Diabetes and immunityWhite blood cells are considered as our body's defence system and they can be referred as "body's army". These white cells which attack and kill the germs get affected by high blood glucose levels and hence Diabetes is associated with reduced functioning of the immune system. Abnormalities in the immune system usually get corrected with good blood glucose control. . postures, choosing correctly fitting footwear and keeping in close contact with your foot care specialist (podiatrist) and/or doctor if you have a foot problem. These can affect any skin surface but most commonly involving feet.Skin and soh tissuesSkin and soft tissue infections can occur in any individual but more easily occur in Diabetes.Bacterial infections such as boils, furuncles and cellulitis are often seen. An aggressive form of skin abscess called carbuncle is almost exclusively found in Diabetes which usually requires surgery to drain the abscess. Fungal skin infections such as ringworm, athletes' foot and thrush are alsocommonly seen in people with Diabetes. Taking good care of the skin along with controlling blood glucose levels can prevent many of these infections.Contiguous spread of infection from a skin ulcer to adjacent bone (osteomyelitis) is common in patients with DiabetesGenital infectionsThe vaginal secretion of women with Diabetes can contain increased glucose which provides a good environment for bacteria and fungi to grow. Symptoms of vaginal infection are itching of the vagina and vaginal discharge. Vaginal infections can be treated with pessaries (small, soluble block that is inserted into the vagina to treat infection) or creams or tablets. Treatment of sexual partner is also needed on occasion. Males can have infection under the foreskin of the penis and it is called balanoposthitis. It often requires treatment with creams and tablets and occasionally surgical procedure such as circumcision.Respiratory infectionsUpper respiratory tract infections affect mainly the throat, leading to sore throat and cough. Lower respiratory tract infection involves airways and lungs leading to cough, wheezing and breathlessness.Respiratory infections that commonly affect people with Diabetes are viral and bacterial. Morbidity and mortality of respiratory infections is more in subjects with Diabetes. Diabetes is also a risk factor for reactivation of tuberculosis.Most of these infections can be easily diagnosed and treated. Some of the infections can have serious consequences such as pneumonia, mucormycosis and kidney infections (called aspyelonephriti.s). Symptoms which suggest serious nature of infection include high grade persistent fever, low blood pressure, breathlessness or chest pain, bloody phlegm or nasal discharge, low urine output and altered mental status.If any of these symptoms are observed, urgent consultation with doctor is a must. Any infection in Diabetesshould be reported to the doctor and be immediately treated as per medical advice. Time should not be wasted on self-medication or home remedies.Managing infedionsManaging severe infections and Diabetestogether is difficult as they both affect each other in an adverse manner.Apart from increasing blood glucose levels, severe infections might affect other vital organs.Any severe infection, especially urinary tract infection will adversely affect kidney functioning. This might prove life threatening in people with diabetic kidney disease.Infection in the body, if severe, might lead to septicaemia (bacterial toxins going into the blood stream) which can lead to multiple organ failure referred as multi-organ dysfunction syndrome (MODS) which can prove lethal.Patients with Diabetes along with heart disease might suffer from congestive cardiac failure in presence of any infection in the body.So early diagnosis and prompt treatment of infections is very important in people with Diabetes.VaccinationsMore than 14 infectious diseases can be prevented by appropriate adult immunisation. People with Diabetes often visit their doctor for glucose control. These visits provide an excellent opportunity for their doctor to recommend various vaccines as per their age group and other risk factors.Vaccines of particular importance in Diabetes are pneumococcal vaccine, influenza vaccine, hepatitis B vaccine and zoster (shingles) vaccine.Dr Bharat D. Purandare (MD. Medicine, Fellowship inID) isan Infectious Disease Consultant.