrew Siegel MD  8/12/17

Your taste buds may crave sugar (glucose), but the rest of your body sure doesn’t!

A common presenting symptom of undiagnosed diabetes is frequent urination because of the urine-producing effect of glucose in the urine. People with such urinary frequency will often consult a urologist (urinary tract specialist) erroneously, thinking that the problem is kidney, bladder or prostate in origin, when in actuality it is the sugar in the urine that is the source of the problem.

Because of this urinary frequency presentation of diabetes, urologists often have the opportunity to make the initial diagnosis and refer the patient for appropriate care. Similarly, many uncircumcised men who have foreskin problems–particularly when the foreskin becomes stuck down over the head of the penis and will not retract (phimosis)–have undiagnosed diabetes. A simple dipstick of urine in conjunction with the typical presenting symptoms of frequent daytime and nighttime urination and/or foreskin issues directs the proper diagnosis.

Diabetes has detrimental effects on all body systems, with the urinary and genital systems no exception. Today’s entry reviews the impact of diabetes on urological health. Many urological problems occur as a result of diabetes, including urinary infections, kidney and bladder conditions, foreskin issues and sexual problems.  Additionally, diabetes increases the risk of kidney stones. Although many of the same urinary issues that are present in diabetics commonly also occur with the aging process (in the absence of diabetes), the presence of diabetes hastens their onset and severity.  Diabetes can have catastrophic consequences including the following: heart disease, stroke, blindness, kidney failure requiring dialysis and vascular disease resulting in amputations.

Wickipedia public domain copy

Thank you, Wikipedia, for the above public domain image

Diabetes 101

Diabetes is a disease in which blood glucose levels are elevated. Glucose is the body’s main fuel source, derived from the diet.  Insulin, a hormone secreted by the pancreas, is responsible for moving glucose from the blood into the body’s cells so that life processes can be fueled. In diabetes, either there is no insulin, or alternatively, plenty of insulin, but the body cannot use it properly. Without functioning insulin, the glucose stays in the blood and not the cells that need it, resulting in potential harm to many organs.

Two distinct types of diabetes exist. Type 1 is an autoimmune condition in which the body’s immune system destroys insulin-producing cells, severely limiting or completely stopping all insulin production.  It is often inherited and is responsible for about 5% of diabetes. It is managed by insulin injections or an insulin pump.

Type 2 diabetes is caused by overeating and sedentary living and is responsible for 95% of diabetes. This form of diabetes is caused by insulin resistance, a condition in which the body cannot process insulin and is resistant to its actions. Anybody with excessive abdominal fat is on the pathway from insulin resistance towards diabetes.  Type 2 diabetes is a classic example of an avoidable and “elective” chronic disease that occurs because of an unhealthy lifestyle.

Sad, but true: Chances are that if you have a big abdomen (“visceral” obesity marked by internal fat) you are pre-diabetic. This leaves you with two pathways: the active pathway – cleaning up your diet, losing weight and getting serious about exercise, in which this potential problem can be nipped in the bud. However, if you take the passive pathway, you’ll likely end up with full-blown diabetes.

Common presenting symptoms of diabetes are frequent urination, thirst, extreme hunger, weight loss, fatigue and irritability, recurrent infections, blurry vision, cuts that are slow to heal, and tingling or numbness in the hands or feet.

Complications of diabetes occur because of chronic elevated blood glucose and consequent damage to blood vessels and nerves.  Diabetes accelerates atherosclerosis, a condition in which fatty deposits occur within the walls of arteries, compromising blood flow and the delivery of oxygen and nutrients to tissues. Diabetic “small blood vessel” disease can lead to retinopathy (visual problems leading to blindness), nephropathy (kidney damage leading to dialysis), and neuropathy (nerve damage causing loss of sensation).  Diabetic “large vessel disease” can cause coronary artery disease, stroke, and peripheral vascular disease.  Diabetes increases the risk of infections because of poor blood flow and impaired function of infection-fighting white blood cells.

Diabetes and the bladder

Many diabetics have urological problems on the basis of the neuropathy that affects the bladder.  These issues include impaired sensation in which the bladder becomes “numb” and the patient gets no signal to urinate as well as impaired bladder contractility in which the bladder muscle does not function properly, causing inability to empty the bladder completely.  Other diabetics develop involuntary bladder contractions (overactive bladder), causing urinary urgency, frequency and incontinence.

