Diabetes and wound healing
Diabetes and wounds
Minor cuts, surgical wounds and burns are an unfortunate but unavoidable part of life. But for people with diabetes, these injuries can lead to serious health issues. When a person has diabetes, a wound that does not heal can quickly become life-threatening. However, with prompt treatment and effective glucose management, diabetic wounds do not need to be a catastrophe.
According to the Centers for Disease Control (CDC), around 30.3 million people in the United States have a type of diabetes, and many of these people experience complications caused by infected wounds.
Many people with diabetes develop wounds that are slow to heal, do not heal well, or never heal. Sometimes, an infection might develop and that infection can spread to tissue and bone near the wound or more distant areas of the body. In some cases, and without emergency care, an infection can be life-threatening or may even be fatal. Even when an infection does not develop in a wound, slow healing can adversely affect a person's overall health and quality of life. Cuts or injuries on the feet or legs can make walking difficult or exercise painful.
It is essential that people who have diabetes keep their blood sugar levels under control to reduce the risk of slow-healing wounds and complications, including foot ulcers. According to some reports, foot ulcers will develop in about 25% of those with diabetes. Foot ulcers are painful sores that can ultimately lead to foot amputation. It’s estimated in an article in the American Journal of Managed Care (AMJC), that approximately 230 amputations take place every day in the United States as a result of diabetes.
People with type 1 diabetes will need to take insulin for life to control blood sugar. People with type 2 diabetes have more options — as well as taking insulin and other medications, making some lifestyle adjustments, such as a changes in diet, regular exercise, and weight management may substantially improve a person's blood sugar levels.
People with both type 1 and type 2 diabetes can benefit from a carbohydrate-controlled diet. Talk to a doctor who will individualize a meal plan that includes a specific amount of carbs that a person should eat each day.
It’s widely known that there is a correlation between blood glucose and wound healing. Diabetes causes impairment in the body's production of or sensitivity to insulin, a hormone that allows the cells to take and use glucose from the bloodstream for energy. This disruption to insulin makes it more difficult for the body to manage blood glucose levels.
When blood glucose remains permanently high, it impairs the function of white blood cells. White blood cells are central to the role of the immune system. When white blood cells are unable to function correctly, the body is less able to fight bacteria and close wounds.
People with uncontrolled diabetes may develop poor circulation. As circulation slows down, blood moves more slowly, which makes it more difficult for the body to deliver nutrients to wounds. As a result, the injuries heal slowly, or may not heal at all.
Diabetes can also cause neuropathy (nerve damage), which can also affect wound healing. Uncontrolled blood glucose can damage the nerves, numbing sensations in the area. This may mean that people with diabetes who sustain trauma to their feet might not be aware of the injury and the wound might not receive treatment promptly. Delayed healing and reduced sensation in the area significantly increases the risk of infection.
Risk factors for infection
People with diabetes have an increased risk of developing a bacterial infection in the wound.
Factors that may increase this risk include:
dry and cracked skin
foot abnormalities, such as Charcot's foot
Other ways diabetes might affect wound healing include:
reduced production of growth and healing hormones
decreased production and repair of new blood vessels
a weakened skin barrier
reduced collagen production
Complications of diabetic wounds
Wounds can develop gangrene, and in severe circumstances, this might require amputation. If an untreated wound becomes infected, the infection may spread locally to muscle and bone (osteomyelitis). If an infection develops in the wound and is left untreated, it can progress to the stage of gangrene, which is a common cause of amputation. Sometimes, people with uncontrolled infections develop sepsis, which occurs when an infection spreads into the bloodstream. Sepsis can be life-threatening.
Prevention of diabetic wounds
People with diabetes can use specific strategies to improve the time it takes for a wound to heal. These include managing blood glucose, thorough foot care, and treating wounds as they occur.
Foot care for diabetes
Appropriate foot care includes:
washing feet daily
patting the skin dry before applying moisturizer
avoiding walking barefoot
carefully trimming toenails
wearing comfortable shoes
inspecting feet and looking inside shoes daily
having a doctor check the feet at each visit
It is essential that people with diabetes carefully monitor their wounds. While wounds might heal slowly, it is not normal for them to remain open for several weeks, to spread, ooze, or become extremely painful.
While an infection might not develop in every ulcer or wound, the first step to preventing it is to clean the wound and cover it with a clean bandage. Repeat this daily.
It might be a good idea for people with diabetes to wear shoes and socks when walking around, especially if a wound has developed. Being barefoot increases the risk of infection.
People who have any type of diabetes should seek treatment if a wound develops on their foot and does not heal. A person will often need to take antibiotics to combat any infections and might require hospitalization if the wound is severe.
Take away message
People with diabetes should immediately contact a doctor when they develop serious or painful wounds that do not heal after several days, or if an infection seems to have developed.
A combination of aggressive antibiotic treatment, wound cleaning, surgical removal of dead tissue, and more effective glucose control may help. If the wound does not respond to treatment, amputation may be necessary. People should take preventive steps before wounds develop to reduce the risk of wound healing complications.
One intervention that may help prevent amputation is Hyperbaric Oxygen Therapy. When used in conjunction with proper wound care, antibiotic therapy and glycemic control, HBOT can promote healing, reduce infection, prevent amputation and loss of life in diabetic patients with chronic wounds. Health insurance, including Medicare, typically covers HBOT for diabetic wounds after only 30 days of failed treatment with standard therapy.
If you or your loved one is faced with a non-healing wound in the setting of diabetes, please call our clinic to discuss the use of HBOT at 781-961-7887 or email us at firstname.lastname@example.org.