Diabetes and Infection: The Silent Danger

The dangerous intersection of diabetes and infection takes center spotlight in this vital conversation between nurse practitioners Nicole and Kelli. They reveal a startling medical reality that deserves immediate attention: infections have risen to become the third leading cause of death in patients with type 2 diabetes.

Moving beyond typical weight-loss discussions that dominate health conversations, especially during resolution season, they emphasize that true health and wellness should be our primary focus. With obesity linked to over half of new type 2 diabetes diagnoses annually, understanding proper management becomes critical. The practitioners explain the dangerous cycle that occurs during infection: blood glucose rises naturally, creating an environment where bacteria thrive, while chronically elevated blood sugar creates blood that's "like syrup," making oxygen delivery difficult precisely where it's needed most.

The conversation delivers practical, actionable advice for diabetic patients and those at risk. Protein intake recommendations (roughly equivalent to body weight in grams for maintenance, or about one-third of daily calories for those trying to lose weight) provide clear nutritional guidelines. They stress the importance of early intervention for suspected infections, proper hydration alongside increased protein consumption, and regular monitoring of laboratory values like albumin levels. A final gem for listeners: information about new at-home combination tests that check for multiple respiratory infections simultaneously, allowing for prompt telehealth treatment without leaving home during infection season. Whether you're managing diabetes, supporting someone who is, or simply interested in preventative health, this episode delivers crucial information that could quite literally save lives.

Have you checked your protein levels lately? Connect with us at hamiltontelehealth.com  to discuss your health concerns from the comfort of home.

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Chapters

• 0:00 Health vs Weight Loss for Diabetics
• 2:44 Infections: Third Leading Cause of Death
• 4:57 Recognizing Infection Signs in Diabetics
• 7:38 Glucose Control and Protein Importance
• 11:24 Protein Goals and Testing Options
• 18:22 Telehealth Options and Episode Closing

Transcript

Nicole: 0:07

Hey everyone, welcome to another episode of Tattoos and Telehealth. My name is Nicole, I'm a nurse practitioner. This is my great colleague, Kelli, she's also a nurse practitioner. And today is my great colleague, Kelli, she's also a nurse practitioner, and today we're going to talk about some pretty important stuff, especially related to those with diabetes. Just as a disclaimer, our lawyers make a say this does not constitute a patient provider relationship and this is not to be construed as medical advice. Just two gals talking and having a conversation. So go ahead, Kelli, take it off, let's go.

Kelli: 0:47

So today I kind of want to back up a little bit in the world of all of the fancy stuff. But you know, we, we kind of get especially around the holidays in the sense of really talking about our weight and you know, those of us gym rats like myself, we start to notice that people really get excited about, you know, the first of the year and we set new year's resolutions and the gym starts to become busy and everybody really kind of starts getting focused on that. But I really want to come back down to the fact that health and wellness should be the goal, right? So instead of weight loss, we really should be considering health and wellness as the goal, and with that comes weight loss, because once you start to become more healthy, you will get that weight off. Now, the reason why Nicole and I get really really, really excited about this and we really kind of hit hard about this is that one of the biggest, biggest burdens of being overweight, even just slightly overweight, is the increased risk for developing type two diabetes. Right, like?

Kelli: 1:51

I don't remember the number. Do you remember the number, nicole? The percentage?

Nicole: 1:56

It's over 50. And I can't think of what the number exact number is, but I'll. I'll look it up while you're talking and we'll go from there. It's the number obesity. Go ahead, you continue talking and I'll look it up while you're talking and we'll go from there. It's the number obesity. Go ahead, you continue talking and I'll look it up. I'll look in our database.

Kelli: 2:09

The reason why is, as clinicians, we always worry about patients that are diabetic when they present to us with infections an infection of any kind, really right.

Kelli: 2:19

So I get super, super stressed about skin infections in my diabetics, especially skin infections in the lower limbs, because I don't know about you.

Kelli: 2:22

But I get super, super stressed about skin infections in my diabetics, especially skin infections in the lower limbs, because I don't know about you, but I get worried about it getting into the tissues, getting down into the bone that patient developing osteomyelitis, which is, in layman's terms, infections that get into the bone of the patient I worry about to treat.

