For many individuals living with diabetes, an unexpected yet telling symptom can be the presence of a distinct breath odor, commonly referred to as ‘diabetic breath.’

What is a diabetic breath?

Dr Jaison Paul Sharma, MBBS, MD (Internal Medicine), Sharma Hospital, Garhdiwala, explains, “Diabetic breath, often described as having a fruity or acetone-like odor, is the body’s way of compensating for excessive glucose in the bloodstream. Our body naturally produces insulin and it helps us in processing glucose and converting it into energy.”

However, he adds, when there is a severe lack of insulin in the body, the body is unable to use glucose for energy. “This is when it starts breaking down fat for fuel, leading to the production of ketones as a by-product. These ketones can accumulate in the blood and are exhaled through the breath, giving it a distinctive smell.”

What causes bad breath in diabetes?

Dr Ashok Kumar Jhingan, senior director, Center for Diabetes, Thyroid, Obesity and Endocrinology, BLK-Max Super Specialty Hospital, Delhi, says, “People living with diabetes may produce less saliva and experience dry mouth. Having less saliva in the mouth can reduce a person’s protection against oral conditions, some of which can cause bad breath.”

Festive offer

People with diabetes may also have higher blood sugar levels, he adds, which can increase how much glucose is in their saliva. Extra glucose can Increase the amount of bacteria in the mouth, resulting in a buildup of dental plaque. Not removing dental plaque can lead to tooth decay and gum disease. These can cause halitosis.

Bad breath can also be a sign of a person having diabetes that is not under control or diagnosed. If a person’s body produces ketones too fast, they can build up to dangerous levels, says Dr Jhingan. “One symptom of DKA is having high levels of ketones in a person’s breath like the smell of over ripened fruits. This can cause bad breath.”

Diabetic breath Extra glucose can increase the amount of bacteria in the mouth, resulting in a buildup of dental plaque. (Source: Freepik)

Diabetic breath: An indicator of diabetic ketoacidosis (DKA) or other diabetes-related conditions

“Fruity-smelling breath is a sign of high levels of ketones in someone who already has diabetes. The smell can be similar to that of rotten apples or pear drops. Others may describe this scent as similar to acetone, or nail polish remover,” says Dr Jhingan.

Some people with diabetes have a higher risk of gum disease, also called periodontal disease, he notes. “It’s a problem mainly of type 1 diabetes but also can happen with type 2 if you get a serious condition called diabetic ketoacidosis.”

Common misconceptions about diabetic breath

Dr Mayank Lodha Seth, chief pathologist, Redcliffe Labs, tells“There are several misconceptions about diabetic breath, and people just follow the internet without consulting their clinicians, which further increases the severity of the health risks associated with diabetic breath.”

The first and the most common one, according to him, is that it takes a prolonged time to develop bad breath with diabetes. “Regretfully, that’s not true. DKA and bad breath in diabetes due to other reasons like dry mouth are sudden complications, and they can grow even in a few hours.”

Another common myth is that diabetic breath can only affect people with Type 1 diabetes. Dr Seth stresses, “As of now, higher instances are observed in people with Type 1 diabetes, but it equally impacts people with Type 2 diabetes. The reason for diabetic breath is high blood glucose, so it does not matter if it is Type 1 or Type 2 diabetes.”

People also have a misconception that diabetic breath cannot be identified early. However, he informs that there are visible symptoms that can be self-monitored. “So, if you are conscious about your well-being and cautious about changes in your body, then it is possible to identify, monitor, manage, and control diabetic breath without facing any of the severe consequences.”

Steps individuals can take to monitor and manage symptoms such as diabetic breath

To avoid an emergency and life-threatening situation, Dr Sharma advises patients with diabetes should always pay attention to drinking plenty of fluids and should avoid dehydration. “They should follow the proper dosing of insulin, as advised by their doctor. And they should check for any infection and get themselves treated quickly, because ketosis precipitation can happen if there is any infection in the body,” he concludes.