Incontinence and Diabetes

Diabetes Explained

About 537 million adults between the age of 20-79 years worldwide are living with diabetes, and the prevalence is steadily increased over the years[1]. The total number of people living with diabetes is expected to rise to 643 million by 2030[2].

Diabetes, with the medical term diabetes mellitus, is a metabolic disease in which the blood sugar (glucose) content is increased beyond normal. This is either because the pancreas does not produce enough of the hormone insulin or the body's cells do not respond to the insulin produced. Diabetes mellitus is classified into four broad categories: Type 1, Type 2, gestational diabetes, as well as "other specific types". The most common type is type 2 diabetes, and more than 90 % of the adults worldwide with diabetes are dealing with this type[3]. And indications suggest that incontinence is most prevalent in those with type 2 diabetes[4].

With these numbers in mind, let’s dive deeper into the most common type of diabetes –Type 2 and look at its characteristics.

What characterizes type 2 diabetes:

Type 2 diabetes is the most common type of diabetes and research shows that the likelihood of developing type 2 diabetes increases after the age of 45. It is a chronic disease, which means that once you are diagnosed, you have it for life. The body's cells become less sensitive to insulin, which is necessary for the cells to absorb sugar from the blood. Insulin is still produced in the pancreas, but the cells cannot utilize it well enough. It is also called insulin resistance. As a result, the cells have a harder time absorbing the sugar in the blood.

When Type 2 Diabetes is not treated, the cells do not absorb enough sugar, then the pancreas will instead begin to form more insulin. It will initially work, and the cells can absorb the sugar they need. However, when the pancreas has been overworked for a long time and has produced more insulin than usual, it gradually becomes worse at producing insulin. It worsens the condition and causes high blood sugar.

In the chart below you see some of the symptoms and risk factors connected to Type 2 diabetes.

While certain people are predisposed to type 2 diabetes, lifestyle plays the predominant part in the onset of the disease. In short, having a genetic disposition for type 2 diabetes does not mean you will suffer from the condition. The choices you make with respect to diet and exercise can determine if you get the disease or not.

The other well-known type of diabetes is type 1. It is less frequent and varies slightly from Type 2 diabetes, so let's look into this one.

What characterizes type 1 diabetes

Type 1 diabetes often develops during childhood, and it most likely occurs from an immune system reaction, where the body’s immune system attacks the body's cells called beta cells. The beta cells are located in the pancreas just below the stomach. When it happens, the body does not produce enough insulin. The blood sugar levels remain high unless a person uses medication to manage them.

The link between diabetes and incontinence

Diabetes is associated with a risk of incontinence. Research shows that women living with diabetes may have up to a 70% higher risk of urinary incontinence than those without the condition[6].

By its nature, diabetes causes increased glucose levels, decreased blood flow, and nerve issues. However, it can also affect sensory function and bladder sensation. Diabetes can change bladder control and cause overactive bladder syndrome (OAB) or the opposite overflow incontinence due to under. This is due to nerve damage, also known as diabetic neuropathy. This means you may lose sensation in the area, making it more difficult to detect when the bladder is full and how to empty it completely. This nerve damage can occur anywhere in the body, including the nerves that control the bladder muscles. When these particular nerves are damaged, they may be less able to send the signals between the muscles and brain that control urine flow. This can cause leaking even though the bladder is not full. And when it’s too full, it’s like a filled cup of water that runs over – called overflow incontinence.

High blood sugar levels can contribute to frequent urinary tract infections (UTI), which can contribute to an overactive bladder and urinary frequency. Furthermore, too high blood sugar means that more sugar will be excreted in the urine. Since sugar binds fluid, it will cause more frequent urination, dehydration, and increased thirst.

The excessive thirst caused by diabetes can be a contributor to incontinence issues, as well. Drinking excessive amounts of fluid at one time increases pressure on the bladder and leads to more frequent urination. It can also contribute to nocturia, which can disrupt your sleep since you wake up multiple times to use the restroom and irritate the bladder.

Medication[7]

People with type 2 diabetes are more likely to develop various medical problems such as damage to their eyes, nerves, kidneys, and blood vessels as well as heart attacks and strokes. The main goal of taking medication is to prevent this from happening as the medication helps keeping the blood sugar on a normal level. However, it’s good to be aware of, if the medication has side-effects like urinary and/or fecal incontinence.

Some diabetes medications attempt to regulate high blood sugar by forcing glucose from the blood out into the urine. When this happens, the bladder can become irritated, leading to incontinence. So, to manage certain side effects and to maintain life quality open up if experiencing these issues, so they can be treated.

Many people with diabetes avoid discussing these issues with their doctors, but treating cases of incontinence and managing symptoms can improve quality of life significantly since incontinence indirectly can affect the physical, psychological and social aspects of both men and women because it may interfere with patients’ family and social life.

