What is diabetes?

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What is diabetes?

Diabetes is a disease in which blood glucose levels are too high. Glucose comes from the food you eat. The cells in your body need glucose for energy. A hormone called insulin helps the glucose get into your cell. In type 1 diabetes, your body doesn’t make insulin. In type 2 diabetes, your body doesn’t make insulin or doesn’t use it properly. Without enough insulin, glucose can’t get into your cells as quickly as it normally does. The glucose accumulates in your blood, causing high blood sugar levels

How does diabetes cause foot problems?

Foot problems are common in people with diabetes. They can occur over time when high blood sugar damages the nerves and blood vessels in the feet. The infection may not heal well because the damaged blood vessels can cause poor blood flow to the feet. The etiology of diabetic foot ulcers is multifactorial. The common underlying causes are poor glycemic control, calluses, foot deformities, improper foot care, ill-fitting footwear, underlying peripheral neuropathy and poor circulation, dry skin, etc. About 60% of diabetics will develop neuropathy, eventually leading to a foot ulcer.

Types of Diabetic Ulcers

Neuropathic Ulcers

One of the long-term effects of diabetes is nerve damage (neuropathy). It has an impact on the nerves in the feet and legs, particularly those that transmit pain, temperature, and touch signals. Small scrapes and cuts frequently go unnoticed and untreated, which can ultimately result in the development of ulcers. Common sites of neuropathic ulcers: Pressure areas of the foot, such as the tips of toes, under the big toe and the sides of the foot and heel.

Appearance: Neuropathic ulcers are often round and have thick calluses on the surrounding skin. The depth of the wound depends on how much trauma the skin has been subjected to.

Ischemic Ulcers

Ischemic means reduced blood flow to a part of the body, and poor blood flow to the legs and feet damages tissue and causes cells to die. Ischemic ulcers occur when there is insufficient blood flow due to peripheral artery disease (PAD), an abnormal narrowing of the arteries. These diabetic ulcers are slow to heal and prone to rapid deterioration.

Common sites of ischemic ulcers: Toes, heels and the margins of feet.

Appearance: They can appear as pink, shallow open lesions with surrounding pink tissue. If the ulcer has dried up, there can be a black necrotic scab.

Neuroischemic Ulcers

These foot ulcers occur in people who have both peripheral neuropathy and ischemia resulting from peripheral artery disease. Neuroischemic ulcers are least likely to heal without intervention and, if infected, the risk of amputation is high.

Common sites of neuroischemic ulcers:  Toes, margins of the foot and the dorsum of the foot. This is the part facing upward when a person is standing up. Neuroischemic ulcers can also develop on the tips of toes and beneath overly thick toenails.

Appearance: Pale or yellow-colored tissue that may have a halo of thin glassy callused skin. There can also be raised edges around the wound.

Role of Negative Pressure Wound Therapy in Healing of Diabetic Foot Ulcers

For diabetic foot wounds, the fundamental therapeutic principles are the control of wound infection, improvement of local tissue perfusion and promotion of tissue repair. Due to its excellent effects of enhancing local perfusion, promoting granulation tissue growth and improving wound healing, NPWT has become an important adjuvant treatment in the management of diabetic foot wounds. According to many clinical randomized controlled studies, the application of NPWT for diabetic foot wounds may significantly increase the rate of wound healing, shorten healing time and reduce the rate of amputation it is currently recommended by the Wound Healing Society and the European Wound Management Association. Many studies have demonstrated that negative pressure wound therapy for diabetic foot ulcers appears to be more effective than non-negative pressure wound therapy and has a similar safety profile.

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