Wound Healing In Diabetes – A Complete Help Guide
A diabetic person’s wounds take more time to heal than the wounds of a non-diabetic patient. This more extended period increases the risk of infections and other developing complications. If a person appropriately manages his diabetes, he can reduce the chances of developing an infection and improve the wound healing in diabetes.
In the United States, according to (CDC) Centers for Disease Control, around 30.3 million people have diabetes, and many of these are experiencing complications due to infected wounds. This article will discuss all the effects of diabetes on wound healing, complications, causes, risks, and preventions.
Diabetes And Wound Healing
The wounds of diabetic patients take more time to heal and are at high risk of having an infection. Unfortunately, Minor wounds and cuts are the inescapable part of life. Theses minors cut sometime leads to severe complications for diabetic people.
Many diabetic patients’ wounds are very slow to heal, don’t heal properly, or never heal. Besides, infections can also develop on the wound. This infection can spread to the nearby bones, tissues, and even more distant areas of our body. In cases, if left untreated, it can be dangerous and life-threatening.
Even without any infection, slow wound healing in diabetes affects the overall health and life’s quality. Any minor injury like a cut on legs or feet will make it difficult for the diabetic patient to walk correctly.
The diabetic patient needs to keep their blood glucose level under control as it can improve the wound healing process and reduce complications like foot ulcers. According to the research, there are maximum chances of developing foot ulcers in diabetic patients with foot wounds.
Foot ulcers and not only sour and painful, but they can lead to foot amputations. According to the (AMJC) American Journal of Managed care, there are almost 230 amputations every day in the United States due to diabetes.
Causes
There is a clear relationship between wound healing and diabetes. According to the research, the people who are doing surgeries for their chronic diabetes wounds have more chances of full recovery if they have a controlled blood sugar level at the time of surgery than the others.
In diabetes, there is impairment in the body insulin production, due to which our body can’t convert the glucose from our blood into energy. This disturbance in insulin makes it difficult for the body to control the sugar level in our blood.
The permanent increase in the sugar level impairs white blood cells function as white blood cells play a vital role in the immune system. When in that situation, white blood cells are not playing their proper role due to which body is more at risk of getting infections and slower wound healing.
People having uncontrolled sugar levels are more likely to develop poor circulation due to which the blood moves slowly. It becomes difficult for the body to move slowly and delivers the nutrients to the wound location. As a result, there is slow healing of a wound or maybe no healing at all.
Diabetes can also result in neuropathy, due to which there is a slow wound healing. Uncontrollable glucose levels in our blood can damage the sensation of numbing and nerves of the area. That may mean a diabetic patient in such a case may not be aware of the injury.
If the patient is unaware of the injury and is not going for any treatment, the wound can worsen. There will be a higher risk of any infection due to slower healing and low sensation.
There is always a higher risk of getting a bacterial infection in type 1 and type 2 diabetes people. Few factors that increase the risk of infection on a wound are:
- Cracked and dry skin
- Impaired sweating
- Toenail infections
- Abnormalities in the foot, like Charcot’s foot
Some other ways in which diabetes affects the healing process include.
- Low collagen production
- Low production of healing hormones
- Week skin barrier
- Low production and repairing of new blood vessels
Complications
Wounds may convert to gangrene, and in worst circumstances, it requires amputation. Diabetic people, due to Nerve and blood vessels improper functioning, might experience some other complications. Complications include kidney disease, eye problems, and heart diseases.
If a wound is left untreated, then the infection spreads to bone and muscles. It can also develop into gangrene. Gangrene is the most common cause of amputations in diabetic patients.
Sometimes people with diabetes can also develop sepsis due to the spreading of infection into the bloodstream. Sepsis is a severe condition.
What Is The Relation Between Wound Healing And Diabetes?
How Does Diabetes Affect Your Body?
The failure of our body to produce a sufficient amount of insulin results in diabetes. Insulin is a hormone that plays a role in converting glucose into energy for the body to function correctly. If there is difficulty in metabolizing glucose, then it results in high sugar levels. It can also affect the ability of the body to heal wounds.
In diabetic patients with abnormal sugar levels, the wounds generally heal slowly but progress faster. So it is vital to know what to look out for. Scratches, blisters, cuts, and grazes are common and can occur at any place. The foot is the most general place for such injury, and a small wound like that can even turn into a foot ulcer.
If not appropriately treated, foot ulcers can be severe. It is important to closely watch your wound and do regular checkups to avoid complications. According to the numbers, about 14 to 24% diabetic patients develop ulcer that ends in the lower limb amputation.