Obesity (the risk of high body mass index)

Type 2 diabetes is often associated with excess body weight, and if that’s the case, it can also be a cause of incontinence. That’s because excess body weight gives extra intra-abdominal pressure and thereby puts extra strain on the pelvic floor muscles which can lead to so called stress incontinence and urge incontinence.

What to be aware of in relation to detect incontinence

• Obesity puts pressure on your bladder mostly leading to stress incontinence where leak occurs on effort or physical exertion.
• Nerve damage affects the nerves that control the bowel, and the bladder often leads to urge incontinence voiding more than 8 times a day and more than twice at night.
• A compromised immune system increases the risk for urinary tract infections (UTIs), which can cause incontinence leading to frequent urination.
• Diabetes medication may cause diarrhea. Increased thirst and more increased toilet visits.
• Social isolation.
• Smell of urine or feces.
• Rushing to the toilet in fear of bladder leakage.

Guidance tips for diabetic patients

• Physical examination by the doctor can exclude if the disease can be the reason and if the cause is treatable.
• Make sure that the diabetes is well regulated so that the blood sugar is within the normal range.
• Propper bladder emptying by double or triple voiding when going to the toilet.
• Drinking approx. 1,5 l of fluids every day to prevent UTI and bladder irritation.
• Bladder training, not just going to the toilet just in case – over time, this will reduce the bladder capacity.
• Try to avoid caffeine drinks as they can be bladder irritants. If obese, try to lose some weight.
• Advice on incontinence product solutions as small as possible, as large as necessary, and that fit your lifestyle.

Diabetes and incontinence treatments

You can’t undo diabetic nerve damage or cure neurogenic bladder. But you can advocate for lifestyle changes to ease symptoms or prevent them from worsening. Of course, managing the blood sugar level and keeping it consistently within a healthy range should be first priority.

Among the options you can try is scheduled voiding, which means you urinate according to a schedule. This helps prevent bladder leaks and also gives you an opportunity to urinate even though you may not feel the urge. Changes to your diet can also help you avoid certain bladder irritants that can trigger symptoms.

It’s also important to keep the blood sugar on a normal state, have a well-treated diabetes in order to prevent sugar in the urine causing UTI and bladder irritation that can lead to incontinence.

The doctor may also treat overactive bladder symptoms with medication if appropriate. In more advanced cases, catheterization can be necessary to help with difficulty urinating and retention to get a completely bladder emptying. Several surgical procedures may also be recommended, especially if the symptoms are persistent and severe.

Prevention

People with diabetes can stop the development of neurogenic bladder by controlling blood sugar levels and preventing autonomic nerve damage from happening. Get a well-regulated diabetes with insulin if type 1 where the amount of insulin is based on the weight, age, physical activity level, types of food eaten and the blood glucose level at any given time. If living with type 2 it can be regulated by regulating your lifestyle – and if necessary, diabetes type 2 medication can be provided.

Diabetes mellitus Type 2 is preventable by lifestyle interventions like exercise and diet. Some research suggests that nearly 50% of severe incontinence could be avoided by preventing type 2 diabetes[8].

6 tips to control diabetes through lifestyle changes

1. Exercise – An active lifestyle helps to control the diabetes by bringing down the blood sugar
2. Eat healthy – Eating plenty of vegetables, fruits, whole grain, non-fat dairy, and lean meats. Limit foods that are high in sugar and fat. Carbohydrates turn into sugar, so limit that’s as well. Try to keep it about the same from meal to meal.
3. Manage stress – Stress increase the blood sugar level
4. Stop smoking – Smoking can make it harder to exercise and also lead to more health problems
5. Get check-ups – Getting a full exam every year and visit the doctor at least twice a year to get a check up on the diabetes and blood sugar levels and if further treatment may be relevant.
6. Be careful with alcohol - Alcohol can make your blood sugar both too high and too low.

How ABENA can help you

Wearing a continence product can increase quality of life. Don't let the fear of leakages stop you from doing the things you love and be with the ones you love. At ABENA, we provide a wide range of incontinence products to cover every need of every patient. Find the size and style that covers your needs, no matter if you need a bariatric solution or a solution for immobile or active clients.

See our range here - don’t hesitate to contact your local distributor to find the products to cover your needs!

Sources

[1] https://www.who.int/health-topics/diabetes#tab=tab_1

[2] https://idf.org/about-diabetes/diabetes-facts-figures/

[3] https://idf.org/about-diabetes/diabetes-facts-figures/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848400/

[5] https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011)

[6] https://www.diabetesselfmanagement.com/managing-diabetes/general-health-issues/urinary-incontinence/

[7] (https://www.ncbi.nlm.nih.gov/books/NBK567989/)

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706373/