What causes increased urine frequency in a diabetic patient with controlled blood glucose (blood sugar) levels?

From the Guidelines

Increased urinary frequency in diabetics despite good blood sugar control is most likely caused by diabetic cystopathy, urinary tract infections, or certain diabetes medications like SGLT2 inhibitors, and should be investigated and addressed to prevent complications and improve quality of life. The causes of increased urine frequency in diabetic patients with controlled blood glucose levels can be multifactorial. Some possible causes include:

• Diabetic cystopathy, a bladder dysfunction caused by long-term diabetes-related nerve damage that affects bladder sensation and emptying 1
• Urinary tract infections, which are common in diabetics and can cause frequent urination even when glucose levels are controlled
• Certain diabetes medications like SGLT2 inhibitors (such as empagliflozin, dapagliflozin, or canagliflozin) that directly increase urination as part of their mechanism of action
• Prostate issues in men or pelvic floor disorders in women that can contribute to this symptom To address this issue, patients should:
• Track fluid intake and urination patterns
• Consider timing fluid consumption earlier in the day
• Consult their healthcare provider for evaluation
• Undergo a urinalysis to rule out infection
• Possibly undergo urodynamic testing to assess bladder function Treatment options might include:
• Pelvic floor exercises
• Bladder training
• Antimuscarinic medications like oxybutynin (5mg twice daily) or solifenacin (5-10mg daily)
• Beta-3 agonists like mirabegron (25-50mg daily) for overactive bladder symptoms
• Discussing medication alternatives with their doctor if taking an SGLT2 inhibitor 1. The persistence of urinary symptoms despite good glycemic control highlights the importance of addressing diabetes complications beyond just blood sugar management, as emphasized in the standards of medical care in diabetes 1.

From the Research

Causes of Increased Urine Frequency in Diabetic Patients

• Diabetic nephropathy (DN) is a major complication of diabetes that can lead to increased urine frequency, even in patients with controlled blood glucose levels 2.
• Diabetic kidney disease (DKD) is characterized by injury to both glomerular and tubular compartments, leading to kidney dysfunction over time, which can cause increased urine frequency 3.
• Other factors that can contribute to increased urine frequency in diabetic patients include:
  • High blood pressure (hypertension) 2, 3
  • Genetics 3
  • Lifestyle habits 3
  • Urinary tract infections (UTIs), which are more common in diabetic patients, especially those with poor metabolic control 4, 5
  • Autonomic neuropathy, which can cause incomplete bladder emptying 5
• Increased angiotensin-converting enzyme (ACE) activity levels have also been found in diabetic patients, which can contribute to the development of complications such as nephropathy 6.

Relationship Between Blood Glucose Control and Urine Frequency

• While controlling blood glucose levels is important for preventing complications, increased urine frequency can still occur in diabetic patients with controlled blood glucose levels due to other factors such as DN, DKD, and UTIs 2, 3, 4.
• Poor metabolic control can increase the risk of UTIs, which can cause increased urine frequency 4, 5.
• The relationship between blood glucose control and urine frequency is complex and influenced by multiple factors, including the presence of complications such as DN and DKD 2, 3.