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Why Do Diabetics Have Problems With Wounds?

Diabetic Foot Problems

Diabetic Foot Problems

What foot problems can be caused by diabetes? Diabetes mellitus can cause serious foot problems. These conditions include diabetic neuropathy (loss of normal nerve function) and peripheral vascular disease (loss of normal circulation). These two conditions can lead to: Diabetic foot ulcers: wounds that do not heal or become infected Infections: skin infections (cellulitis), bone infections (osteomyelitis) and pus collections (abscesses) Gangrene: dead tissue resulting from complete loss of circulation Charcot arthropathy: fractures and dislocations that may result in severe deformities Amputation: partial foot, whole foot or below-knee amputation What are the symptoms of a diabetic foot problem? ​Symptoms of neuropathy may include the loss of protective sensation or pain and tingling sensations. Patients may develop a blister, abrasion or wound but may not feel any pain. Decreased circulation may cause skin discoloration, skin temperature changes or pain. Depending on the specific problem that develops, patients may notice swelling, discoloration (red, blue, gray or white skin), red streaks, increased warmth or coolness, injury with no or minimal pain, a wound with or without drainage, staining on socks, tingling pain or deformity. Patients with infection may have fever, chills, shakes, redness, drainage, loss of blood sugar control or shock (unstable blood pressure, confusion and delirium). How do some of these complications develop? ​Neuropathy is associated with the metabolic abnormalities of diabetes. Vascular disease is present in many patients at the time of diagnosis of diabetes. Ulcers may be caused by external pressure or rubbing from a poorly fitting shoe, an injury from walking barefoot, or a foreign object in the shoe (rough seam, stone or tack). Infecti Continue reading >>

Enluxtra Helps Heal Diabetic Wounds Faster

Enluxtra Helps Heal Diabetic Wounds Faster

ENLUXTRA Smart Self-Adaptive Dressing is the first and only self-regulating superabsorbent fiber dressing with adaptive absorbencyand built-in adaptive hydration function. The dressing utilises patented smart polymers for sensing the underlying tissue conditions and adapting local functions accordingly, in order to reliably maintain sustainable moist healing environment and gently cleanse a wound when needed. PRESCRIBING U.S. PROFESSIONAL? ​For diabetic foot patients, Enluxtra clinical studies show outstanding results. Diabetes makes healing process much more sensitive to deviations from ideal healing conditions. Enluxtra makes healing easier by continuously adapting the dressing's function to every part of the wound individually, down to every square millimeter. ​ Enluxtra is the only dressing that controls what is going on in the wound and adjusts its properties on the fly: 1. If parts of the wound are exuding large amounts of fluid, Enluxtra absorbs and retains the fluid inside itself, preventing maceration. 2. At the same time, if any part of the wound becomes too dry, Enluxtra is able to provide moisture exactly to that part, preventing desiccation. 3. Sustainable moist wound environment, created by Enluxtra, supports effective natural autolysis of non-viable tissues. Autolytic process is gentle and selective, it affects ONLY non-viable tissues while they are present in a wound, and STOPS when the wound becomes clean, so viable tissues are protected. 4. Unlike any other dressing, Enluxtra is able to effectively evacuate microorganisms, disintegrated biofilms, and liquefied components of slough and necrotic tissue, as well as other pro-inflammatory components, from the wound. This fast non-traumatic natural cleansing process stops chronic inflammation and accele Continue reading >>

Elevated Blood Sugars How Do They Affect Wound Healing?

Elevated Blood Sugars How Do They Affect Wound Healing?

Constant high blood sugar levels can cause your wounds to heal slowly. It can also cause your wound to not heal. Monitor and control your blood sugar. This is one of the most important things you can do to heal your wound. Work closely with your doctor to heal your wound as quickly as possible. It can also decrease possible complications. Your doctor may ask you to keep track of your blood sugar changes. Check them at home as often as you doctor has asked you to. You may want to write down your blood sugar results. This will tell you what your blood sugar level is at any one time. How Can I Tell How Well I am Doing with Managing My Diabetes? An HbA1C (estimated glucose average) will give you an idea of how well your blood sugar was controlled over the last three months. It shows you and your doctor how well your diabetes treatment plan is working. A goal HbA1c number for most people is 6%. Your risk for complications increase with every 1% above the goal of 6%. Consistently High Blood Sugar Levels Can Lead to: Skin problems Difficulty fighting infections Nerve damage Clogged arteries A wound that does not heal A wound that heals slowly Amputation What Can I Do? Use your diabetes meal plan. Eat healthy foods including those with less fat and salt and more fiber. Get 30 to 60 minutes of physical activity on most days of the week. Stay at a healthy weight. Learn to cope with stress. Stress can raise your blood sugars. Stop smoking or reduce smoking as much as you can. Take medicines as prescribed even when you feel good. Check your blood sugar when your doctor has told you to. Control your blood sugar level. Take good care of yourself to try to avoid long term diabetic problems. Continue reading >>

