How does diabetes affect wound healing?
A person who manages their diabetes well can improve the rate at which wounds heal and reduce the chances of developing a severe infection.
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.
In this article, we look at the effects of diabetes on wound healing and ways to reduce the risk of complications.
Diabetes and wound healing
For people with diabetes, wounds heal more slowly and are prone to infection.
Minor wounds, cuts, and burns are an unfortunate but unavoidable part of life. However, for people with diabetes, these injuries can lead to serious health issues.
Many people with diabetes develop wounds that are slow to heal, do not heal well, or never heal. Sometimes, an infection might develop.
An 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 1 in 4 people with diabetes. Foot ulcers are painful sores that can ultimately lead to foot amputation.
According to an article in the American Journal of Managed Care (AMJC), about 230 amputations take place every day in the United States as a result of diabetes.
A 2013 study found a clear correlation between blood glucose and wound healing.
The research revealed that people undergoing surgery for chronic diabetes wounds were more likely to heal fully if they were controlling their blood glucose well at the time of surgery.
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.
If a person is not aware of an injury, they might not receive treatment, which might allow the wound to worsen. A combination of slow healing and reduced sensation in the area significantly increases the risk of infection.
People with either type 1 or type 2 diabetes have an increased risk of developing a bacterial infection in the wound.
Factors that may increase this risk include:
- impaired sweating
- dry and cracked skin
- toenail infections
- 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
Wounds can develop gangrene, and in severe circumstances, this might require amputation.
People who experience poor wound healing due to the effects of diabetes on the nerves and blood vessels might also experience other complications. These include heart disease, kidney disease, and eye problems.
If an untreated wound becomes infected, the infection may spread locally to muscle and bone. Doctors call this osteomyelitis.
If an infection develops in the wound and is left untreated, it can progress to the stage of gangrene. Gangrene is a common cause of amputations in people who lose limbs as a result of diabetes.
Sometimes, people with uncontrolled infections develop sepsis, which occurs when an infection spreads into the bloodstream. Sepsis can be life-threatening.
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.
Glucose control is essential for preventing slow wound healing.
People who manage their blood glucose levels are less likely to experience severe wounds that do not heal.
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 healthful diet, regular exercise, and weight management may substantially improve a person's blood sugar levels.
These lifestyle changes may even allow a person to manage diabetes without medication.
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.
When a person has diabetes, a wound that does not heal can quickly become life-threatening. A positive outlook for slow-healing wounds depends on prompt treatment and effective glucose management.
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.
Is there a way to save a limb if gangrene develops?
Gangrene typically refers to a critical loss of blood supply with tissue destruction and possibly infection. Gangrenous tissue needs to be removed surgically.
However, if a doctor diagnoses the condition early, and there is a limited risk to tissue, a full amputation might not be necessary.
Early intervention and detection are crucial.Maria Prelipcean, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.