Itching in Type 2 Diabetes: Not Just Discomfort, but an Important Signal from the Body
Skin itching (medical term: pruritus) is a common and extremely unpleasant companion of type 2 diabetes. It is not an independent disease, but an important indicator that diabetes is affecting the body systemically. Ignoring this symptom can lead to complications, and relieving it often begins with improving diabetes control.
Why Does Itching Occur in Diabetes? Main Causes
High blood glucose levels (hyperglycemia) — the key cause
Skin dehydration:
Excess sugar in the blood forces the body to excrete it through urine, taking large amounts of fluid with it. The skin becomes dry, dehydrated, flaky, and itchy. This is the most common cause of diabetic itching.
Blockage of small blood vessels:
Glucose damages the walls of small capillaries that supply the skin. Microcirculation worsens, the skin receives less oxygen and nutrients, leading to thinning, dryness, and increased sensitivity.
Irritation of nerve endings:
Chronically elevated blood sugar can damage small nerve fibers (peripheral neuropathy). This damage may manifest not as numbness or pain, but as neuropathic itching—a distressing, often localized sensation (for example, on the shins or back) that is difficult to relieve with conventional remedies.
Fungal and Bacterial Infections
High levels of sugar in the blood and sweat create an ideal environment for the growth of microorganisms, especially yeast fungi of the Candida genus.
Common locations:
Groin folds, under the breasts, armpits, between the fingers and toes, corners of the mouth.
Such itching is usually accompanied by visible signs: redness, rash, whitish coating, and small cracks.
Allergic Reactions to Medications
Itching may be a side effect of certain glucose-lowering drugs or insulin. It is important to note whether itching appeared after starting a new medication and to inform your doctor.
Comorbid Conditions
Type 2 diabetes often coexists with other conditions that can cause itching: diseases of the liver and gallbladder (cholestasis), kidneys (with the development of nephropathy), and the thyroid gland.
What Kind of Itching Occurs? Typical Features
Generalized:
Widespread itching over the entire body, most often associated with dry skin or systemic causes.
Localized:
In specific areas (shins, feet, scalp, anogenital region). Often points to neuropathy or infection.
Persistent, distressing itching that interferes with sleep and concentration.
Scratching-related damage, which can lead to lichenification (thickening and roughening of the skin) and secondary bacterial infections (pyoderma)—a serious complication.
What to Do? Action Plan and Treatment
Treatment of itching in diabetes always requires a comprehensive approach aimed at eliminating the underlying cause.
1. The Main Step — Achieving Diabetes Control
Regular monitoring of blood glucose levels (self-monitoring).
Achieving target glycated hemoglobin (HbA1c) values.
Adhering to diet, taking prescribed medications, and maintaining physical activity.
Often, improved glycemic control alone significantly reduces itching within a few weeks.
2. Proper Daily Skin Care (for dryness)
Hygiene:
Use warm, not hot, water. Choose mild, pH-neutral, fragrance-free cleansing gels or creams.
Moisturizing:
Daily, after showering, apply special creams or lotions for diabetic skin (with urea, lactic acid, collagen) to slightly damp skin. Avoid products containing alcohol.
Hydration:
Drink enough water.
Clothing:
Wear clothes made of natural, breathable fabrics (cotton, linen).
3. Medications and Topical Treatment
(PRESCRIBED BY A DOCTOR ONLY)
Antihistamines (e.g., cetirizine, loratadine) may help with an allergic component but are often ineffective for neuropathic or metabolic itching.
Topical treatments:
For fungal infections: antifungal creams/ointments (clotrimazole, etc.).
For neuropathic itching: ointments with capsaicin or local anesthetics.
In severe cases: short courses of topical corticosteroids as prescribed by a dermatologist.
Treatment of neuropathic itching:
A doctor may prescribe medications typically used for neuropathic pain—gabapentin, pregabalin, or amitriptyline.
Antidepressants may be considered for chronic itching that disrupts sleep and quality of life.
4. Mandatory Specialist Consultations
Endocrinologist: to adjust diabetes therapy.
Dermatologist: for accurate diagnosis of the cause of itching (especially with rashes or infections) and topical treatment.
Neurologist: if a neuropathic origin of itching is suspected.
When Should You Seek Medical Help Urgently?
The itching is unbearable and disrupts sleep and daily life.
A rash, pustules, ulcers, or pronounced redness appear.
Itching is accompanied by yellowing of the skin or eyes, dark urine (a sign of liver or gallbladder problems).
Scratched areas become inflamed, hot to the touch, or produce discharge (signs of infection).
Conclusion
Itching in type 2 diabetes is not just a minor nuisance, but an SOS signal from your skin and nervous system. It indicates that blood sugar levels are too high and/or complications have already begun. The most effective strategy is not merely to suppress the symptom with ointments, but to focus on achieving stable diabetes control in close cooperation with your healthcare provider.