Best Ways to Prevent Vaginal Yeast Infections in People With Diabetes

There is a strong correlation between diabetes and yeast infections — resulting in pain and discomfort for many sufferers. Can too much sugar trigger a yeast infection? And, what are the best ways to prevent and treat yeast infections for people with diabetes? Let's review the risk factors, and explore tips for women on managing and preventing recurrent yeast infections with diabetes.

What is a vaginal yeast infection?

A yeast infection happens when yeast overgrows in the body. Yeast is a type of fungus and is present in the body all the time. Unlike mushrooms, which are multi-cell organisms, yeast is a single-cell organism.

There is a natural amount of yeast present in the body, but when too much grows, an infection can develop. The vagina naturally has a balanced mix of yeast and bacteria. When this balance is thrown off, you are at risk of a yeast infection.

A yeast infection is NOT a sexually-transmitted infection, although sexual activity can be a risk factor for its development. It is curable and can sometimes resolve on its own without the use of medications. Yeast can overgrow in any areas of increased moisture, such as skin folds, mouth, or nails. This article will focus on vaginal yeast infections.

The relationship between vaginal yeast infections and diabetes

Yeast feeds on sugar, so more sugar encourages more yeast growth. Higher blood sugar levels also result in more sugar in the mucosal surfaces of the vagina, encouraging yeast growth.

As a result, studies have found that people with diabetes have 1.5–2 times higher risk of developing yeast infections compared to those without. Many other factors can cause yeast infections including:

• Medications. Certain medications including birth control pills, hormones, and antibiotics are a risk factor for vaginal yeast infections.
• Smoking. Smoking increases the risk of infection as it interferes with the natural balance of yeast and bacteria in the body.
• Sex. Sexual activity can alter the balance of yeast and bacteria in the vagina — leading to a yeast infection.
• Immunity. Having a weakened immune system is a risk factor for developing vaginal yeast infections.

What are the symptoms of a vaginal yeast infection?

There are many symptoms that indicate a vaginal yeast infection. These may include the following:

Vaginal yeast infection diagnosis

Symptoms of a vaginal yeast infection can be similar to sexually-transmitted infections such as gonorrhea or chlamydia, so it’s important to see a healthcare provider to get tested as soon as possible.

Your healthcare provider will usually do a pelvic exam and use a cotton swab to identify the yeast under a microscope. They might send the sample for further testing to figure out what kind it is, so they can better tailor their treatment plan.

How is a vaginal yeast infection treated?

While it can get better on its own, a yeast infection usually requires medication, Treatment options include:

• Cream. Rubbed onto the affected area.
• Powder. Used directly on the affected area.
• Pill. Taken orally to treat the infection from the inside.
• Ointment. Applied regularly to the affected area.
• Suppository. A capsule that is inserted into the vagina to treat the infection locally.

Medications include antifungals such as fluconazole, butoconazole, clotrimazole, miconazole, and terconazole. Treatment length varies depending on the severity of the infection. They can be anywhere from 1 single dose to a 2-week-long course.

Treating yeast infections is harder for people with diabetes

Treatment is more challenging for people with diabetes because the type of yeast that is most common in diabetes is resistant to many antifungals. There may also be unfavorable interactions between antifungals and certain diabetes medications, such as Invokana (canagliflozin), Farxiga (dapagliflozin), Jardiance (empagliflozin), and Steglaro (ertugliflozin). Because of the difficulties in treating vaginal yeast infections effectively, prevention is key.

Can yeast infections come back?

Unfortunately, yes. Many people, especially those with diabetes, have such frequently recurring yeast infections that their providers may choose to put them on a preventative medication regimen of weekly doses. This is to maintain and prevent yeast overgrowth.

Speak with your provider if you are concerned about the frequency of yeast infections. More than 4-6 in a year would be frequent enough to consider preventative medication.

In people with diabetes, the most common types of yeast found are Candida glabrata and Candida albicans. These species may be extra resistant to treatment from typical antifungal medications.

The better-controlled blood sugars are, the less likely for yeast infections to occur or recur.

Tips for preventing yeast infections

Regardless if you have diabetes or not, good hygiene practices can help prevent yeast infections:

• Cleaning. Keep your vaginal area clean and dry by wearing breathable cotton underwear and other loose fabrics.
• Sleeping. Consider sleeping at night without underwear to further decrease moisture in the area.
• Sweat. After exercise, change out of sweaty underwear and clothing as soon as possible.
• Clothing. Avoid tight-fitting pants and underwear.
• Douching. Avoid using douches or vaginal sprays — they are NOT needed to clean the vagina, which is a self-cleaning organ.
• Perfumes. Avoid scented tampons, menstrual pads, or other perfumed products in that area.
• Period products. Avoid leaving tampons or pads on for too long; change them frequently, at least every 8 hours.
• Bathing. Avoid long baths or hot tubs.

Tips for preventing yeast infections as a person with diabetes

For people with diabetes, controlling your blood sugar is extremely important. Make sure you are monitoring your diet and medication.

• Medication. Take your medications as instructed by your doctor. Do not miss any doses.
• Whole foods. Eat a balanced, low-carb diet, with high-fiber whole grains that increase blood sugar slowly and steadily, rather than refined carbohydrates and sweets that spike blood sugar and increase sugar cravings.
• Food alternatives. Replace white bread, flour, rice, grains with whole wheat versions or even vegetables such as zucchini noodles, tofu shirataki noodles, spaghetti squash, or other lower carb versions.
• Limit sugar intake. Limit sweets and sugar substitutes since they increase sugar cravings.
• Mealtimes. Eat at regular times and don’t skip meals.
• Portion control. Keep track of your portion sizes.
• Meal balancing. Try to fill half your plate with non-starchy vegetables, ¼ with protein and ¼ with a grain/carb.
• Good bacteria supplements. Consider eating yogurt or supplements with live cultures of Lactobacillus acidophilus to counteract Candida growth.
• Changing meds. Ask your doctor about changing your medications — some diabetes meds such as Invokana (canagliflozin), Farxiga (dapagliflozin), Jardiance (empagliflozin), and Steglaro (ertugliflozin) are associated with a higher risk of vaginal yeast infections because they increase the amount of sugar excreted in the urine.
• Hydration. Increase your water intake so that your urine will be more diluted — this will make it less likely that the urine's sugar residue will affect your pelvic organs.
• Insulin accuracy. If you need to calculate your carb intake with every meal, so you can give yourself an appropriate dose of insulin, do so promptly and accurately. Do not give yourself too much or too little medication.
• Blood sugar. Check your blood sugar regularly, if instructed. This may include upon waking, before meals, 2 hours after meals, and at bedtime.
• Know your symptoms. Become familiar with the symptoms of too high or too low blood sugar, and learn what to do when you experience them.
• Snacks. Consider carrying a healthy snack with you at all times in case you experience hypoglycemia (low blood sugar).

Uncontrolled diabetes is a big risk factor for yeast infections. You can limit your risk with these tips. Controlling your blood sugar levels and regularly checking them, either on your own or with your healthcare provider, are important. If you suspect you have developed a yeast infection, contact your healthcare provider.