woman with bad breath

Bad Breath and Diabetes

Sweet, fruity, with subtle notes of pear. This isn’t the description of a dessert wine. Instead, these are words often used to describe unpleasant breath associated with diabetes.

Your breath has an interesting ability to provide clues to your overall health. Just as a fruity odor can be a sign of diabetes, an ammonia odor is associated with kidney disease. Similarly, a very foul fruit odor may be a sign of anorexia nervosa. Other diseases, such as asthma, cystic fibrosis, lung cancer, and liver disease also can cause distinct odors on the breath.

Bad breath, also called halitosis, can be so telling that doctors may even be able to use it to identify diabetes. Recently, researchers have found that infrared breath analyzers can be effective in identifying if you have prediabetes or early-stage diabetes. And researchers at Western New England University are testing a breathalyzer that measures blood glucose levels. 

Find out why bad breath can accompany diabetes, and learn what you may be able to do about it.

Diabetes patient describes the extreme thirst and bad breath that comes with diabetes »

What Causes Diabetes Breath?

Diabetes-related halitosis has two main causes: periodontal disease and high levels of ketones in the blood.

Periodontal Diseases

Diabetes and periodontal disease is like a double-edged sword. While diabetes can lead to periodontal diseases, these diseases can also create further problems for people with diabetes. According to a report in IOSR Journal of Dental and Medical Sciences, an estimated one in three people with diabetes will also experience periodontal diseases. Heart disease and stroke, which can be complications of diabetes, are also linked to periodontal disease.

Diabetes can reduce blood flow throughout your body, including your gums. If your gums and teeth aren’t receiving a proper supply of blood, they may become weak and more prone to infection. Diabetes may also raise glucose levels in your mouth, promoting bacteria growth, infection, and bad breath. To make matters worse, when your blood sugars are high it becomes hard for the body to fight infection, which makes healing the gums difficult.

Periodontal diseases, also called gum disease, include gingivitis, mild periodontitis, and advanced periodontitis. In these diseases, bacteria attack the tissues and bone that support your teeth. This may lead to inflammation. Inflammation can affect metabolism and increase your blood sugar, which worsens diabetes. 

If you get periodontal disease, it may be more severe and take longer to heal than in a person without diabetes.

Bad breath is a common sign of periodontal disease. Other signs include:

  • red or tender gums
  • bleeding gums
  • sensitive teeth
  • receding gums


When your body can’t make insulin, your cells don’t receive the glucose they need for fuel. To compensate, your body switches to plan B: burning fat. Burning fat instead of sugar produces ketones, which build up in your blood and urine. Ketones can also be produced when you are fasting or you are on a high-protein, low-carbohydrate diet.

High ketones levels often cause bad breath. One of the ketones, acetone (also the chemical found in nail polish) can cause a nail polish-like odor on your breath.

When ketones rise to unsafe levels, you’re at risk of a dangerous condition called diabetic ketoacidosis (DKA). Symptoms of DKA include:

  • a sweet and fruity odor on your breath
  • more frequent urination than normal
  • abdominal pain, nausea, or vomiting
  • high blood glucose levels
  • shortness of breath or difficulty breathing
  • confusion

DKA is a dangerous condition, mostly limited to people with type 1 diabetes whose blood sugars are uncontrolled. If you have these symptoms, seek medical help immediately.

What You Can Do

Along with neuropathy, cardiovascular disease, and others, periodontitis is a common complication of diabetes. You can, however, take steps to stave off gum diseases or to lessen their severity. Take control with these daily tips:

  • Brush your teeth at least twice a day and floss daily.
  • Don’t forget to brush or scrape your tongue, a prime breeding place for foul-smelling bacteria.
  • Drink water and keep your mouth moist.
  • Use sugar-free mints or gum to stimulate saliva.
  • Visit your dentist regularly and follow treatment recommendations. Make sure the dentist knows you have diabetes.
  • Your doctor or dentist may prescribe a medication to stimulate the production of saliva.
  • If you wear dentures, make sure they fit well and take them off at night.
  • Don’t smoke.

Finding the Care You Need

If you have bad breath, you’re not alone. Approximately 65 million Americans will have halitosis in their lifetime, according to the National Institute of Dental Research.

Bad breath may be a sign of something more. If you have diabetes, it’s important to be aware of what your breath may be telling you. Your understanding may save you from advanced gum disease or the dangers of DKA.