Lower Extremity Wound Pathway

Lower Extremity Wound Pathway

People with diabetes or other problems that affect blood circulation can develop ulcers (open wounds) on their legs or feet. Leg and foot wounds associated with poor circulation do not get better by themselves. They can sometimes get worse very quickly, but they can usually heal with treatment from a doctor or nurse. The purpose of this pathway is to make sure that people with these types of wounds get the right care as soon as possible, to promote wound healing, prevent hospital visits, and avoid the possibility of amputation. What can you do, as a patient? 1. Tell your doctor or nurse if you notice an open wound on your legs or feet, especially if you have risk factors that affect your blood circulation. Do not treat the wound yourself or “suffer in silence”. 2. If you know that you have risk factors, pay attention to your legs and feet and be extra careful to prevent cuts or other wounds. Risk factors include: heart disease, kidney disease; diabetes, especially if you have lost some of the feeling in your feet; smoking; obesity; lack of mobility; and previous leg wounds or injuries. 3. If you have a wound, follow the treatment carefully so you can heal faster. Ask your doctor or nurse for help if you have any problem with the treatment. 4. Keep your legs and feet healthy. Many people will have problems with circulation as they age, but there are some things you can do to prevent wounds from happening: Exercise your legs regularly – walk, swim, cycle, or anything you like. Exercising your legs helps to keep your blood pumping. Avoid sitting or standing for long periods of time. If you do, try to alternate by resting, moving around, raising your legs or moving your feet around while seated. Care for your skin with simple, unscented moisturizer. Problems with circ Continue reading >>

How To Care For Cuts And Scratches If You Have Diabetes

How To Care For Cuts And Scratches If You Have Diabetes

If you have diabetes, you may want to be a little more cautious about taking care of simple cuts, scratches, scrapes and bruises. In fact, skin care of any kind is important to your health. Bruises are the simplest to address. As long as the skin is not broken, you really don’t need to do much of anything, except keep an eye on the area. “A bruise is a bruise and will act like a bruise and go through the different changes in color over time,” says dermatologist Christine Poblete-Lopez, MD. “So being diabetic does not necessarily mean it will lengthen the way a bruise will resolve or not.” If you have any type of laceration, however, you should keep a keen watch for infections because diabetics are more prone to developing infections, according to Dr. Poblete-Lopez. The signs of infection to look for around the cut are redness, warmth, tenderness and pus drainage. “If you have any of those signs, you definitely need to bring it to the attention of your doctor, because you may need oral antibiotics,” she says. A diabetes specialist’s approach There are some differences of opinion among diabetes experts and dermatologists when it comes to healing wounds, so we will take a look at both. When cleaning out a cut, for example, diabetes specialist Leann Olansky, MD, says to wash the cut with soap and water and then add an over-the-counter topical antibiotic such as Neosporin® or a prescription ointment such as Bactroban® to help prevent bacteria from entering into your subcutaneous tissue. The next step for Dr. Olansky is to cover the cut with a bandage to keep it moist so that it will heal faster. “I don’t think there’s any advantage to keeping it open to the air,” Dr. Olansky says. “If the edge of a laceration gets dry, those cells dry, and you’r Continue reading >>

Cellular And Molecular Basis Of Wound Healing In Diabetes

Cellular And Molecular Basis Of Wound Healing In Diabetes

Go to: Molecular pathogenesis of diabetic wound healing The moment a person with diabetes suffers a break in the skin of their foot, they become at danger for amputation. Most commonly, patients have neuropathy, which could be causative. When coupled with an impaired ability to fight infection, these patients become largely unable to mount an adequate inflammatory response. Thus, the DFU that may look like a healing wound becomes a portal for infection that can lead to sepsis and require limb amputation. Over 100 known physiologic factors contribute to wound healing deficiencies in individuals with diabetes (Figure 1). These include decreased or impaired growth factor production (6–8), angiogenic response (8, 9), macrophage function (10), collagen accumulation, epidermal barrier function, quantity of granulation tissue (8), keratinocyte and fibroblast migration and proliferation, number of epidermal nerves (11), bone healing, and balance between the accumulation of ECM components and their remodeling by MMPs (12). Wound healing occurs as a cellular response to injury and involves activation of keratinocytes, fibroblasts, endothelial cells, macrophages, and platelets. Many growth factors and cytokines released by these cell types are needed to coordinate and maintain healing. Molecular analyses of biopsies from the epidermis of patients have identified pathogenic markers that correlate with delayed wound healing. These include overexpression of c-myc and nuclear localization of β-catenin (13). Coupled with a reduction in and abnormal localization of EGFR and activation of the glucocorticoid pathway, keratinocyte migration is inhibited (13, 14). At the nonhealing edge (callus) of DFUs, keratinocytes show an absence of migration, hyperproliferation, and incomplete diffe Continue reading >>

