Nearly three of every four women will have a yeast infection in their lifetimes, and up to 45 percent of women will have two or more. Women tend to be more susceptible to vaginal yeast infections when their bodies are under stress from lack of sleep, poor diet, pregnancy, or antibiotic use. And women with immune-suppressing diseases like diabetes and HIV are at a significantly higher risk of getting yeast infections.

Over nine million American women, or nearly nine percent of all adult women in the U.S., have diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases. For this population, understanding the risk of yeast infections, and knowing how to prevent or treat them, becomes essential.

Below, three experts in the area of vaginal health and diabetes, discuss why women with diabetes are at increased risk, and how they can protect themselves from recurrent yeast infections.

First, why does diabetes increase the risk for developing yeast infections?
GERALD BERNSTEIN, MD: It's important to understand what the elevated blood glucose in people with diabetes actually does to the body. When the blood sugar increases, two things happen. One, all the body secretions will have an increased amount of glucose. Two, all of the tissues of the body stop functioning normally, and therefore the normal defenses that the body has against intrusion by outside substances -- such as yeast -- will be abnormal.

Is the risk different between patients who have Type 1 and Type 2 diabetes? And if so, how?
GERALD BERNSTEIN, MD: No, it's not different. An elevated blood sugar acts like a poison, and it will poison both Type 1 and Type 2 patients if the glucose is not controlled.

Obviously, it's important for any diabetic to control blood sugar. But what are the target blood sugars for women that will lower their risk of developing a yeast infection?
GERALD BERNSTEIN, MD: We make a diagnosis of diabetes when a person's blood sugar is 126mg/dL or above. Our goals are to have a patient's morning and before-meal blood sugar at around 100-110 mg/dL and then, after a meal, no more than 140 mg/dL. Now that's what the normal level is. When we let the glucose levels rise past these numbers, people develop problems.

What role does diet play in the development of yeast infections in women with diabetes?
GERALD BERNSTEIN, MD: Diet can be used as a tool to control glucose levels, just like medications and insulin. We control the amount of glucose that comes into the body through our diet. By controlling the blood sugar through diet, we control the blood sugar in the vaginal secretions and the impact of that glucose on the function of different tissues.

If a woman with diabetes thinks that she has a yeast infection, what should she do?
JOSEPH APUZZIO, MD: She should visit her doctor to make a diagnosis. The diagnosis is really crucial.

And there are certain tests that she should make sure her doctor performs. Is that correct?
JOSEPH APUZZIO, MD: Yes. In order to make a diagnosis, one should do a slide test of vaginal secretions under the microscope, to see if it is a yeast organism causing the infection. Usually that will suffice. Sometimes one also has to culture the vaginal secretions as well, but that's in a small number of patients.

GLORIA BACHMANN, MD: It is really important for women to visit the doctor before they douche or before they start treatment for the first infection, so that we can see exactly what the vaginal health looks like and make the appropriate diagnosis.

What are the treatment options for a diabetic woman with a yeast infection?
GLORIA BACHMANN, MD: A diabetic woman can use all the same treatments that a woman who does not have diabetes can use. She can use an oral or vaginal treatment, depending on her preference.

How effective are the different options?
JOSEPH APUZZIO, MD: The success rates are probably on the order of 85-90% success, for both pills and creams.

Do yeast infections in women with diabetes take longer to treat in some cases?
JOSEPH APUZZIO, MD: There are one-day therapies, three-day therapies, seven-day or fourteen-day therapies, and usually, patients who are diabetic need the longer therapy, not the shorter.

There are a lot of yeast infection treatment products sold over-the-counter. Is it advisable, especially for women with diabetes, to diagnose and treat themselves this way?
GLORIA BACHMANN, MD: It's advisable once the woman knows what she's dealing with. If she has been diagnosed by her physician before, knows the symptoms, and the physician has looked at the vaginal secretions and confirmed -- under the microscope -- that indeed she has a yeast infection, then she can treat recurrent ones. When she understands what a yeast infection is, and what it feels like, she can treat herself.

Any additional thoughts that you'd like to add?
GLORIA BACHMANN, MD: I think it's important that women understand how essential it is to complete the therapy. Many women will come in and say to me, "You know what? I finished sooner than I should according to the package, because I felt better." It's important not to stop midway.

Also, if a woman still feels that she has symptoms after completing therapy, then she should go back to her doctor and go through a full pelvic examination. The doctor should look at the secretions under the microscope to be sure that the infection has been resolved with the medication.

So bottom line, start with a doctor and make sure that your doctor knows -- when you've completed treatment -- that the infection is gone.