Natural Urinary Tract Infection Cure and Treatment

UTI-Be-Gone By Sherry Han

UTI Be Gone by Sherry Han is a comprehensive and simple e-book that describes how sufferers can eliminate urinary tract infection quickly and naturally. The document will demonstrate customers how you can quickly stop the discomfort brought on by UTI and how to cure it with practically no negative effects. UTI Be Gone takes people step-by-step through the process of learning how to get rid of symptoms of urinary tract infection easily. With the program, people will learn how to get immediate relief from endless pain caused by urinary tract infection. The program also reveals to users secrets to prevent this disease from coming back. The program is designed to be suitable for those who want to eliminate their urinary tract infection without any medication. Buying the program, people will get a lot of instruction books from the author such as the UTI Be Gone-Beat Urinary Tract Infections 100% Naturally book, the Secrets Of Organic Foods book, and theHealth Secrets Of Water book.

Uti be gone Natural Urinary Tract Infection Cure Summary


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Author: Sherry Han
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Urinary Tract Infections in Diabetes

A twofold to fourfold higher incidence of bacteriuria has been reported in diabetic women compared to nondiabetic women, although it is not seen in men (220-222). As compared with nondiabetic women, diabetic women with bacteriuria are usually asymptomatic (223). However, asymptomatic bacteriuria can be a predisposing factor for overt urinary tract infections (UTIs) (224). Also, diabetes predisposes patients with UTI to more severe infections of the upper urinary tract and to various complications. The upper tract is involved in up to 80 of UTIs in diabetic patients and, in contrast to nondiabetic patients, bilateral infection is more common in diabetics (220). The most common microbe in diabetics with UTI is Escherichia coli. However Klebsiella and Proteus sp are more frequently found in diabetic patients than in the control population (220,221). Also, unusual microbes such as fungi, particularly Candida, staphylococci, and Pasteurella multocida may also be responsible for a small...

Urinary Tract Infection

Urinary tract infection (UTI) is commonly encountered in patients with diabetes (9). However, studies have failed to demonstrate significant differences in epidemiological, clinical, and microbiological features of UTI in patients with or without diabetes except for a relative difficulty in eradicating infection in the former group (10). Asymptomatic bacteruria occurs with a higher frequency one study demonstrated a 26 incidence in diabetic women compared to 6 in controls (11). Whether this increase is the result of an increased use of urinary catheters in these women or to diabetes itself has been debated (12). Other possible reasons for the increased incidence includes the presence of diabetic neuropathy, which affects the sympathetic and parasympathetic afferent fibers, causing decreased reflex detrusor activity. Impaired bladder sensations result in bladder distension, increased residual urine volume, vesicoureteral reflux, and recurrent upper UTI (1,13). Coexisting vaginitis,...

Evolution Of Diabetic Nephropathy

Diabetic Nephropathy Evolution

The major clinically identifiable initiators are hyperglycaemia and blood pressure control. Increases in AER into the microalbuminuric range may occur transiently with exercise, urinary tract infection, uncontrolled hyperglycaemia and cardiac failure, and on a long-term basis with hypertension, non-diabetic renal disease, and in association with large vessel disease. However, progression to overt diabetic nephropathy does not occur without long-term hyperglycaemia. Following the onset of overt nephropathy there is usually a close coupling of increases in AER with decreases in GFR. The subsequent rate of decline of GFR is influenced by several progression promoters including the level of blood pressure, hyperglycaemia and proteinuria, as well as retinopathy and smoking. Recent evidence suggests that a decline in GFR may occur, less commonly, in subjects with minimal or no increases in AER. This raises the question of whether the sequence of microalbuminuria leading to macroalbuminuria...