Diabetes and the kidneys

Diabetes is the most common cause of kidney failure, accounting for almost half of all new cases. Even with diabetic control, the disease can lead to chronic kidney disease, kidney failure and the need for dialysis or kidney transplantation.

Diabetes and urinary/genital Infections

Diabetics have more frequent urinary tract infections than the general population because of factors including improper functioning of the infection-fighting white blood cells, glucose in the urine (a delightful treat for bacteria) and compromised blood flow. Diabetics have a greater risk of asymptomatic bacteriuria and pyuria (the presence of white cells and bacteria in the urine without infection), cystitis (bladder infections), and pyelonephritis (kidney infections).  Impaired bladder emptying further complicates the potential for infections.  Diabetics have more serious complications of pyelonephritis including kidney abscess, emphysematous pyelonephritis (infection with gas-forming bacteria), and urosepsis (a very serious systemic infection originating in the urinary tract requiring hospitalization and intravenous antibiotics).  Fournier’s gangrene (necrotizing fasciitis) is a soft tissue infection of the male genitals that often requires emergency surgery (that can be disfiguring) and has a very high mortality rate.  Over 90% of patients with Fournier’s gangrene are diabetic. Diabetic patients also have an increased prevalence of infections with surgical procedures, particularly those involving prosthetic implants, including penile implants, artificial urinary sphincters, and mesh implants for pelvic organ prolapse.

Diabetes and the foreskin

Balanoposthitis is medical speak for inflammation of the head of the penis and foreskin. As mentioned previously, a tight foreskin that cannot be pulled back to expose the head of the penis (phimosis) can be the first clinical sign of diabetes in uncircumcised men. At least 25% of men with this problem have underlying diabetes.  It is common for these men to have fungal infections under the foreskin because of the risk factors of a warm, moist, dark environment in conjunction with the presence of glucose in the urine. The good news is that phimosis and fungal infections often respond nicely to diabetic control.

Who Knew? I learned from a patient of mine that this issue is referred to in slang as “sugar dick.”

Diabetes and sexual function

Sexual functioning is based upon good blood flow and an intact nerve supply to the genitals and pelvis.  Diabetics often develop sexual problems (in fact, diabetes is the most common cause of erectile dysfunction) because of the combination of neuropathy and blood vessel disease.  Men commonly have a reduced sex drive and have difficulty achieving and maintaining erections.  Diabetes increases the risk of erectile dysfunction threefold.  Diabetes has clearly been linked with testosterone deficiency, which can negatively impact sex drive and sexual function.  Because of the neuropathy, many diabetic males have retrograde ejaculation, a situation in which semen goes backwards into the bladder and not out the urethra.  Female diabetics are not spared from sexual problems and commonly have reduced desire, decreased arousal and sexual response, vaginal lubrication issues and painful sexual intercourse.

Diabetic management

With Type 2 diabetes it is vital to modify lifestyle, including dietary changes that avoid diabetic-promoting foods and replacement with healthier foods in order to have appropriate sugar control to help prevent diabetic complications. Diabetics should refrain from high glycemic index foods (those that are rapidly absorbed) including sugars and refined white carbohydrates and instead should consume high-fiber vegetables, fresh fruits, and whole-grain products.  Regular exercise is equally as important as healthy eating, and the combination of healthy eating, physical activity, and weight loss can often adequately address Type 2 diabetes.

When lifestyle measures cannot be successfully implemented or do not achieve complete resolution, there are different classes of medications that can be used to manage the diabetes. However, lifestyle modification should always be the initial approach, since lifestyle (in large part) caused the problem and is capable of improving/reversing it.  At times, when diet, exercise and drugs are unable to control the diabetes, bariatric (weight loss) surgery may be needed to control and even potentially eliminate the diabetes.

Bottom Line:  Diabetes is a serious chronic illness with potentially devastating complications. Type 1 diabetes is relatively rare and unavoidable, but is manageable with insulin replacement. Type 2 diabetes is epidemic and its prevalence has increased dramatically coincident with the expanding American waistline. It can be improved/reversed through integration of healthy eating habits, weight management, and exercise. Lifestyle modifications can be amazingly restorative to general, urological and sexual health and overall wellbeing. After all, our greatest wealth is health.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

Amazon page for Dr. Siegel’s books

 

 

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Liquid Gold

February 23, 2013

Liquid Gold

Andrew Siegel, MD  Blog # 95

 

Urine is as valuable as gold is—at least when it comes to its potential for revealing our underlying health or infirmity.  Our kidneys work 24/7/365 filtering and removing from our bloodstream toxic wastes.  These include nitrogen-rich soluble products generated from cellular metabolism, numerous other organic and inorganic chemicals, salts and metabolites, as well as excessive water.  Urine—the end product appearing in our bladders—can provide amazing insight into our overall health.