That’s why regular self-checkups will catch the wound early and also lowers the risk of complications. Keep reading to learn some essential details about wound healing in diabetes, the healing process, and much more vital information.
How Long Do Normal Wounds Take To Heal?
The healing of a wound depends on the nature of the wound means how deep or long cut you have. It may take up to a year to completely heal; besides, a closed wound heals faster than an open wound.
According to john Medicine, wounds mostly take up to three months to repair. The University of Rochester Medical Center studies explain that 80% of the tissues and new skin are as strong as before wound or injury.
A large and deep can heal faster if it is sutured y your health care provider. It minimizes the area of the wound that your body has to rebuild. That’s the main reason behind the fast healing of surgical wounds. Surgical wounds generally take 6 to 8 weeks to heal completely.
There are maximum chances that a wound heals better and faster in case they are covered. A wound needs moisture to heal completely; besides wound will be cleaner. Some medical and health conditions result in slow healing or maybe no recovery of the wound. It can happen to a surgical cut as well. Here are some significant factors mentioned below.
Why Is Wound Healing Slow?
There are several factors in diabetic patients that affect the wound healing of a person.
High Level Of Blood Sugar:
The blood sugar level is the main factor that determines how quickly the wound will heal. In case the blood sugar is higher than usual, it:
- Increases the inflammation in cells.
- Prevent oxygen and nutrients from energizing cells.
- It prevents the proper functioning of the immune system.
These are some significant effects of high blood sugar that slowdowns the healing.
Neuropathy:
Blood sugar levels that are consistently higher than usual can result in peripheral neuropathy; it can also cause damages to the vessels and nerves. Besides, it can also result in the loss of sensation in affected areas.
Mostly neuropathy is common in feet and hands. In neuropathy, a person is unable to feel his wounds. It’s the primary reason due to which foot wounds are common in diabetic patients.
Poor Circulation:
Peripheral vascular disease is poor circulation, and diabetic people have twice more chances to develop it than others. In peripheral disease, there is a decrease in the blood flow in limbs due to narrowing blood vessels.
Besides, this condition is also responsible for affecting the ability of red blood cells to pass the blood vessels. It is due to the increase in the thickness of red blood cells due to higher sugar levels. This thickness, even more, affects the consistency of blood flow.
Immune System Deficiency:
Diabetic patients often have problems with the activation of the immune system. Due to diabetes, there is a reduction in the ability of the fighter cells to take action in healing wounds. Besides, the risk of infection increases as the wound healing takes place at a lower rate.
Inflammation:
Generally, the inflammation takes place while the wound is healing, but it is noted that the inflammation in diabetic patients lasts too long. Due to that reason, there is a delay in the wound healing process, and it may become chronic.
Immune System’s Function:
Diabetic wounds are at higher risk of delayed healing because diabetes produces enzymes and hormones that weaken our immune system. Thus it increases the chances of delayed healing in diabetic wounds. Furthermore, when healing cells reach the wound, their ability is almost lost.
Infection:
Our body feels difficulty fighting with bacteria that result in infection due to the poor functioning of the immune system. Besides, there is a higher risk of infection in higher blood sugar patients because they flourish from the extra glucose in the blood.
The immune system doesn’t correctly fight the invading bacteria due to a large amount of sugar present in the blood. If the infection is not treated, it can spread to complications like sepsis or gangrene.
Higher than regular blood sugar can also increase the risk of infection due to the excess blood sugar available to the invasive bacteria. Diabetic patients need to perform proper wound care for the smooth and speedy recovery of their wounds.
What Happens If Wounds Are Left Untreated?
Wounds can be severe if they aren’t adequately cared for and can quickly change into an infection or something serious. The most serious concern regarding a wound is amputation. There is about a 15% higher risk of foot amputation resulting from foot ulcers and wounds in a diabetic patient.
Here is the main reason and what you can do to prevent it.
How To Help The Healing Process:
Here are some tips that will help you with the wound healing process.
Daily Self-Checkups:
self-checks regularly to find a new wound, especially under your toes.
Remove Dead Tissues:
In diabetic wounds, there are often excess tissues; it can promote toxins, bacteria and increase wound infections. The dead tissues are the cause of promoting toxins and bacteria in a wound infection. It can also prevent you from knowing the condition of your wound. You can ask your doctor to help you with the removal process.
Fresh Wound Dressing:
The regular new dressing will help you get rid of the bacteria and maintain the moisture level in the wound. According to the wounds, doctors will recommend the type of dressing that will benefit.
Don’t Put Pressure On The Wound:
Putting a lot of pressure on the wound can damage the ulcer that leads to a severe condition.
