Diabetic Wound Treatment
Cuts, burns, abrasions, and basic wounds are a part of everyday living. But with diabetes it’s more important when it comes to healing. More often than not, we experience some form of injury or mishap, I mean no one has the invincibility of Superman or the immunity of Wonder woman! However, the case isn’t as straightforward with diabetics. These basic wounds and injuries, which many people class as insignificant or “it’ll go on its own”, have a more dramatic effect on the overall health of diabetics.
Diabetics often suffer enigmatic complications from very insignificant wounds; complications which, if not managed properly, can often be a threat to their very lives. So what are the ways in which diabetics can properly treat wounds? What information do diabetics require to arm themselves with the appropriate knowledge on how to treat even the most advanced wound complications? Well, we’re here to find out.
Understanding Just How Diabetes Works
Diabetes Mellitus, commonly known as Diabetes is a disorder of metabolism. To put this simply, a metabolic disorder is essentially a disorder that disrupts the natural process of metabolism (conversion and utilization of energy by organs of the body). In the case of diabetes, the focal zone is glucose (blood sugar) regulation.
INSULIN is a hormone, produced in the pancreas (an organ behind the stomach), that regulates the blood sugar in the body. Essentially, insulin is needed to move the sugar or glucose (converted from the breakdown of the carbohydrates we eat) around the body and into our cells. Our cells then store the glucose and provide the energy we need to carry out daily activities. Insulin disruption leads to the diabetic condition, and there are three main forms:
- Type 1 diabetes; which occurs when the pancreas is not producing enough insulin. People with type 1 diabetes need daily insulin injections to live.
- Type 2 diabetes; which occurs when the fat, liver, and muscle cells do not respond correctly to the insulin produced in the pancreas. Consequently, blood sugar does not get into these cells and can’t be stored for energy.
- Gestational Diabetes; which develops during pregnancy. In this form of diabetes, pregnant women without a prior history of diabetes, develop unusually high blood sugar levels. In gestational diabetes, blood sugar levels usually stabilize after delivery, but there is still the possibility of developing type 2 diabetes.
Diabetes may lead to many complications ranging from kidney damage, eye damage, cardiovascular disease, nerve damage, foot damage, skin conditions and healing impairment. Diabetes, unfortunately, has no cure (YET) and it is always advised to consistently manage, monitor and control blood sugar levels by eating healthily, exercising regularly and scheduling frequent health checkups.
How Does Diabetes Affect Healing?
As the title of this article suggests, we have sought out on a journey to understand the effective ways of treating diabetic wounds. But how exactly does diabetes affect healing?
The first and most important factor is blood sugar level. High blood sugar levels have the unwanted consequence of disrupting the body systems. When there is an accumulation of sugar (glucose) in the blood, the blood vessels begin to narrow and the arteries begin to stiffen.
As a result, blood is not circulated around the wound site making it difficult for oxygen to reach the wound and instigate healing. Also, increased glucose levels greatly decrease the functioning of red blood cells carrying nutrients to the injured area and consequently limit the ability of the white blood cells to fight infection.
Another very important factor that impairs the healing of wounds is diabetic neuropathy. Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. Elevated blood sugar levels often damage nerves throughout the body. This damage, in many cases, is irreversible and leads to an increasing numbness (loss of pain sensation) in the affected areas.
As a result, most patients do not feel sensation in their limbs, making it difficult to sense a blister, infection, or existing wound change and hence, utterly paralyze their abilities to heal. Diabetic neuropathy most often affects the nerves of the feet and legs, causing foot ulcers and leg wounds which heal slowly or hardly heal at all.
It is important to establish that high glucose levels also lower the body’s ability to fight infections by attacking and damaging the body’s immune system. This is called Immunosupression. In a high glucose environment, the immune system fails to efficiently produce the hormones associated with healing and thus, increases the risk of bacterial infections.
These bacterial infections have the ability to completely shut down the immune system and consequently, retard healing and increase the risk of infection.
On to Diabetic Wounds
Now that we’ve understood the mechanism of infection and how diabetes impairs healing, we can proceed to understand how diabetic wounds can affect the health of diabetics.
