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July 3, 2002

Diagnosis and Symptoms

Question from Marlborough, Massachusetts, USA:

Two months prior to diagnosis, my three year old presented with a yeast infection, and I was convinced that there was a secondary reason to the cause, but this was never considered. She was potty trained and had never had an antibiotic, yet the yeast infection was severe and recurring. Her A1c was 17.7% at diagnosis, which I believe indicates that she obviously had diabetes when the yeast infection started to occur, and shortly after insulin was started, it completely resolved. My son has prediabetes, and, when his blood glucose is elevated, he too gets a yeast infection. With these most vulnerable victims of diabetes, I do not understand why it is not recognized and emphasized in the diagnosis criteria for children. This is basic stuff and could change the level of decompensation that infants, toddlers, and young children are in before diagnosis. Ruling out diabetes in yeast infections would be cost effective as it would prevent in some cases long stays in hospitals. I personally have spoken with many parents throughout the world regarding this issue. Many parents responded that their infants, toddlers, and young children presented with yeast infections, and this included male children some with a yeast infection from the shoulders to knees. Often, the most vulnerable are in critical condition before diabetes is suspected. Why isn't a yeast infection strongly emphasized as a recognized symptom of diabetes to those caring for children?


I can understand your frustration over the delay in recognising a yeast infection as a sign of diabetes in your three year old daughter. In fact, yeast infections are rather uncommon as a presenting sign of type�1A (autoimmune) diabetes.

I am sure that with an initial hemoglobin A1c of 17.7%, there must have been other more usual symptoms. In the last few years these latter have indeed been increasingly publicised, and, with more regional availability of diabetes care teams and attention to diabetes in re-certification courses, it is very unlikely that this problem would recur as a result of inadequate information. This doesn’t mean that there aren’t still areas that need especial emphasis (such as the early signs of cerebral edema) in new onset cases.

Additional comments from Dr. David Schwartz:

I think that recurrent and persistent yeast infections are well recognized as a possible symptom of diabetes, for many of the reasons that you state: yeast love dark, moist places, where there is an abundance of sugar: like a baby’s diaper area or a teenage girl’s vaginal area. However, I think the confounding issue is age and the axiom: “common things happen commonly.”

Far more infants have yeast infections and do not have diabetes than those with yeast infections who do have diabetes. In an adolescent girl, the index of suspicion for diabetes may be a little higher. However, there is no doubt that recurring or persistent infection warrants an answer to the “Why is this happening?” question rather than simply treating.

Another “common things happen commonly” issue is that for many children with diabetes, yeast infections are not the primary issue. Changes in the degree and frequency of urination and thirst occur much more often.

Additional comments from Dr. Linda DiMeglio:

You are quite correct that yeast infections are sometimes related to high blood sugars (since yeast likes to grow in high sugar environments). However, yeast infections are quite common, whereas diabetes is much more uncommon. Therefore, physicians do not consider yeast infections alone as a reason for testing children (or adults) for diabetes unless accompanied by other signs of diabetes such as frequent urination, frequent drinking, weight loss, or vomiting.