Emphysematous Pyelonephritis and Cystitis

The symptoms are suggestive of acute pyelonephritis and include chills and fever, flank pain, nausea and vomiting, dysuria, lethargy, and altered sensorium. Spread of infection to perirenal space produces a crepitus (60,61). Contralateral flank pain may occur. This reflects an atypical mirror pain secondary to a renal or ureteric calculus (62). Bilateral involvement may occur infrequently. The failure of fever to resolve after 3-4 d of treatment of UTI should raise the possibility of this infection. Laboratory investigations reveal leucocytosis, hyperglycemia, azotemia, and pyuria. Screening abdominal films demonstrate air in the renal parenchyma in 85 of cases (63). Ultrasound reveals similar findings. Intravenous programs may show obstruction but can be hazardous in view of deranged renal function. CT scanning is the diagnostic test of choice. Type I emphysematous pyelonephritis refers to renal necrosis with a total absence of fluid content on CT scan or the presence of a mottled,...

Adjusting Insulin for Illness or During Periods of Stress Sick Day Rules

Stress and illness clearly impact glycemic control. In the patient with DM1, release of insulin counterregulatory hormones under such circumstances will typically lead to hyperglycemia. Indeed progressive development of hyperglycemia without other aggravating factors may indicate that an illness, e.g., urinary tract infection or viral syndrome is in its prodromal stages. Careful questioning of the patient about symptoms that suggest underlying illness is part of a thorough assessment under these circumstances. It is necessary for the patient to have a plan of action to enable glycemic control on sick days.

Methylsulfonylmethane MSM

Published, controlled studies on MSM are limited, but more than fifty-five thousand studies have been published on a very similar molecule, dimethyl sulfoxide (DMSO). Stanley Jacob, M.D., of Oregon Health Sciences University, Portland, a pioneer in researching both substances, has found MSM very effective in reducing muscle and joint pain, interstitial cystitis (a type of very painful bladder inflammation), and even pollen allergies in some people.

HONK Coma Risk Factors and Management

As with DKA, undiagnosed diabetes is a major risk factor for HONK coma, and infection is a common precipitant. In one series, 68 of subjects with HONK coma had undiagnosed diabetes, and infection was the precipitant in 55 (Small, Alzaid and MacCuish 1988). Residents of care homes are also at increased risk of HONK coma (Wachtel et al 1991), with a greater risk of fatal outcome. Often a patient (a resident) is not known to be diabetic and seems to have had a UTI recently whether they have had a UTI precipitating the coma or they have urinary symptoms due to glycosuria is unknown. HONK coma can also be precipitated by diuretic therapy (Fonseca and Phear 1982).

Pathogenesis Pathogenesis in general

UTIs almost exclusively result from the ascending route. Bacteria colonizing the perineum and vagina can enter the bladder and further ascend to the kidneys. The most important defense mechanisms of the host, are the urine flow from the kidneys to the bladder and the intermittent voiding, resulting in complete emptying of the bladder. Patients with urinary obstruction, stasis and reflux have more difficulty in clearing bacteria and these conditions also seem to predispose to the development of a UTI, although exact data are lacking 13 . The essential step in the pathogenesis of UTIs, is the adherence of uropathogens to the bladder mucosa. Adhesins (fimbriae) are therefore important virulence factors. Although virulence factors have been characterized best in E. coli (the most common uropathogen), many of the same principles may be applicable to other gram-negative uropathogens, for example Klebsiella 14 . Type 1 fimbriae mediate the adherence of E. coli to glycoprotein receptors...

Headache and Migraines

Tooth infection, urinary tract infection, bowel problems, and a wormlet, Strongyloides are the common causes. Headaches are also caused by toxins in your environment especially things you breathe in. Household gas is the most common offender. You don't smell it after you get used to it Gas pipes are notoriously leaky. Conducting gases through pipes with joints in them, where gases could escape, must be the most ludicrous of all modern conveniences . Would you try to conduct water through pipes with holes in them You would soon see the water on your kitchen or bathroom floor. But gas doesn't land on the floor, it doesn't make a puddle, so you, the consumer, are left helplessly believing you don't have leaks. Every gas pipe that has a seam should have a clear plastic boot around it containing indicator compound to let it be known when gas is escaping. Other methods could be invented to make the gas utility safe. As you will see from the case histories, very many persons are living in a...

