Kate Bristow, a diabetes nurse educator, shares easy and practical tips to nourish and care for your skin during the colder months.

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Skin 101

Did you know that your skin is an organ? In fact, it’s the largest organ of the body, packed with blood vessels and nerves and is the centre for your senses (touch and pressure, pain and temperature).

The skin sheds about 40 000 skin cells every day and is a protective barrier that is capable of continually replenishing itself. Its primary role is temperature regulation, but it’s also a shield from disease, infection and the sun.

When we talk about the effects of diabetes on all organs in the body, this includes our skin. Your skin is a very good indicator of general health. If you notice skin changes have them checked out. Early diagnosis and treatment are essential in preventing complications from skin problems caused by diabetes.

How does winter affect your skin?

As we go into winter, the changes in temperature and humidity may change your skin’s texture and it will need a bit more care. Winter can make your skin drier and more irritated, and heaters will further dry out your skin.

If you suffer from eczema, rosacea or psoriasis, these conditions can flare in the winter. Note, these conditions are common conditions of the skin, not isolated to persons with diabetes.

Tips to take good care of your skin in the cold weather

1. Go easy on cleansing of the skin – A daily wash/cleanse is important, but don’t wash multiple times in a day. Moisturising cleansers instead of foaming face wash will strip less of the natural oil off the skin. Also using a thicker moisturiser may help prevent dryness.
2. Don’t forget the sunscreen – Shorter days and a weaker sun may make you slacker with using sunscreen. Although the UV rays are less, they are still there, and sunscreen remains an essential part of skincare management. Remember to re-apply it every two hours and pick shade where possible.

Did you know that sunscreen loses its properties of protection when it is expired? So, check the expiry date. A sun protection factor (SPF) of 30 or higher is recommended.

3. Use a humidifier with heaters – If you are using a heating device, such as a gas heater or an air conditioner on heat, have a humidifier going in the same room to keep the skin more comfortable. Remember this rule applies for an open fire too.
4. Avoid soaking in the tub – Long hot showers and baths which are so divine in winter can actually dry the skin out. So, try keep soaking in the tub to a minimum and keep the water lukewarm and not piping hot. Try to use your moisturiser while your skin is still damp to seal the hydration in. If you have a dry skin, this is important all year round.
5. Switch to fragrance-free products – Certain products may be more irritable to your skin. Know how you react and if you have an irritable skin, avoid products, such as laundry detergent with fragrances.
6. Take care of your nails – Often, we don’t look at our nails until it’s time to wear sandals but things like fungal infections can start developing in winter. Foot care and nail care is important; if you notice brittle, yellowing or nails lifting check in with a doctor.
7. Wear gloves and keep your skin warm – It’s also a good idea to wear gloves for doing dishes or with use of any cleaning products.
8. Remember your lips – Use a gentle lip balm on a regular basis. Try not to use products that sting or make your lips tingle.  Suggested ingredients include glycerine, shea butter, beeswax, olive oil, castor oil and coconut oil.
9. Be patient with dry, cracked skin – If your skin is already irritated, please be patient; badly cracked and dry skin or broken skin barrier may take months to heal properly. If you suffer from any diagnosed skin conditions (rosacea, eczema, or psoriasis), it’s important to get specialised treatment from a dermatologist.
10. Stop smoking – Smoking makes you look older and contributes to wrinkles. It also narrows the tiny blood vessels in the skin, decreasing blood flow and increases the risk of squamous cell skin cancer. In the words of the Mayo clinic, “The best way to protect your skin is to quit!”
11. Manage your stress levels – This may be the hardest one, but stress can increase your skin’s sensitivity and trigger acne and other skin conditions. Try to get a balance: enough sleep, exercise and time to do the things you enjoy.
12. Follow a healthy eating plan – Plenty of vegetables, whole grains, lean protein and some fruit. Drink enough water to keep your skin hydrated.

References:

• https://www.today.com/health/skin-beauty/winter-skin-care-tips
• Skin Care: Dermatologist Recommended Tips (clevelandclinic.org)
• Skin care: 5 tips for healthy skin – Mayo Clinic

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Gynaecologist, Sumayya Ebrahim, educates us on vaginal candidiasis, also known as vaginal yeast infections, and its link to diabetes.

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Research has consistently shown that vaginal yeast infections are common in patients with both Type 1 and Type 2 diabetes. This is especially so if glucose control is not optimised.

Candida 101

Candida (or yeast) is a type of fungus that lives naturally in the body. We find it usually in the mouth, throat, gut and vagina. It also lives on the skin surfaces. Occasionally, when certain conditions exist in the body, this organism will multiply and cause an infection. This infection goes by the common name of thrush or candida.

What conditions favour the development of vaginal candida?

• Pregnancy – due to the hormonal changes
• Users of hormonal contraceptives
• Diabetes – especially if control is poor
• Recent antibiotic usage
• Weak immune system – from HIV, chemotherapy or any immune-related illness

Lifestyle factors

Candida loves a warm moist environment. Below are some lifestyle factors to get candida:

• Staying in a wet swimming costume
• Not changing sweaty gym clothes like lycra
• Using scented tampons
• Using a vaginal deodorant
• Unhealthy diet that consists of refined and processed foods and deficient in fresh fruits and vegetables

What are the symptoms?

Please note, vaginal candidiasis is not a sexually transmitted disease.

Symptoms can range from very mild to severe. In some instances, if the underlying problem is ongoing, the infection can recur frequently.

• Vaginal or vulva itching and irritation
• Sensation of burning during urination or intercourse
• Vaginal rash, tiny blisters or even cuts
• Redness and swelling of the vulva
• Vaginal or vulva pain
• Thick white vaginal discharge that resembles cottage cheese; this often has no odour

How is vaginal candida treated?

Treatment of vaginal candida involves either topical antifungal treatment like a cream to the skin or an ovule into the vagina. These are available over the counter.

Treatment usually lasts up to five days and resolves the problem. Oral antifungals are also available on script from your doctor. These can be used as an alternative for an early infection or be reserved for when candida recurs.

Prevention of vaginal candida

The best way to prevent vaginal candida infection is to avoid all the lifestyle factors that can act as triggers. In sufferers with ongoing diabetic challenges, the key strategy is good glucose control. Without good glucose control, candida overgrowth and symptomatic infection are never really kept in check.

Oral probiotics in the form of capsules or regular dietary unsweetened yoghurt with lactobacillus also prevents candida overgrowth.

Gynaecologists may also recommend vaginal probiotics inserted as a pessary directly into the vagina once or twice per week. This restores the good bacteria in the vagina called lactobacilli and allows the vagina to regulate its own pH. Thus, keeping it healthy. This in turn, helps to prevent ongoing or recurrent infection. A recurrent infection is said to occur if it happens more than four times per year.

Special considerations with diabetes

1. New research shows that a new group of drugs to treat Type 2 diabetes, called sodium glucose cotransporter 2 (SGLT2) inhibitors, makes users more prone to develop recurrent candida infections. These include dapagliflozin and empagliflozin.
2. Recent studies show that people with diabetes are more prone to having candida caused by strains different to the general population. In the general population, candida albicans is the most common yeast identified. In people with diabetes, the most common strain is candida glabrata; this strain has also been shown to be more resistant to successful treatment.

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