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Ask UPMC: How does diabetes affect wound healing?

A small cut or bruise may not seem like a big deal, but for millions of Americans with diabetes, they can be. For individuals with diabetes, all wounds are a serious health concern and require careful attention.

Understanding the Complications

Diabetes is a result of your body’s inability to produce or use insulin. Insulin is a hormone that allows your body to turn glucose, or sugar, into energy. If your body has difficulty metabolizing glucose, it can lead to high blood sugar levels.

The Effects of Diabetes on the Body

High blood glucose causes stiffening of the arteries, narrowing of blood vessels, weakens immunity, and diabetic neuropathy, which is nerve damage throughout the body, particularly the limbs. The effect of these body changes causes increased risk of wounds as well as more complications in wound healing.

• Circulatory System –People with diabetes are twice as likely to develop peripheral vascular disease, a condition of poor circulation. Peripheral vascular disease causes your blood vessels to narrow, which reduces blood flow to the limbs. The condition also affects red blood cells’ ability to pass through the vessels easily. Combined with a higher-than-normal blood glucose level which increases the thickness of blood, the heart must work harder to pump blood throughout the body.

• Immune System — Diabetes can weaken our immunity which complicates wound healing. If your immune system isn’t functioning at its best, your body may struggle to fight off bacteria that cause infection. Higher-than-normal blood sugar levels increase the possibility of infection because bacteria thrive on the extra sugar that’s available in the bloodstream. If your infection is untreated and left to spread, it can lead to complications such as gangrene or sepsis.

• Nervous System — Neuropathy is both a major cause of injury in individuals with diabetes, and a reason for complications in diabetes wound healing. When high blood sugar destroys nerves, they do not regenerate making individuals increasingly less sensitive to pain in their limbs. With this loss of sensation, they don’t feel developing blisters, infections, or existing wound changes.

Tips to Promote Wound Healing

Managing your blood sugar helps reduce the risk for other complications. If you have diabetes, it’s important to work with your doctor to develop a long-term plan of management and care.

Additional tips to consider include:

• Regular Self-Checks — Catching wounds early is the key to avoiding infections and complications. Make sure you do daily self-checks and look for new wounds, especially on areas you cannot easily see like your back and your feet. Don’t forget to check in between and under your toes.

• Care for Your Wounds — If you have a wound, regularly change the dressings to reduce bacteria and maintain appropriate moisture levels in the wound. Doctors often recommend special wound care dressings for those with diabetes. Necrosis (dead cells) and excess tissue often occur with diabetic wounds. This can promote bacteria and toxins and increase wound infection. It can also prevent you from being able to inspect the underlying tissue. Your doctor will often help you with the removal process.

• Reduce Pressure and Wear Appropriate Footwear — Keep pressure off the area. Pressure can cause wear and tear that damages the skin and leads to a deeper wound or ulcer. Since the feet are especially vulnerable, be sure to wear appropriately fitting footwear and socks or non-binding compression stockings. Non-binding stockings and socks help encourage blood flow in the lower legs and feet, and socks designed for those with diabetes may also have padding on the bottom and seamless features to prevent scratches and sores.

When to See a Specialist

If you or a loved one has a wound or sore that has not healed in 30 days, you may have what is referred to as a “chronic, non-healing” wound.

Chronic, non-healing wounds can have serious health consequences and may adversely affect your quality of life. Specialized treatment for these wounds begins with a comprehensive assessment of the wound which may include testing. Specialists then design a healing treatment plan specific to your situation which can include vacuum or hyperbaric therapy, prescribed medicine, physical therapy, or a combination of services and treatments.

Steven Hawley, DPM, is a foot and ankle physician with UPMC in Williamsport who specializes in wound care. The Wound Healing Center at UPMC Williamsport, Divine Providence Campus provides individualized outpatient care to patients with chronic or difficult-to-heal wounds. Learn more about options for non-healing wounds at UPMCSusquehanna.org/Wound.

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