Antimicrobial treatment

Urine cultures showing 105 CFU) were randomized to receive a 3- or 14-day course of either trimethoprim-sulfamethoxazole or placebo. Ciprofloxacin was provided to patients in the antibiotic-treatment group who were infected with a resistant organism. Because the first 6 patients assigned to a 3-day antibiotic regimen had early relapses, this study arm was discontinued. All patients were subsequently screened every 3 months for bacteriuria, and women in the antibiotic therapy group were given further suppressive antimicrobial therapy if they were bacteriuric. Four weeks after the end of the initial course of therapy, 78 percent of placebo recipients had bacteriuria, as compared with 20 percent of women who received antimicrobial agents (P

Medical Complications

Urinary incontinence affects up to 60 of stroke patients admitted to hospital, with 25 still having problems on hospital discharge, and around 15 remaining incontinent at 1 year. The most common cause is detrusor hyper-reflexia as a direct consequence of stroke. Impaired sphincter control, preexisting bladder outflow obstruction, constipation, immobility, confusion, impaired consciousness, and urinary tract infection may also play a role (63). Data from the available trials are insufficient to guide continence care after stroke. It has been suggested that structured assessment and management of care and specialist continence nursing may reduce urinary incontinence and related symptoms after stroke (63). Nursing strategies, such as scheduled voiding, intermittent catheterization, or the use of condom catheters in men, are useful first-line treatments (64). Whenever possible, indwelling catheters should be avoided because of the risk of urinary tract infections. When incontinence...

Screening For Diabetic Complications

Renal function should be monitored at least annually by measurement of microalbuminuria and plasma creatinine. Urinalysis should be checked regularly to detect occult urinary tract infection. Strict control of hypertension is important for preventing or reversing early diabetic nephropathy.

Course Of Nephropathy During Pregnancy

Maternal anemia results from both decreased erythropoietin production by damaged kidneys and the physiologic hemodilution of pregnancy. The degree of anemia is related to the severity of nephropathy as reflected in lower creatinine clearance and is not usually associated with abnormal iron studies 95 . Exogenous erythropoietin can be used to treat anemia unresponsive to iron and folate replacement 194-197 . Asymptomatic bacteriuria is more common in diabetic than non-diabetic women, leading to a greater risk of UTI 198-201 , but there is controversy over screening and treatment outside of pregnancy 202,203 . During pregnancy screening and preventive treatment of women with hypertension or DN is justified due to the deleterious effects of pyelonephritis 95 . Although paradoxically PET in the third trimester may be less common in non-diabetic women who smoke cigarettes 175,177,204 , smoking should be strongly discouraged in diabetic women due to impaired

Should asymptomatic bacteriuria be treated in diabetic individuals

Asymptomatic bacteriuria (ASB) is defined as the recovery of the same microbe in at least two consecutive urine cultures in quantity of 105CFU ml (colony forming units) with a simultaneous absence of clinical symptoms of urinary tract infection. It is seen more frequently in diabetic individuals and especially in diabetic women. In a recent European epidemiological study it was found that 26 percent of diabetic women had ASB versus 6 percent of control subjects. The importance of ASB lies in the probability of it causing complications and more specifically in the production of upper urinary tract infections and decrease in renal function. It has indeed been observed that upper urinary tract infections are more frequent and more serious in women with Type 2 DM and ASB. This has not, however, been proven for women with Type 1 DM. As regards the effect of ASB on renal In the general diabetic population, several experts, mainly Americans, believe that ASB should be treated, aiming at the...