As we’ve already established, Diabetic wounds are quite simply that: Wounds that are associated with diabetes. These wounds could be as insignificant as an insect bite, or as chronic as foot ulcers.
Many a time, the mechanisms of diabetes that impair healing are so significant that amputations may be necessary to avoid spread (if a wound is left untreated, it may become infected and spread locally to the muscle and bone [osteomyelitis] or to the blood stream [sepsis]) or death.
Diabetic wounds can occur on virtually every part of the body. However, one of the most prevalent forms of diabetic wounds is diabetic foot ulcers.
A diabetic foot ulcer is an open sore or wound which is sustained and complicated over a period of time due to high glucose levels causing a combination of neuropathic, weak immune system and poor circulation factors.
Diabetic foot ulcers affect around 15-20% of people with diabetes and according to a paper published in June 2017 in The New England Journal of Medicine, it is estimated that between 19% and 34% of diabetics will struggle with at least one foot ulcer in their lifetime, with about 20% of them requiring a total amputation.
Foot ulcers can transform from a tiny opening in the foot to a full-grown infection requiring amputation. The devastating part of this is: The transformation can literally happen overnight!
Management and Treatment of Diabetic Wounds
Through a combination of diabetes-induced factors, diabetic wounds often have a hard time healing and can cause serious health complications. Diabetic wound management and treatment is of vital importance when dealing with diabetic wounds to ensure that the affected diabetic patient sustains an acceptable quality of life.
There are a number of steps to take when it comes to the treatment of a diabetic wounds. The first step to take is basic assessment of the wound. Diabetics who notice the onset of a diabetic wound are advised to see a doctor immediately. A diabetic wound could be classed as Ischaemic, Neuroischaemic or Neuropathic.
Upon examination, a medical professional (podiatrist) will identify which class the wound belongs to and proffer a viable treatment procedure. A failure to class a diabetic wound can lead to inappropriate wound treatment which may further complicate matters or possibly result in amputations.
The next step to take in the treatment of a diabetic wound (in this case a foot ulcer), is Wound Debridement. Debridement is the removal of dead or necrotic tissue from the wound area. This helps the medical professional to more closely examine the underlying area, provide drainage for the wound, and optimize the effectiveness of the wound dressing.
After necrotic tissue has been removed and adequately dressed, the next step to take is Infection Control. Exposed diabetic wounds are prone to infections and complications, hence it is important to ensure that they are guarded as sensitively as possible. Topical antibiotics, Anti-bacterial ointments and lotions and Topical antimicrobials should be appropriately applied to reduce the possibility of further complication from infections.
Also, advanced wound care dressings (such as Honey sheet dressings, Alginate dressings, and Occlusive dressings, amongst others) help to balance moisture and give the wound a chance to drain and heal properly.
In the case of Foot or leg ulcers, an important treatment to consider is Pressure Offloading. Medical professionals have proved that taking pressure or weight off a wound can greatly reduce the likelihood of complications by giving the affected area more room to breathe and thus, fractionally improving healing.
In the more extreme cases of diabetic wounds, surgery may be required to alleviate the possibility of long-term complications to the diabetic’s health. Amputation is the ultimate necessity when a wound has been complicated to the point of no return.
The Role of Nutrition in Diabetic Wound Treatment
Diabetic wounds are complicated by a variety of factors, chief among them being elevated blood glucose levels. The importance of nutrition to stabilizing these high blood sugar levels cannot be underemphasized. Poor nutrition can result in altered immune function and poor glycemic control which are risk factors for poor healing.
As a result, the National Pressure Ulcer Advisory Panel (NPUAP) has established evidence-based nutrition recommendations for the prevention and treatment of pressure ulcers. These nutritional recommendations help to ensure that blood sugar levels are regulated whilst promoting immune system functions for the overall health.
Statistics show that by 2030, around 600 million people around the world would be diabetic, with approximately 30% developing some form of diabetic wound or the other during their lifetime (20% of these being foot ulcers). Diabetic wound treatment is critical to address as soon as possible.
It is important to identify and prevent the onset of diabetic wounds and manage them effectively once they appear in order to greatly improve quality of life and ensure a prolonged existence irrespective of the odds.
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