Diabetes Mellitus is a condition in which the body cannot synthesise or utilise insulin properly. As a result, the body is unable to take up glucose into its cells to use as fuel, which leads to elevated glucose levels in the bloodstream. Minor cuts, burns, sores, and ulcers, especially to the feet, are a part of daily life. Healing of wounds is a complex process that majorly depends on intact nerve function and adequate blood flow to the affected area, as well as robust immunity of the body to fight off infections.
In India, foot ulcers occur in 15-25 per cent of diabetics during their lifetime, of which 50 per cent become infected, and up to 20 per cent require amputations.
What is the link between diabetes and wound healing?
Research shows a clear correlation between elevated blood glucose levels and poor wound healing. High blood glucose levels damage the nerves, causing numbing of the sensations in the area, called diabetic neuropathy. This means that people with diabetes who sustain day-to-day minor trauma to their feet might not be aware of the injury, and they may not receive prompt care, which allows the wound to worsen.
Nerve damage also leads to dry, cracked skin, which allows a convenient entry point for the infection into the body. Uncontrolled diabetes also affects circulation, causing blood to move sluggishly. With inadequate blood flow, the body becomes unable to promote the body’s ability to ward off infections and promote the healing process.
Moreover, when blood glucose levels remain constantly high, the function of the white blood cells, which are responsible for protecting your body from various infections, is impaired. Consequently, the immunity of the body is compromised, and it is less able to fight bacteria and close wounds.
The infection can later spread to the muscles and bones causing osteomyelitis, or it can progress to the stage of gangrene and ultimately amputation of the affected limb may be needed to halt the spread of gangrene. Sometimes, the infection spreads to the bloodstream causing sepsis, which is a dangerous condition and can be life-threatening.
Diabetes might also affect wound healing in other ways, like reducing the local production of growth and healing hormones, decreasing the production and repair of new blood vessels, and reducing collagen production.
Foot care instructions for diabetic patients
- Inspect the feet daily. Check for cuts, blisters, redness, swelling, or nail problems. Use a hand mirror to look at the bottom of the feet.
- Bathe the feet in lukewarm, never hot, water. Confirm the temperature of the water with your fingers/hands.
- Moisturise the feet, but not between the toes. Using a moisturiser regularly will help keep dry skin, itching and cracking at bay.
- Cut nails carefully. Cut them straight across, and file the edges. Avoid cutting the nails too short, as it could lead to ingrown toenails, which can lead to complications.
- Never treat corns or calluses by yourself. No “bathroom surgery” or medicated pads. Visit the doctor for appropriate treatment.
- Always wear clean, dry, cotton socks. Change them daily. Wear socks to bed, especially if the feet get cold at night. Never use a heating pad or a hot water bottle.
- Never walk barefoot, not even at home! Always wear shoes or slippers. Shake out the shoes and feel the inside before wearing them.
- Never again wear the footwear which has caused an ulcer once. Preferably buy the footwear in the evening. The inside of the shoe should be 1-2 cm longer than the foot and should not be too tight or too loose. In case of deformities, one may need special footwear. Ask the doctor regarding the same.
- Do not smoke as it can restrict the blood flow in the feet.
- Take care of diabetes. Keep the blood glucose levels under control.