Slow Healing Of Cuts And Wounds

Slow Healing Of Cuts And Wounds

Tweet Wounds or sores that take more than a few weeks to heal might be infected and require medical treatment, and often indicate an underlying disease such as diabetes. When you cut or burn yourself, your body begins a three-stage process to repair the damaged skin. First, an immune response causes the wound to become inflamed to prevent infections. Second, new cells (a scab) form over the wound, and finally scar tissue forms to heal the wound. Some wounds heal easily while others can take longer, particularly if they are severe or the individual has a poor state of health. Causes of slow wound healing There are a number of things that can delay or complicate the healing of wounds, including: Diabetes and slow healing wounds High levels of blood glucose caused by diabetes can, over time, affect the nerves (neuropathy) and lead to poor blood circulation, making it hard for blood - needed for skin repair - to reach areas of the body affected by sores or wounds. This can cause them to remain open and unhealed for months, increasing the risk of: Fungal infections Bacterial infections Gangrene Keeping blood glucose levels under good control can help to reduce the risk of slow healing wounds now and further in the future. Slow healing wounds can be a symptom of undiagnosed diabetes, particularly if other symptoms are also present. Slow healing of wounds, including cuts, grazes and blisters, can be particularly problematic if they affect the feet of someone with diabetes and if not treated properly, can raise the risk of amputation. It is important therefore that people with diabetes check their feet daily and report any signs of damage to their health team. When to see your doctor If you do not have diabetes and a cut or burn is taking a long time to heal or showing signs of Continue reading >>

Why Do Cuts Take So Long To Heal?

Why Do Cuts Take So Long To Heal?

What can I do to help with the healing of cuts? I have type 2 diabetes and it seems to take forever for any wounds to heal. — Sally, New York You raise an important issue. Wounds are more difficult to heal in people with diabetes for various reasons: Wounds are infected quite easily; blood circulation to the wound might be poor; some diabetics might have nutritional deficits; and often wounds are managed poorly. More importantly, having high glucose levels causes poor immune response and makes the cell walls become rigid. As a result, the flow of much-needed oxygen and nutrients is impaired. Feet in particular are more vulnerable to wounds that heal poorly, especially among diabetics who have lost sensation due to nerve damage. My first recommendation is to examine your hands, feet, and other vulnerable areas such as insulin injection sites daily for any sign of early skin breaks. Second, if you have identified worrisome areas, seek immediate medical attention. A callus or scrape on your feet, and especially any sign of infection in the toe webs (the connective skin between your toes) should be taken care of early by a foot specialist or your doctor. This is a very important step to prevent the development of ulcers or a skin infection called cellulitis. Third, if you have a skin break on your feet, try to stay off your feet. If you have a wound anywhere else, prevent pressure that will further compromise blood circulation. Fourth, always maintain adequate nutrition and hydration. Fifth, and most importantly, maintain a close-to-normal glucose level. Once you have an ulcer, close follow-up with your doctor or a wound specialist is important. You might need to apply an antibiotic ointment or take an antibiotic pill if the wound is infected. Also, the wound should be ke Continue reading >>