Pancreas Transplantation The Operative Procedure And The Need For Immunosuppressive Drugs

And the avoidance of small-bowel complications such as obstruction and infection. Advantages of enteric drainage include the avoidance of urinary infections, acidosis (resulting from loss of bicarbonate), hematuria, and reflex pancreatitis. In all variations, the native pancreas is left untouched so that it continues to deliver normal exocrine secretions for the recipient's small intestine.

Maternal Complications

Women with type 1 diabetes mellitus have a relatively high risk of developing diabetic complications before pregnancy because the onset of the disease occurred at a young age (18). Complications include retinopathy, nephropathy, hypertension, impaired thyroid function, neuropathy, and atherosclerosis, in rare cases. In addition, hyperglycemia in the mother may lead to maternal complications, such as polyhydram-nios, urinary tract infections, candidal vaginitis, recurrent spontaneous abortions, and infertility. Because these concomitant diseases affect growth and development of the fetus, it is all the more important to treat and control them. They can be minimized and prevented by tight glycemic control, maintaining HbAlc measurements under 5 in pregnant women. HbAlc values are generally lower in pregnancy because of active hemopoiesis and hemodilution from an expanded blood volume. Nephropathy and hypertension, common complications of poorly controlled diabetes, can be aggravated...

Case Study Diabetic Ketoacidosis

A 25 year old young woman came to the hospital with fever and mild confusion. During the previous few weeks she had experienced polydipsia, polyphagia and polyuria, with significant weight loss (12 kg). She reported pain in her left flank area, with dysuria, for the previous 48 hours. Her mother reported that her daughter's breath had a peculiar, uncommon smell, and that her breaths were more frequent.

How does diabetes affect your kidneys

One of the substances that appear in the urine when the filters are damaged is protein and a particular protein called albumin appears in the urine at a very early stage of diabetic kidney damage. Albumin in the urine is also called albuminuria and a current test can detect the presence of very small amounts (microalbuminuria). The availability ofthese tests is one reason why you will be asked to provide a urine sample at each of your diabetic clinic visits, even if you are normally performing blood tests for glucose. Sometimes you may get a positive result from the albumin test, which may in fact be caused by a urinary infection. Your clinic will check your urine sample to exclude this.

Microalbuminuria Techniques Of Measurement And Monitoring

In Fig 1 the different methods and cut off points for the detection of microalbuminuria are depicted. For large scale screening, we find the use of albumin creatinine ratio in early morning urine a convenient and reliable screening method. In other settings, office tests such as microalbuminuria teststrips 15 and microalbumin creatinine assays seem to fulfil the requirements of adequate sensitivity, specificity and reproducibility. It is important to consider potential confounders in the detection of microalbuminuria such as exercise, urinary tract infection, menstruation, and severe dysregulation. In addition, there is considerable intra-individual variation in urinary albumin excretion, up to 40-50 when measuring albumin concentrations or albumin creatinine ratios under routine clinical conditions. Thus, several samples should be taken in order to avoid misclassification of patients and screening should be a continuous process. Detection of microalbuminuria facilitates the...

Clinical Presentation

UTIs in diabetic patients can be either asymptomatic or symptomatic. ASB is defined as the presence of at least 105 colony-forming units of the same urinary tract pathogen per milliliter in two consecutive clean voided midstream urine cultures. Several studies have shown that the presence of ASB is a predictor of symptomatic infections, in patients with as well as in patients without DM 17,34 . The presentation of a lower (symptomatic) UTI can be accompanied by classical symptoms as dysuria, frequency, urgency, hematuria, and or abdominal discomfort. However, the same symptoms may be produced by inflammation in the urethra or by infective agents as Chlamydia trachomatis, herpes simplex or by a vaginitis (e.g. Candida albicans) which also occur frequently in women with DM. Therefore a urine specimen should be checked for leukocyturia (the presence, in uncentrifuged urine, of 5 leukocytes high power field or 10 leucocytes mm3) and bacteriuria. Upper tract involvement is common in...