Kelli: 2:41

Yeah, I worry about infections in the feet and the reason why I'm circling back to this right now is that some of the latest articles that are coming out that Nicole and I get inundated with daily is one of the more popular articles that we ascribe to has just released an article talking about infections in type two diabetics and how infection, just infection overall, any infection of any kind, infections overall has risen to the third leading cause of death the third, nicole, of death in type 2 diabetics. So patients with diabetes as a whole, infection in general, has risen to the third leading cause of death in our patients with diabetes and that freaked me out. I was like. You know how many of my diabetic patients I treat for infections, and it's just in general.

Nicole: 3:32

Yeah, so there's so many that it goes beyond just an acute infection.

Nicole: 3:36

But sepsis and that's what Kelli talking about is it goes from just a in just a, an infection in, you know, in a small wound or in a scratch or in whatever.

Nicole: 3:46

We don't have good blood supply as diabetics in the lower extremities, typically especially advanced, and you need blood supply with oxygen to heal. And because the blood supply is poor to the lower extremities, it has trouble healing. So because it has trouble healing, it spreads and it spreads to be sepsis and that is where it's in your bloodstream, it's everywhere, or, like Kelli saying, it goes to the bone and that's a huge problem because that's when you end up with a lot of amputations, is when you get the osteomyelitis. But I did find that obesity significantly increases the risk of developing type 2 diabetes and studies indicate individuals with obesity are nearly three times more likely to be diagnosed with type 2 diabetes and obesity has been linked to 53 percent of new type 2 diabetes diagnoses annually in the United States. So this certainly, certainly enhances the criticality of making sure that we are reducing the prevalence of type 2 diabetes, and that is with health and wellness and obesity management Exactly.

Kelli: 4:55

And I want to stress, we are strictly talking about type 2 diabetics today. I have a lot of love for autoimmune diabetes and type 1 diabetics hold a special place in my heart, but that is a very, very different conversation. Okay, so we're not talking about you're not talking about type one diabetics. We are not talking about juvenile diabetes. We are talking about specifically type two diabetes. Okay, guys, so we're not that. That is a very different conversation, okay, and the takeaway to that is that, as years have gone by, studies have shown that, as the proportion of deaths have increased to infection, specific diagnosis codes even things like pneumonia has become so prevalent in causing infection related deaths in diabetics. It was startling to me and I want to get back to visiting for just a little bit with patients that have diabetes and chatting with you about the importance of recognizing signs and symptoms of infection. Now, this is specifically again for our diabetes patients. If you feel like something that you are experiencing is an infection, please, please, please, do not wait until it turns into something that is out of control. It is especially especially if it is a wound, if you have a wound, if it is a wound on an extremity like, outward of your body, a digit, a foot, a leg, an arm, something far away from your body, from your trunk. That means it is being affected by your blood supply and or lack thereof, depending on how bad your diabetes is. Please go see your provider, let them take a look at it. That may need to be treated aggressively. That gets into your system. Patients with pneumonia I have seen I don't know about Nicole, but right now cold and flu season is rampant and I am seeing very, very healthy yes, very, very healthy people very quickly get bronchitis and then pneumonia and they're going downhill fast. Yeah, and I think that's just because we are a post COVID society and we think, oh, I'll get over it, I've done, battled the worst, you know what? What? How worse can it be? You know I've already had this and this and this and I'm fine, it'll go away and it's not.

Kelli: 7:17

And if you are a diabetic, it's just not. It's not the time to play. If you start feeling poorly, please go be seen. There are so many more things that we can do to help make you feel much, much better, and a lot of that comes down to us just having a conversation with you, not only about your infection but saying while you're infected, your blood sugars will go up, your blood glucose levels will rise. Okay, and bacteria, guys? Bacteria loves glucose, it loves to eat sugar. So as your glucose levels increase, the bacteria becomes harder and harder for us to treat. So it becomes very critical for us to keep your glucose levels under control, especially while you're infected. So let's chat quickly, nicole. Talk to me about glucose control during an infection. Let's talk about why that's so important. What would you tell your patient?

Nicole: 8:09

Yeah, certainly so. When your glucose is consistently over 200, even over 150, like consistently, you know you're going to eat and your glucose is consistently over 200, even over 150, like consistently, you know you're going to eat and your glucose is going to go up and down as it normally should in a normal person. However, for those that are diabetic, they have it likes to stay up higher. When your glucose is very, very high, your blood is like syrup going through, and so the oxygen has a hard time doing its job. When it's your it's so sticky right Blood carries your oxygen, but when it's overwhelmed with sugar, it is very difficult for that oxygen to get transported where it needs to go, especially in those smaller vessels that are in the digits and the lower extremities as well.