Wounds That Don't Heal Can Lead To Other Health Problems

Wounds That Don't Heal Can Lead To Other Health Problems

Normal wounds heal within weeks, but for people with health problems, the injuries may fester for much longer. In the worst cases, persistent wounds that aren't treated can infect the bone and even lead to amputation. Dr. Kapil Gopal, vascular surgeon and assistant professor of surgery at the University of Maryland School of Medicine and medical director of the Maryland Wound Healing Center at the University of Maryland Medical Center's Midtown Campus, talks about treatment options for severe wounds. What is a healthy amount of time for it to take a wound to heal? The amount of time it takes to heal a wound is variable and depends upon several factors. These include the cause and size of the wound, nutritional status of the patient and their overall medical condition. Decreased blood flow can play a critical role in how fast a wound heals. The presence of active smoking, uncontrolled diabetes, persistent pressure, infection or cancer in the wound, along with the patient's environment and current wound-dressing regimen, can impair the process of healing. However, in an otherwise healthy patient, a wound should be completely healed or show significant signs of healing within four weeks. When should a person become worried about a wound and go to see a doctor? The skin is the largest organ system in the body and functions as a barrier. When a wound is present, there is an opening in this barrier, and the longer it remains open, the greater the chance that bacteria can cause an infection. This can affect not only underlying structures like bone, but also cause a life-threatening systemic reaction known as septic shock. In those dire and emergent situations, the only treatment is removal of the infected tissue. This could sometimes mean limb amputation or having a very large Continue reading >>

How Diabetes Affects Wound Healing

How Diabetes Affects Wound Healing

Diabetes is a condition in which the body does not effectively use sugar. It is estimated that there are nearly 18 million Americans with diabetes, and approximately 15 percent of diabetics will develop a foot ulcer at some point. Foot ulcers are the most common wounds for this patient population. Wound healing can be slowed when the patient is diabetic. An important point to remember about a diabetic patient wound is that it heals slowly and can worsen rapidly, so requires close monitoring. There are several factors that influence wound healing in a diabetic patient, and may include: Blood Glucose Levels It all starts here. An elevated blood sugar level stiffens the arteries and causes narrowing of the blood vessels. The effects of this are far-reaching and include the origin of wounds as well as risk factors to proper wound healing. Poor Circulation Narrowed blood vessels lead to decreased blood flow and oxygen to a wound. An elevated blood sugar level decreases the function of red blood cells that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, a wound heals slowly. Diabetic Neuropathy When blood glucose levels are uncontrolled, nerves in the body are affected and patients can develop a loss of sensation. This is called diabetic neuropathy. When there is a loss of sensation, patients cannot feel a developing blister, infection or surgical wound problem. Because a diabetic patient may not be able to feel a change in the status of a wound or the actual wound, the severity can progress and there may be complications with healing. Immune System Deficiency Diabetes lowers the efficiency of the immune system, the body's defense system against infection. A high glucose level ca Continue reading >>

The Role Of Glucose In Wound Healing

The Role Of Glucose In Wound Healing

Maintaining a healthy blood sugar level is important to the wound healing process. People who have been diagnosed with diabetes are well aware that their bodies may not recover from wounds as efficiently as those without the metabolic condition. For that reason, clinicians heavily stress the importance of diabetic wound care. Maintaining healthy blood sugar levels, staying aware of the condition of the feet and properly caring for lesions and abrasions on the feet are all essential to avoiding infections that could lead to gangrene and, in severe cases, amputation. While many know that blood sugar plays a big role in wound recovery, the precise reason why may still remain a mystery. Learn more about how glucose affects the body and, when too high, can inhibit the healing process. How does blood glucose affect healing? When a person has high glucose levels, they may experience difficulty healing from wounds. That’s because an increased amount of sugar in the blood causes the cell walls to become stiff and rigid, impairing the flow of blood throughout the small vessels located at the surface of the wound. This, in effect, impedes the flow and permeability of red blood cells, which are required for the development of dermal tissue, according to a study conducted at the University of British Columbia. Another way that high glucose levels affect the wound healing process is by impairing the hemoglobin release of oxygen. By doing so, it effectively starves the affected area of oxygen and nutrients that promote healing. The importance of balancing blood sugar Diabetes patients may understand how unbalanced blood sugar can affect the body’s ability to recover from a wound. However, many do not comprehend the severity of the situation. As the journal Ostomy Wound Management Continue reading >>

Wounds & Complications

Wounds & Complications

Diabetes puts you at greater risk for a number of health problems. As you work with your doctors and diabetes educators to control your blood sugar, they will also help you keep an eye on these other potential complications: Wounds and skin problems Foot problems Heart and vascular problems Stroke Trouble with hearing or vision You may develop sores or infections that require special cleaning and care. You may also have trouble with circulation or blood pressure. Or you may need assistance with proper foot care, such as toenail clipping. If you need support, your educator can find out about trained specialists who can come into your home and assist you. Learn more about home care In addition to personal care, you may need supplies. You can find specialized footwear, socks, and bandages at our ThedaCare At Home stores. Getting a Referral Diabetes care starts with a referral from your doctor. Don’t have a primary care doctor at ThedaCare? Find one now Continue reading >>