Identifying symptoms of type diabetes

Slow healing of skin, gum, and urinary infections Your white blood cells, which help with healing and defend your body against infections, don't function correctly in the high-glucose environment present in your body when it has diabetes. Unfortunately, the bugs that cause infections thrive in the same high-glucose environment. So diabetes leaves your body especially susceptible to infections.

Diagnosing Diabetes in the Elderly

Elderly people with diabetes often do not complain of any symptoms. When they do, the symptoms may not be the ones usually associated with type 2 diabetes, or they may be confusing. Elderly people with diabetes may complain of loss of appetite or weakness, and they may lose weight rather than becoming obese. They may have incontinence of urine, which is usually thought of as a prostate problem in elderly men or a urinary tract infection in older women. Elderly people with diabetes may not complain of thirst because their ability to feel thirst is altered.

Female Sexual Dysfunction

Problems affecting sexuality in diabetic women are fatigue, changes in perimenstrual blood glucose control, vaginitis, decreased sexual desire, decreased vaginal lubrication, and an increased time to reach orgasm. Even minor episodes of depression which is twice more frequent than in men can result in a loss of libido. To which degree these symptoms are related to autonomic neuropathy has also been examined in a few studies, the results of which are at variance (155). The examination for a diabetic woman with sexual dysfunction should include the duration of symptoms, psychological state, concomitant, medications, presence of vaginitis, cystitis, and other infections, frequency of intercourse, blood pressure, BMI, retinal status, pelvic examination, presence of discharge, and glycemic control (156).

Diagnostic Procedures

In rare situations, renal biopsy may be indicated, in particular if the disease has developed very rapidly, but even so, in most cases typical diabetic lesions are found (27). In some situations, the renal biopsy may not show specific diabetic abnormalities, which is by no means a sign of non-diabetic renal disease (and by no means minimal change disease). Structural lesions might also be explained by hypertension (39). Obviously, screening for urinary tract infection that may be more common in diabetic patients due to cystopathy is a very reasonable procedure. Often blood pressure is moderately elevated in these patients so careful measurements of blood pressure are always warranted. BP-elevation is often related to sodium retention (40), therefore, careful clinical examination regarding edema is crucial, but even without edema, there might be sodium retention (40). Diuretic treatment becomes essential, also for BP-lowering.

Etiology And Precipitating Factors

Insulin deficiency and increased counter-regulatory hormone secretion (i.e., glucagon, growth hormone, catecholamines, and cortisol) underlie the basic mechanism leading to DKA in patients with diabetes. If insulin is present, lipolysis and the development of ketoacidosis are prevented. The most common precipitants of DKA are infections (such as pneumonia and urinary tract infection) and insulin omission or under-treatment (13). Other

Choice Of Screening Modality For Albuminuria

Screening is recommended from the time of diagnosis in all patients with type 2 diabetes and for all with type 1 diabetes of greater than 5 years' duration.46 Several factors can confound the assessment of microalbuminuria, including urinary tract infection, heavy exercise, high dietary protein intake, congestive cardiac failure, acute febrile illness, metabolic decompensation, water loading and menstruation vaginal discharge.49 For accurate evaluation, testing should be postponed if these factors are present. Once microalbuminuria has been confirmed, ongoing monitoring may be done with either a timed urine collection or ACR measurement.49,50

Common Management Problems

Recurrent skin, chest and urinary infections may occur, especially if control of blood glucose is not optimal. Infections themselves predispose the resident with diabetes to marked hyperglycaemia or metabolic decompensation owing to hyperosmolar non-ketotic coma or ketosis. Urinary incontinence. This may be secondary to hyperglycaemia, urinary infection, poor mobility or cognitive impairment.

Other Emphysematous Infections

Emphysematous cystitis is a rare disease. Characteristic features include pneuma-turia or hematuria. It is associated with vesicocolic or vesicovaginal fistula. X-Ray abdomen shows air in the bladder wall, intramural air bubbles, or air-fluid level in the lumen. Antibiotics and relief of bladder outlet obstruction are therapeutic.