With every pulsation of our heart, arterial blood flows into the kidney via the renal arteries; after the blood is filtered, the cleansed blood is returned via the renal veins.  In essence, the artery brings “dirty” blood to the kidneys for filtering, with the renal veins providing transport back of cleansed blood. Urine is a sterile by-product of this filtering process.  For this reason, when operating on the urinary tract (for example when the bladder is opened and urine enters the abdominal cavity), it is of no concern from an infectious point of view.

Using a simple and inexpensive dipstick, in a matter of moments, diabetes, kidney disease, urinary tract infection and the presence of blood in the urine can be diagnosed.  Although there are many benign causes of blood in the urine, the worrisome possibilities are kidney and bladder cancer.  The dipstick also reveals specific gravity, a test that can indicate dehydration, over-hydration, and other potential health issues. Not only can the dipstick disclose the presence of diabetes mellitus (sugar diabetes), but it can also reveal a condition known as diabetes insipidus, in which the kidneys lose their ability to concentrate urine. As a result, massive amounts of dilute urine are produced, which can have dire consequences.  Urine testing can also reveal substance and performance-enhancing drug abuse. Who knew that a waste product could be so revealing?  Of all the waste products that humans produce, urine uniquely provides the best “tell” regarding our health.

Urine odor can provide information as well. A sweet smell is consistent with diabetes mellitus; a foul odor may indicate a urinary infection or the intake of certain foods such as asparagus.  Vitamin intake can also cause the urine to have an unpleasant odor. Vitamins B and C are water soluble and therefore not stored in the body.  Any excess above what is necessary for the body’s use is immediately excreted in the urine.  Malodorous urine that has a feculent scent may indicate an abnormal connection between the colon and the bladder that is known as a colo-vesical fistula. This happens most commonly on the basis of diverticular disease of the colon.  When it occurs, there is often air in the urine, designated by the term pneumaturia.

Color is a “tell” with respect to hydration status.  When well hydrated, our urine will look clear or very pale yellow, like a light American beer.  When dehydrated, our urine becomes very concentrated, appearing dark amber, like a strong German beer.  Excessive B vitamins can result in light orange urine. Red urine is most often blood in the urine, which may indicate a potentially serious underlying condition, although overconsumption of beets, blackberries, and rhubarb may sometimes impart a red color to urine.  “Iced tea” or “cola” colored urine is often indicative of old blood, as opposed to the bright red color of urine indicative of fresh and active bleeding. Dark brown urine may indicate jaundice.  Pyridium, prescribed for the discomfort of urinary infections, turns the urine a neon orange color.  Other urinary analgesics that contain methylene blue can turn the urine blue or green.  Cloudy urine may be indicative of a urinary tract infection, but can also occur when phosphate salts crystallize in the urine on the basis of dietary intake of foods high in phophates.

When our urine is occasionally foamy or sudsy, it is considered to be normal. When it occurs consistently, it can be a sign of protein in the urine, indicative of kidney disease.

Bottom Line:  Urine is an invaluable waste product and offers many clues as to our overall health or presence of illness.

 

What a dipstick can reveal:

specific gravity…status of our hydration

pH…acidity of urine

leukocytes…urinary infection

blood…many urological disorders including kidney and bladder cancer

nitrite…urinary infection

ketones…in the absence of carbohydrate intake, fat is used as fuel and ketones are by-products of fat metabolism; may also indicate a very serious condition known as diabetic ketoacidosis

bilirubin…a yellow pigment found in bile, a substance made by the liver; its presence may be indicative of jaundice

urobilinogen…a byproduct of bilirubin breakdown formed in the intestines by bacteria—when elevated may indicate: impaired liver function; hepatitis; cirrhosis; excessive breakdown of red blood cells—when low may indicate bile obstruction or failure of bile production

protein…kidney disease

glucose…diabetes

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Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

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