Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, increased thirst, and increased appetite. If left untreated, diabetes can cause many severe complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, damage to the nerves, damage to the eyes, and cognitive impairment.

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin being produced.

There are three main types of diabetes mellitus:

Type 1: Diabetes results from the pancreas's failure to produce enough insulin due to the loss of beta cells. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The loss of beta cells is caused by an autoimmune response, but the cause of this autoimmune response is unknown.

Type 2: Diabetes begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as "non-insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is a combination of excessive body weight and insufficient exercise.

Type 3: Gestational diabetes occurs when pregnant women without a previous history of diabetes develop high blood sugar levels.

Who gets vaginal infections?

Vaginal infections (such as Candida, bacterial vaginosis, and trichomoniasis) are common. Women more likely to get vaginal infections include those who:

· Have diabetes
· Are pregnant
· Are taking or have recently taken antibiotics
· Use hormonal contraceptives (for example, birth control pills)
· Have a weakened immune system (for example, due to HIV infection or medicines/medical treatments that weaken the immune system, including steroids and chemotherapy)

3 in 4 women have vaginal infections

Typical symptoms of vaginal candidiasis include pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge. An estimated 75% of women will experience at least one episode of vaginal candidiasis, and 40%-45% will have two or more episodes.

Candida sp. infections in patients with diabetes

Candidiasis has increased substantially worldwide in recent decades and is a significant cause of morbidity and mortality, especially among critically ill patients. Diabetes mellitus (DM) is a metabolic disorder that predisposes individuals to fungal infections, including those related to Candida sp., due to an immunosuppressive effect on the patient.

Results of the review show that DM patients have an increased susceptibility to Candida sp. infections which aggravates in the cases of uncontrolled hyperglycemia. The conclusion is that, for these patients hospitalization periods have increased and are commonly associated with the prolonged use of indwelling medical devices, and this also increases the costs associated with disease management.

Vaginal candidiasis

Vaginal candidiasis is an infection caused by a yeast (a type of fungus) called Candida. It typically lives inside the body, in places such as the mouth, throat, gut, and vagina as well as on the skin without causing any problems. Sometimes Candida can multiply and cause an infection if the environment inside the vagina changes in a way that encourages its growth. Candidiasis in the vagina is commonly called a “vaginal yeast infection”. Other names for it include “vaginal candidiasis”, “vulvovaginal candidiasis”, and “candidal vaginitis.”

Symptoms

The symptoms of vaginal candidiasis include:

· Vaginal itching or soreness

· Pain during sexual intercourse

· Pain or discomfort when urinating

· Abnormal vaginal discharge

Side effects of SGLT2 inhibitors

SGLT2 (sodium-glucose co-transporter 2) inhibitors are well-known prescription oral medications used to treat type 2 diabetes. The most common side effect of SGLT2 inhibitors include:

· Genital yeast infections in men and women (vaginal yeast infection known as candidiasis)

· Urinary tract infections

· Increased urination

· Urinary discomfort

· Kidney problems

· Flu-like symptoms

· Constipation

· Nasal congestion

· Back pain

Correlation between SGLT2 and VVC

SGLT2 improves glycemic control by increasing urinary glucose excretion and is related to increased vaginal colonization with Candida sp. and in vulvovaginal candidiasis (VVC) adverse events in women with type 2 diabetes mellitus (DM).

Some investigations have theorized that urinary glucose excretion and the subsequent deposition of urine on the vulvovaginal tissues with voiding are more significant factors in increasing the risk of VVC in diabetic women than overall glycemic control.

Prevention of vaginal infections

If you have the vaginal yeast infection known as candidiasis, the chances are good that you know exactly what led to it. For example, some women experience these infections every time they take antibiotics.

Whether you know the exact cause or not, here are some habits you can start avoiding to help prevent recurring infections:

Avoid:

· Wearing tight pants, pantyhose, tights, or leggings

· Using feminine deodorant and scented tampons, pads and vaginal douches

· Sitting around in wet clothing, especially bathing suits

· Sitting in hot tubs or taking frequent hot baths

· Douching

Take up:

· Eating a well-balanced diet

· Eating yogurt or taking supplements with lactobacillus

· Wearing natural fibers such as cotton, linen, and silk

· Washing your underwear in hot water

· Replacing feminine products frequently and using as directed for proper hygiene