Diabetes and Urination: Everything You Need to Know

From everydayhealth.com 

Diabetes can affect every part of the body, including the urinary system. High blood sugar levels can directly cause increased urination, and nerve damage contributes to long-term urinary problems like incontinence and kidney disease.

Urination problems aren’t just annoyances; they are serious symptoms that deserve the attention of a doctor and can be warning signs of more dangerous complications. If you have diabetes and experience any of these symptoms, you should seek medical care to help ensure that both your quality of life and any serious complications are addressed.

Acute High Blood Sugar and Excessive Urination

For people with diabetes, it’s not just drinking more fluids that makes you go to the bathroom more frequently. If blood sugar levels surpass 180 after eating, the kidneys exceed their ability to hold onto the sugar, says endocrinologist Thomas W. Donner, MD, director of the Johns Hopkins Diabetes Center in Baltimore. 

“When sugar appears in the urine, that leads to increased urination,” he says.

Increased urination, a direct result of very high blood sugar (hyperglycemia), is a hallmark symptom of diabetes and is often one of the first signs of the condition. But if you have already been diagnosed with diabetes and you suddenly need to pee more often, it could be a warning sign of an emergency. Excess urination may be a symptom of two dangerous and potentially lethal medical conditions:

• Diabetic ketoacidosis (DKA) is caused by insulin deficiency, leading to ketogenesis and eventually acidosis, and it is more common in people with type 1 diabetes. DKA generally develops acutely, and it may cause intense symptoms such as headache, nausea, abdominal pain, and rapid, deep breathing. If you’re experiencing any of those, you may need to seek emergency medical treatment.
• Hyperosmolar hyperglycaemic state (HHS) occurs in people with type 2 diabetes when their blood glucose levels are too high for a long period of time. HHS tends to happen when very high blood sugar causes severe dehydration.

Both of these conditions are considered medical emergencies.

Incontinence and Leaky Bladder

Urinary incontinence isn’t peeing too often; it’s urinating or leaking when you don’t want to. It’s a common problem among people with diabetes, since over time, high blood sugar levels can damage the nerves that control bladder function.

“The bladder is a muscle, and if it loses normal nerve connections or function, the bladder may not empty fully,” says Dr. Donner. Nerve problems can also make it harder to sense when you have a full bladder.

There are several subtypes of incontinence:

• Urge incontinence is when someone feels an intense need to urinate and will leak urine. Uncontrolled diabetes can also contribute to an overactive bladder.
• Overflow incontinence happens when the bladder gets distended, then urine leaks out. Diabetes is a risk factor for this condition.
• Stress incontinence is when urine leaks when pressure is put on the bladder. Obesity and nerve damage both increase the risk for it.
• Mixed incontinence is a combination of stress and urge incontinence.

Donner says that normalizing blood sugar can help prevent leaks, but nerve damage typically can’t be recovered. Treatment for incontinence can include urinating at regular times, doing exercises that strengthen the pelvic floor muscles, and creating a schedule for drinking fluids. Avoiding bladder irritants like chocolate and coffee may also be helpful in urge incontinence.

Medications can be helpful, too, and are specific to the type of incontinence. For example, alpha-adrenergic agonists can help with urge and overflow incontinence, as they help with muscle relaxation.

People who struggle with complete bladder emptying may want to try intermittent catheterization, says Abbal Koirala, MBBS, an assistant professor of medicine at Johns Hopkins University. This involves inserting a tube into the bladder to drain the urine regularly.

“Incontinence associated with diabetes can be prevented by maintaining good blood sugar control,” Donner says. Other habits that might help with incontinence prevention include not smoking and avoiding alcohol and caffeine.

Diabetes and UTIs

The link between diabetes and urinary tract infections (UTIs) is multipronged: High blood sugar weakens the immune system, creates a breeding ground for bacteria in urine, and causes nerve damage that leads to incomplete bladder emptying. Common UTI symptoms include the following:

• Pain in your lower back, abdomen, penis, or pelvic area
• Cloudy urine that smells bad
• Urinary incontinence
• Pain when you urinate
• Blood in your urine
• Fatigue
• Fever and chills
• Nausea and vomiting
• Mental changes or confusion 

Treatment for UTIs involves taking antibiotics and drinking fluids. For people with diabetes, Donner says that more well-controlled blood sugar can make infection treatment more effective. “People with very uncontrolled blood sugar levels typically don't respond as well to antibiotics,” he says. 

Dr. Koirala says that uncomplicated bladder infections can be treated with medications:

• nitrofurantoin (Furadantin, Macrodantin)
• trimethoprim-sulfamethoxazole (Bactrim)
• Fosfomycin (Monurol) 

For complicated or severe infections, or infections that involve the kidney, longer use and broader spectrum antibiotics are often needed, says Koirala. 

Once again, more effective blood sugar management can lower risk. Other UTI prevention strategies include drinking plenty of fluids, urinating after sex, wearing cotton underwear, and urinating often.

Urinary Symptoms and Kidney Disease

Diabetes is the leading cause of kidney disease. It can create several changes to urination:

• Foamy or bubbly urine
• More or less frequent urination
• Peeing larger or smaller amounts than usual
• Darker, paler, or bloody urine
• Difficulty urinating

Koirala says that kidney disease doesn’t always have symptoms in early stages, but it can be detected through laboratory tests. People with diabetes should be screened every year for chronic kidney disease.

Some strategies to help prevent chronic kidney disease include not smoking, staying active, following a healthy diet, and limiting alcohol. Donner says that blood sugar, blood pressure, and cholesterol control are all important in preventing kidney disease in people who have diabetes.

When to See a Doctor

You should seek medical care if you have any urinary symptoms that concern you, particularly if they’re paired with painful urination, blood in the urine, or a fever. Donner adds that you should ask to see a urologist if your bladder isn’t emptying all the way and if you notice swelling in your legs, as this may be a sign of kidney disease and may necessitate seeing a specialist.

Not being able to urinate is considered a medical emergency.

The Takeaway

• Short-term high blood sugar levels in people with diabetes can lead to intense thirst and increased urination, which can be a warning sign of an emergency such as diabetic ketoacidosis.
• Chronic high blood sugar can lead to urinary incontinence and related urinary problems. This is often a result of damage to the nerves that control bladder function.
• Diabetes can increase the risk of urinary tract infections and cause kidney disease, a common severe complication of diabetes.
• Managing blood sugar is key to preventing these urinary conditions. If you experience painful or bloody urination, fever, or swelling in the legs, it's important to seek medical care immediately.
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• https://www.everydayhealth.com/diabetes/diabetes-and-urination/