Wounds And Diabetes

Wounds And Diabetes

Individuals with diabetes are at especially high risk for chronic wounds, especially on the feet. Circulation issues and a decreased sense of feeling, known as neuropathy, can mask the presence of sores and ulcers. Left untreated, these wounds can lead to serious problems, including chronic infections, gangrene and amputations of toes or a limb. Call us at 703-664-8025 for an appointment or for more information. Don't take a chance with your health It is vitally important for a physician to assess any foot wound on a person with diabetes as soon as possible. The experts at Inova Wound Healing Center are highly experienced in treating and healing chronic wounds for people with diabetes. We have cared for individuals from throughout the northern Virginia and Washington, DC, metro area. Our hyperbaric oxygen therapy program (HBO) at Inova Mount Vernon Hospital is one of several effective healing options. Read more about Inova's conditions and treatments Statistics 1.5 million people who suffer from chronic wounds have diabetic ulcers 15 percent of all people with diabetes develop chronic wounds People with diabetes have a 15-fold increase in the risk of amputation 60,000 people with diabetes will undergo amputation Half of all people with diabetes have or will develop neuropathy (loss of sensitivity), which can lead to injuries, sores, chronic infections, gangrene or amputations Diabetes-related amputation could be reduced by 50 percent (according to the American Diabetes Association) if patients were tested routinely for neuropathy (decreased sensitivity), educated to prevent injury or complications, and provided related ancillary services Continue reading >>

Diabetes Complications - Foot Problems

Diabetes Complications - Foot Problems

Diabetes and Foot Problems Foot infections are another important concern for people with diabetes. Diabetes-related nerve damage can reduce feeling in the feet, making it difficult to detect a foot injury. Diabetes can also impair blood circulation and wound healing by narrowing the arteries that carry blood to the legs. This combination is extremely serious, because a wound on your foot or leg that doesn't heal can turn into an ulcer (deep sore) that quickly becomes infected. Amputation is often necessary. In fact, one fifth of all hospitalizations in people with diabetes are for foot infections, resulting in over 80,000 lower-limb amputations each year. Blood glucose control, quitting smoking, and proper foot care can greatly reduce these risks. That's why everyone with diabetes, and especially those with neuropathy or poor circulation, should follow a routine of inspecting each foot and lower leg every day and carefully treating and monitoring even the most trivial blister, cut, or abrasion. Any injured areas should be washed with warm water and soap, cleaned with a mild antiseptic (such as Bactine), and covered with a dry, sterile dressing and paper tape. If you do develop a foot or leg ulcer, call your doctor immediately. Because people with diabetes often have poor blood circulation, ulcers can become infected rapidly. Although treatment with antibiotics is needed, it's not enough to cure these serious infections. Incision and drainage procedures are the best treatment. Severe ulcers usually require wearing a boot to protect the foot. These woundcare treatments are so complex that most doctors now send people with infected ulcers to specialized wound care centers. Treatment can take many months because wound dressings must be applied and changed frequently, and de Continue reading >>

A Closer Look At Exercise For Patients With Diabetic Wounds

A Closer Look At Exercise For Patients With Diabetic Wounds

Desmond Bell DPM CWS FACCWS Let me begin by stating that exercise and patients with diabetes are not mutually exclusive. This also holds true for a patient with diabetes who has a non-healing foot ulcer. Preliminary research suggests that exercise may work to increase the rate of wound healing in such patients. That being said, many patients seeking treatment for diabetic foot ulcers are not the most disciplined when it comes to lifestyle choices. Exercise and the lack thereof is often a contributing factor to the declining quality of life that affects many patients with diabetes. Over the years, I have recommended regular exercise to my patients. First, I am an advocate for my patients and want nothing more than for them to enjoy quality in their lives. Too often, patients with chronic ulcers experience a downward spiral of declining health and mental well-being that is marked by seemingly endless doctor appointments. How is it possible to encourage these patients to exercise when they may have never exercised before or simply do not see the potential benefits of getting off the couch? Secondly, I also practice what I preach. I have exercised regularly since I was in grade school, whether it was via after school pick-up games, high school sports, or later in life as a fitness instructor in a commercial health club and as a competitive men’s softball player. Even now with a hectic daily schedule, I manage to get out and walk an hour and hit the gym at least three times per week. Nothing clears your mind and helps you focus like a brisk walk or a 30-minute stretch and circuit in the gym. It does take some planning but as legendary basketball Coach John Wooden used to say, “Plan your work and work your plan.” Why shouldn’t we “plan our exercise and exercise our Continue reading >>

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