Consequences Of Asymptomatic Bacteria

Recently, a large study among 796 sexually active, non-pregnant women without DM (age 18-40 years old), identified ASB as a strong predictor of a subsequent symptomatic UTI 34 In (other) studies of non-diabetic patients, it was suggested that ASB can lead to recurrent UTIs, progressive renal impairment, hypertension, and an increased mortality 35 , although most authors agree that ASB per se in a healthy individual causes no harm 36,37 . However, despite the high prevalence of ASB among women with DM, little is known about the consequences in this specific population 12,7 . In the study mentioned earlier, we have shown that women with DM type 2 with ASB at baseline had an increased risk of developing a UTI during the 18-month follow-up, compared to women with DM type 2 without ASB at baseline (17 without ASB versus 27 with ASB, p 0.02). In contrast, we did not find a difference in the incidence of asymptomatic UTI between DM type 1 women with and without ASB. However, a more...

Which other conditions except diabetic nephropathy may be accompanied by microalbuminuria

Transient increase in albumin excretion in the urine or even proteinuria can be due to poorly controlled diabetes, urine infections, uncontrolled hypertension, heart failure, febrile illnesses, physical activity, pregnancy and increased intake of protein with the food. Furthermore, variation of albumin excretion can be observed not only during a 24-hour period, but from day to day as well. Nephropathy from other causes also - albeit rare - should be considered, especially in cases of acute deterioration of renal function and proteinuria, without an obvious cause (vasculitides, collagen vascular diseases, glomerulonephritides, multiple myeloma, monoclonal gammopathies accompanying other diseases, etc.). This is particularly likely when nephropathy is not accompanied by retinopathy. When there is pyuria, urine culture is necessary for exclusion of urinary tract infection. Other recommended tests are erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and immunologic...

Genitourinary Autonomic Neuropathy

There is loss of autonomic afferent innervation that results in infrequent urination. Efferent bladder deficits result in incomplete emptying. These abnormalities typically result in frequent urinary tract infections and overflow incontinence, with dribbling and poor urinary stream. More than two bladder infections per year (especially in men) should alert the physician to possible bladder neuropathy and elicit appropriate diagnostic procedures. A postvoiding residual of greater than 150 cm3 is consistent with the diagnosis of diabetic cystopathy and should be confirmed by a urological consultation and a cystometrogram. Coexistent urologic conditions (such as bladder outlet obstruction) may be present and should be excluded.

Diabetic Nephropathy

Diabetic nephropathy is characterized by proteinuria, decreasing glomerular filtration rate and increasing blood pressure. In the absence of urinary infection or other renal disease, proteinuria in the order of 0.5g day is an indication of established diabetic nephropathy.


The majority of the infections in diabetic patients are localized in the urinary tract. 5 An autopsy study in 1940 showed that approximately 20 percent of the patients with DM had a serious infection of the urinary tract. The authors stated that this prevalence was 5 times higher than found in studies with non-diabetic patients. 6 Although different studies show a wide range, nearly all investigators report that the prevalence of asymptomatic bacteriuria (ASB) in women with DM is 3-4 times higher than in women without DM 7,8 . In men results are more consistent, a frequency between 1-2 has been found, with no difference between diabetic and non-diabetic men 9 . The frequency of symptomatic infections in women with DM is also increased 10 . Both men and women with diabetes have an increased risk of acute pyelonephritis requiring hospital admission. In a recent study diabetes was estimated to increase the probability 20 to 30-fold under the age of 44, and 3 to 5-fold over the age of 44...