When To See Your Doctor
In the case of a foot wound, it’s good to wear white socks during the whole healing process. In a white dress, it would be easy for you to notice any blood or drainage from your wounds compared to the other colors.
Notice if you are experiencing any of the following symptoms:
- Burning
- Tingling
- Persistent pain
- Swelling
- Burning
- Sensation loss
If you are continuously experiencing these symptoms for more than a week, then do visit your doctor. If you have any wounds on your feet or even a break, then you should visit your doctor as it’s a cause of concern. Because in earlier treatment, there are maximum chances of avoiding any severe complications.
How To Promote The Healing
Here are a few valuable tips to help you promote the healing process by boosting the aid and immune system.
Healthy Diet:
A healthy diet with proper nutrition is the key to healthy living as it directly affects your blood glucose levels. To help your wound heal faster, it is essential to maintain your blood sugar levels. You have greater chances of avoiding future wounds and recovering the present ones.
By avoiding the processed food, fast food, sugars, and carbohydrate, a diabetic patient can maintain the blood sugar level better. Besides, avoiding these will automatically increase the intake of vegetables, fruits, legumes, and fiber. Having good nutrition fulfills your body’s nutrients required for proper healing by providing Vitamin C, protein, Zinc, e.t.c.
Activity:
By remaining active, you can improve the insulin sensitivity in your body. It will help the glucose in your blood to enter the cells effectively. That will automatically enhance the healing process.
Quit Smoking:
In smokers, there is a decrease in the ability of cells to carry oxygen across the body. Besides, it also increases vascular diseases risk and disrupts the normal functioning of the immune system.
Consider Honey:
According to the research, honey is an effective alternative dressing for diabetic foot ulcers and wound healing.
How To Prevent Having A Diabetic Wound?
Self-Check Your feet
In any case, the best medicine one can have is preventive medicine. Do regular self-check for wounds. Take care of your feet, toes, and especially your foot bottoms. If you notice any unusual spot, contact your doctor immediately.
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Keep Track Of Your Sugar Level:
If you have diabetes, make a habit of checking your blood sugar level regularly. To have the ideal immune system function keeps the safety record of your daily blood sugar level. In this way, you can make sure you have a healthy sugar level daily. Besides, in case of any disturbance, your diet and exercise will help you be on the healthy track.
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Watch For Any Changes And Pain In Your Wound:
Feel your legs and feet to notice any changes. Look if you feel that you are quickly getting tired while walking or having cramping while walking. You can look for the signs of poor circulation on your feet if there is no longer growth of hairs in your feet and legs. For further evaluation of your blood circulation, your podiatrist will perform a particular circulation test.
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Look If You Have Numb Toes And Feet:
If you have tingling, numbness, or burning sensation in your feet, there is a possibility that you are suffering from neuropathy. Make sure not to walk barefoot. As I mentioned above, wearing white socks will help detect early wound leakage and bleeding. Check your feet for pressure sores. Your podiatrist can perform some to test the functioning of your nerves.
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Appropriate Shoes:
To prevent the development of any wound or ulcer, wear proper fitting shoes. Try to avoid walking when you are barefoot. Properly measure the size of your feet before buying shoes. It will make sure that you are wearing the proper size. Try on shoes before purchasing as there is always a slight difference in the sizes of different brands.
If you have a wound, you can discuss the shoe you are wearing with your podiatrist to avoid complicating the wound. Besides, these days there are diabetic shoes present for diabetic patients. These shoes are available in almost all sizes and different styles, and the plus point that a diabetic patient wants, soft plastazote inserts are present. These shoes completely protect your foot from any harm in a convenient way.
Foot Care For Diabetes
Best foot care for diabetes includes:
- Wear comfortable shoes.
- Trim your toenails carefully.
- Avoid barefoot walking.
- Wash your feet daily.
- Before applying any moisturizer, pat your skin dry.
- On your every doctor visit, ask your doctor to have a feet check-up.
- Look inside your shoes before wearing them and inspect your feet.
Wound Treatment
It is vital that every diabetic patient monitor their wounds carefully. While the slow healing of wounds in diabetes is normal, but it’s not normal that the wounds remain open for weeks or become painful or spreads.
Every wound doesn’t develop ulcer or infection, but still, it’s vital to keep the wound clean and cover it with a clean bandage. In case you have a wound walking barefoot can increase the risk of infection. Wearing socks and shoes while walking is a good idea to protect the wound.
Diabetic patients should seek treatment if they have developed a wound and it’s not healing normally. The patient may need to take antibiotics to avoid the chances of any infection, and if the wound is rigorous, then hospitalization may be the available option.