Nicole: 8:53

So you know being active is important to help blood flow. If it's at all possible, even small short walks are important. But, you know, just to promote that healing and make sure you get attention quickly when you start, because patients that are diabetic will typically get started on antibiotics sooner, although we, you know we don't want to overuse. There's a balance between, you know, kind of letting yourself heal and letting um the antibiotics you know take effect or you know to be prescribed. But for diabetics we would in a lot of cases start antibiotics sooner than we would a normal, healthy person, and it's important to get on that sooner rather than later, because it can just go bad. It can go really bad, really fast.

Kelli: 9:40

Yeah, and you may even hear us say things like a broad spectrum antibiotics. You may hear us say things like resistant organisms or use words that are not the same that we would use for other people, and that's simply because we know that our diabetics are more at risk for bugs that other people wouldn't get. So your type of infection could be a different source of bacteria than the normal person that doesn't have diabetes would get. Um, simply because it's easier for those organisms to overgrow in you. Um, the other thing that I want to really really hit home. I'm going to go all the way back to the health and wellness conversation, the reason why we stress good nutrition and good health and wellness. So many of our patients I know a lot of my patients when I do just a baseline lab if you have poor nutrition, your albumin levels are low, your protein level is low, pre-albumin stores are low. That's a good indication to me that your body is not getting the protein and fat and nutrients that it needs to be healthy. When those levels are low, automatically your body cannot produce the strength and the robust response to a bacterial infection or viral infection that it needs to fight it. So one of the things that unfortunately, diabetics also face is having a poor nutrition status, and that's something that I hit home with my diabetic patients is that staying on top of their nutrition, their health and wellness is incredibly important Protein drinks, keeping an eye on their macros, making sure their protein take is adequate. It's not just about watching their sugars and watching their carbs, it's about making sure that you get enough protein, and if you don't have good protein stores, your body simply cannot fight off infection. It can't. It can't heal those. That's when those wounds start to break down. That's when those infections start to take over. That's when we start to see, especially in diabetic patients, in their feet and in their lower extremities when we start to see those wounds dehisce what we say dehisce by meaning the wound starts to tunnel down into the tissues. That can risk getting into the bones, and that's because the tissues aren't healthy, the blood supply is poor, there's not enough adequate nutrition for the body to just take care of itself.

Kelli: 12:00

It's incredibly important. So I know my patients, I chat with them. I know Nicole is really good about breaking down those labs and going over every single little detail with you. If your provider is not doing that for you, please ask them to. When you go in for your appointments, ask them what is my protein? What is my albumin, my prealbumin? Do I need to increase my protein intake? What does my nutrition look like? That's important, it's very important, and it's oftentimes something that I think sometimes providers just glance over because they think, oh well, they just you know, that's just not important and they just glance over it and keep going. It's incredibly important, especially in the face of infection it is.

Nicole: 12:37

it really is, and you can get protein from you know, I tell my patients, especially those that were I'm working with with obesity, with I don't care how you get your protein, really. Um, if you're diabetic, you want to watch the sugar, but it may be cottage cheese. It has a great protein in it. It may be a protein bar, like a health bar. It may be a protein shake. It may be a steak, that's. You know. Everything in moderation is okay, based on you know what's going on with you. But really, however you get it like it's better than no way, right? So it you know. It may be a cottage cheese for some people, it may be a steak for others.

Nicole: 13:16

I'm not a big meat eater, so the cottage cheese and the bars and stuff is how I get my protein, because I do struggle with that myself. But it's super important for healing and just for prevention. Don't just kick up your protein, like Kelli saying, when you have this infection, but overall, for overall wellness, make sure you are getting good protein. And, just as a general, Kelli, what do you like to see your patients intake as far as protein per day? What is what is a good number that patients?

Kelli: 13:49

can say, okay, I need to kind of target this number. So I tried to get my patients to get pretty close to their weight in grams of protein if at all possible, or at least a third of their calories. So it depends on what their weight and what my goal is with them. So if I'm trying to get my patient to lose weight, then I take their calorie goal for the day and I cut that into a third and I say this in grams is what your protein intake should be. Okay, if my person is not trying to lose weight, they are of average, normal, healthy weight, our weight is good, we're not overweight, we're not obese, we're not trying to lose weight, we're trying to maintain. Then I tell them your weight in grams is about how much protein you should be taking in, give or take 10%, and I try to use that as my marker. So it really depends on my patient. Am I trying to lose weight, am I trying to maintain? And I let that be my marker and my goal.