The bacteria isolated from diabetic patients with a UTI are similar as found in nondiabetic patients with a complicated UTI 31 . As in uncomplicated UTIs, E. coli causes the majority of infections. However, other strains are relatively more frequently cultured in these patients. For example, one study reported E. coli to be the causative uropathogen in 47 of the UTIs in diabetic patients and in 68 of the UTIs in nondiabetic patients 32 . Non-E. coli uropathogens, found in patients with DM, include Klebsiella species, Enterobacter species, Proteus species, Group B Streptococci and Enterococcus faecalis 7,12,26 . Some authors found that diabetic patients are more likely to be infected with a resistant uropathogen 32,33 . However, we could not confirm this finding in our cohort of diabetic women with ASB. A total of 135 E. coli were isolated from women with diabetes mellitus (mean age 57 14 years) were compared to 5907 routine isolates of E. coli obtained from female patients visiting an

Renal Assessment

Urinary albumin excretion should be tested annually by a microalbuminuria method. If albuminuria is above normal, serum creatinine should be measured. Some factors can artificially increase the levels of albumin in the urine and should be avoided at the time of the urine collection these factors include blood in the urine, prolonged heavy exercise, fever, congestive heart failure, uncontrolled diabetes, severe hypertension, UTI and vaginal fluid contamination of specimen.

Future Issues

Longer follow-up studies among diabetic patients (as ongoing in our center) analyzing the effects of ASB on renal function should answer the question whether women (especially type-1) with DM should be kept non-bacteriuric. Furthermore, randomized therapeutic trials specifically enrolling patients with DM will have to define the best therapeutic management, focussing on type of antimicrobial agent and optimal treatment duration. New developments on non-antimicrobial approaches must show their value in preventing UTIs in diabetic patients.


Barrier methods, preferably sheath and spermicide, are the best option, but only if properly used. Condoms protect both partners from infection, protect the cervix from sperm and have no effect on blood glucose. They are also easily bought in a wide variety of shops, supermarkets, and garages. A diaphragm requires gynaecological assessment for fitting and there may be an increased risk of vaginal and urinary infection. However, barrier methods are useless if not used properly planned conception and the avoidance of unwanted pregnancy are particularly important in women with diabetes.

Nosocomial Infection

Hyperglycemia has been firmly established as an independent risk factor for the development of infection. In animal and human studies, even brief periods of hyperglycemia interfere with leukocyte chemotaxis, opsinization, and phagocytosis (20). Furnary etal. demonstrated in a prospective, controlled study of coronary artery bypass patients, that tight glucose control can decrease the incidence of deep sternal wound infection (2.0-0.8 ) (6). Other perioperative studies have demonstrated an association between tight blood glucose control and decreased risk for bacteremia, pneumonia, sepsis, cystitis, and wound infection (12,13,20).

Tissue damage

Nephropathy may develop insidiously and the first sign may be hypoglycaemia. Diuretics, recurrent urinary tract infection, non-steroidal anti-inflammatories, dehydration, and hypertension may worsen the situation. Bladder and bowel problems can be due to autonomic neuropathy or other factors. Incontinence may be precipitated by urinary tract infection. Thrush may cause severe perineal soreness which the patient is too shy to mention. Urinary retention is less common but diabetic neuropathy may add to the effects of prostatism. Constipation can be stubborn despite a high-fibre diet and may require laxatives or enemata.


Despite the high prevalence of the disease, clinical trials specifically dealing with the treatment of UTIs in diabetic patients are rare. No randomized trials are available comparing the optimal duration and the choice of the treatment. Therefore most recommendations for treatment of UTIs in diabetic patients are based on expert opinions more than on scientific evidence. Discussion exists whether all UTIs in patients with DM should be considered and subsequently treated as complicated infections. Do the vast majority of UTIs in diabetic patients need to be labeled 'complicated' with the resulting more aggressive management Why not be more conservative, get the data from prospective studies and not create 'disease' when there is none in many patients Some authors indeed state that the term 'complicated' should be reserved for (diabetic) patients with therapy failure (persistent or recurrent infection) or with the presence of other conditions which in itself would lead to...