Diabetes and your largest organ – your skin!

Did you know that you are wearing 8 pounds – or 22 square feet – of skin? As your biggest organ, there is bound to be a relationship between your skin, your diabetes and your blood glucose levels.

To clarify, some skin conditions are caused by diabetes, i.e. they are more likely to occur if your blood sugar levels are high or you have complications of diabetes. Other skin conditions are associated with diabetes, which means that they occur together, but controlling your blood glucose levels doesn’t make the condition go away. As well, some skin conditions are associated with type 1 diabetes, while others are linked to type 2 diabetes.

Conditions that are linked to higher blood glucose levels in type 1 and type 2 diabetes

Fungal infections

Candida albicans (yeast infection). One of the most common signs of uncontrolled blood sugar levels is a vaginal yeast infection. This usually appears as a white, itchy discharge. Because yeast likes warm, moist areas, a yeast infection can also occur under the breasts and under the foreskin of the penis. Candida albicans usually causes a reddish rash that may also have little white spots that appear near the main rash area. Yeast infections usually respond to improved blood glucose control, keeping the skin dry and cool, and using an anti-fungal cream. There are also some oral treatments available.

Tinea (athlete’s foot, jock itch) is another type of fungus that causes a scaly, sometimes itchy, red rash, which often presents in the groin area, or on the edges of the feet and between the toes. Generally, like yeast infections, tinea appears on skin that is moist and when a person’s blood glucose levels are high. However, because athlete’s foot can sometimes cause the skin to develop cracks, this may lead to bacteria entering the skin – especially on the feet – which may cause a bacterial skin infection. That’s why it is important that tinea is treated  in people with diabetes. Similar to yeast infections, the treatment involves maintaining good blood glucose control, keeping the skin dry and using anti-fungal creams.

Fungal toenail infections are common in people with diabetes. Symptoms include toenails that look yellow and thickened. However, other things can cause this appearance, so before trying a ‘home cure’ that may damage the skin, check with your healthcare team and have them do a “fungal scraping” (removing a few flakes of nail) to make a proper diagnosis. A thick nail may be a sign of other issues, such as repeated trauma (due to a misshaped toe or an ill-fitting shoe) or decreased circulation. Nail fungus is very hard to treat; while prescription treatments are available nowadays – both topical and oral – it takes many months to see an improvement, as nails grow very slowly.

Bacterial infections

Although not specific to people with diabetes, skin infections caused by bacteria are more common in people with diabetes who have higher blood glucose levels. One common example is “folliculitis,” which is inflammation or infection of the hair follicles. This could happen, for example, from shaving under the arms. Boils on the skin or a sty by the eye are other examples. These infections are usually red, raised up and tender. Consulting your healthcare team is a good idea, because some of these infections may require treatment with antibiotics.

Itchy or dry skin

This is not specific to people with diabetes, but it is not an uncommon complaint. Some people say that their skin feels itchy when their blood sugar levels are high. Skin in people with diabetes may feel dry if they also have damage to the nerves (also known as neuropathy), and their skin may not sweat properly. As well, if there are complications of diabetes, for example, fatty liver damage in type 2 diabetes, or kidney damage in type 1 or 2 diabetes, these might manifest as itching. That’s why it is important to visit your healthcare team regularly, to have your liver and kidney functions checked out.

Necrobiosis lipoidica diabeticorum

This condition shows up as raised, brown, shiny spots, usually on the front of the lower legs. It can occur prior to the diagnosis of diabetes but it is usually associated with diabetes and blood vessel damage from “vascular” risk factors, especially smoking. For more information, click here.

Skin conditions that are associated with, but not caused by, diabetes

Type 2 diabetes

Acanthosis nigricans: This is a darkening and roughening of the skin, and usually appears on the back of the neck and the inside of the elbows, armpits and knees. It is more common in people with dark skin, such as African-Americans or Aboriginals. It is thought to be a sign of insulin resistance, and is more common in obese people and women with polycystic ovarian syndrome, which is associated with obesity, diabetes, and sometimes infertility and excess body hair.

Type 1 diabetes

Vitiligo: This is a condition where the pigment cells in the skin are wiped out by an autoimmune attack, much like the pancreas cells are in type 1 diabetes. The result is a loss of colour in the skin, so white patches appear, usually in a symmetrical pattern. These areas can vary greatly in size, and are more obvious in people with darker skin. Vitiligo doesn’t actually cause any disease, but it can be psychologically distressing. Recently, Chantelle Winnie, an international fashion model from Canada who has vitiligo, has been showing this as a variation on beautiful!

The bottom line is that your skin is a very important organ that can be affected by higher blood sugar levels. Take care of yourself and your skin!