Kelli: 14:44

So for anyone listening, an easy way to think about that if you're losing weight, calculate your calories that you want to take in a day. So let's say you want to take in 2000 calories a day. 30% of your macros should be protein. Okay, if you don't want to lose weight, you want to maintain your weight, you don't want to gain, you don't want to lose your happy where you are, like um, I'll just come out and say it. I weigh 130 pounds. About 130 ish grams of protein is what I try to get in per day. Sometimes it's a little less, sometimes it's right around there, but I try to get between 100, 125 grams of protein a day. That's for me. Now, having said that, you also want to be sure that you are getting in good exercise, because your body needs to be able to utilize that protein in a way that's effective, for it to burn fat, store calories, for you to use in a productive way and also be able to sustain a really good homeostasis for your body to be healthy.

Nicole: 15:47

I love it. That's very, that's very, very good advice. That's very good advice. I like that a lot.

Nicole: 15:51

So it is going to depend per patient, you know, unless you are on some specific renal diet or on some specific whatever cardiovascular, but most of the time protein. That is a great, a great, great rule of thumb for for the majority of patients. But always check with your provider to make sure that that is, you know, an okay target for you. As we're just chatting about it and just kind of giving you a number. But the more you ask about what is my protein level, what is my albumin, the first time or two you're going to it's just going to be a number to you. But then the third and fourth time you're going to be like, okay, it's up or it's down, what's going on, what do I need to do? And so you're not going to know what that number means at first, and that's okay. But it's about being consistent and knowing your numbers so that when something is way up or way down, you're like, okay, what has changed with me and what do I need to do to make those numbers improve? Either way?

Kelli: 16:43

And also be sure that when you increase your protein you increase your water intake. It's really important. So, especially in diabetics, you know our kidneys are important. In diabetics your kidneys become quite a big discussion Um and so with increasing your protein, you have to increase your water intake too. You want to make sure that. You know protein is a big molecule and so it needs a lot of hydration to pass through your kidney. So be sure that you're drinking a lot of water, and Nicole and I harp on that a lot too. So you know, a lot of water drink your, drink your water. Your body weight in water every day. Body weight in water every day.

Nicole: 17:14

Yep, unless you have some other condition where you cannot do that, such as kidney disease or whatever, but otherwise, that's that's a very good rule of thumb for otherwise healthy individuals. I think that's all for today. Thank you for joining us. We just wanted to get some quick information out there. We don't want to be want want boring, but we want to make sure that, um, you know, we're getting some good information out there and um it's infection season.

Nicole: 17:36

Absolutely A hundred percent. I've seen so many influences, so many influences, but there is a test out now that will test for influenza and COVID.

Kelli: 17:44

Yes, guys, if you haven't seen that, nicole, thanks for bringing it up. Um, we're not going to endorse any companies, that's not what we do. But yes, nicole brought up a great topic. So there is a test kit out now that you can test for flu A, flu B, covid, and you can get it over the counter and you can have your little test strip all in one. It does all three all in one, right, love it? Yeah, I love it. I love it. And then guess what guys? Guess what you can do. You can, to your little test strip, have it in front of you, come see one of us on video, flip it around, let us see the positive result and we can treat you and you can go on your way and you'd never have to leave your home.

Nicole: 18:21

It's awesome, so nice. It's so nice. No more urgent cares, no more sitting in the waiting rooms, for you know everybody else hacking on you. No, for you know everybody else hacking on you. No more waiting to get into your primary care and it's days out, you know it's the weekend or it's the evening. Let us know, Kelli and I will be happy to take care of you anytime.

Kelli: 18:41

And you're wrapped up in your robe with your little onesie or whatever your favorite cuddle bug is. We don't care. You don't have to leave your house, just come see us, we'll take care of you.

Nicole: 18:56

I see patients in bed all the time and that's okay, cause that's cause that's where they should be. You know, for the most part, yeah, for sure, for sure. So thank you for joining us.

Kelli: 19:02

You can find me at hamiltontelehealthcom.

Nicole: 19:07

You can find me at carihealthcom, ch A R I healthcom. All right, have a good day. We'll see you next time. Bye, guys.