Glucose Control
Sugar control is a vital step in the prevention of slow healing of wounds in diabetes. People having control sugar levels are less likely to experience any complications with their wounds.
For type 1 diabetes patients taking insulin for a lifetime is a must option to control sugar levels. In comparison, type 2 diabetes patients have many more options like managing their blood glucose levels with a little change in their lifestyle, diet, and exercise routine. Besides, weight management plays a key role in improving the lifestyle of a diabetic patient.
With the help of such small daily changes in life, a person can manage diabetes without using any medication. Carbohydrate controlling diet is beneficial for both Type 1 and Type 2 diabetic patients. It is better to talk with your nutritionist to get a specialized meal plan.
How Can I Heal My Wound Faster?
Local Wound Care
For the successful healing of ulceration, it is important to see your local podiatrist for local wound care. You may notice a yellow tissue overlying your wound, and it’s called fibrotic tissue in medical terms and, in simple words, known as slough.
The bio-film of this non-viable tissue can slow down your wound healing. So it’s important to see your doctor on a regular basis so that they can remove the bio-film or slough from your wound. In more simple words, it’s the cleaning of the wound that gives the healthy bleeding tissues the conditions for an ulcer to heal.
Off-Landing Diabetic Wound
Mostly diabetic wounds are in such areas that break due to chronic pressure. To heal such wounds, you must properly off-load those sites. It can be accomplished with padding or with a cut-out in the shoe. Proper off-loading in the wound area will help in the prevention of wound reoccurrence.
Diabetic shoes and custom pastorate inserts are best for the use of patients after the healing of the wound. In this way, your podiatrist can make sure there is no pressure alleviated from the infected area.
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Bioengineered Skin Substitutes:
There are different types of local treatments available for persistent and difficult diabetic wounds. Recently there has been a lot of success in wound healing by bioengineered skin substitutes. There are growth factors present in these skin substitutes that accelerate wound healing. There are different types of bioengineered skin substitutes present; some of them are derived from our skin tissues, while some are from the pig (porcine) and bovine (cow), e.t.c. A podiatrist can apply these crafts in his office.
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Skin Flaps And Skin Grafting:
Split thickness skin grafting is the best option for diabetic wounds that are big and difficult to heal. In this method, a part of the skin is taken from the thigh of the patient, and then the new skin is crafted on the wound place. While in the case of split-thickness crafting, the upper layer of skin is taken from the thigh or calf so that it doesn’t form a new wound to heal.
Your podiatrist might consider taking a skin flap according to the wound location. In this method, there is the surgical removal of the wound, and then the skin nearby the wound is rotated in a way to cover the wound. Your podiatrist will close your wound with stitches after performing the suitable skin flapping method.
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Surgical Options:
In order to prevent the reoccurrence of the wound, your doctor may prefer a surgical option on the basis of your condition. Surgery is a preferred option if there is an underlying deformity or a prominent bone at the site. Sometimes the only way to treat a wound is by knowing its cause and addressing it to prevent any complication.
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Watch Your Diet:
While we are discussing the wound healing in a diabetes diet is the point that is most generally ignored. A person having a deficiency in vitamins C, Zinc, and other essential nutrients, wounds heal slower in comparison to a healthy person. The only solution to this is having a well-balanced and nutrition-rich diets like vegetables, fruits, grains, dairy, and others. However, don’t forget to monitor your blood sugar so you can balance your sugar levels whenever needed.
End Words By The Writer
In the case of the diabetic patient, a wound doesn’t usually heal and, in some cases, can become life-threatening. But the positive side for slow-healing wounds is that you can accelerate the healing process by effective treatment and quick healing.
A diabetic patient should immediately contact a doctor if the wound is not healing faster, becoming severe and painful, or maybe an infection is developing.
There are many methods to control the wound in a diabetic patient. The ways include wound healing by antibiotic treatment, maintaining glucose levels, diet, wound cleaning, or maybe surgical removal. If the wound isn’t responding to any treatment, the amputation may become necessary to save it from life-threatening.
In the end, I would recommend following all the preventive steps to reduce the risk of wounds or further complications in the healing process.
FAQ’s
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Is there any way to save the limb in case of gangrene?
Gangrene is the severe loss in blood supply that results in the destruction of tissues and emerging of infection. It is essential to remove the gangrene tissues surgically. However, if you have diagnosed it early and there is less risk to the tissue, amputation may not be needed. It’s essential to detect it at the early stages.
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How does diabetes affect wound healing?
People that have uncontrolled diabetes may also develop poor blood circulation. Due to the slow blood circulation, our body doesn’t get the proper nutrition for the wound to heal. Due to which the injuries may heal slowly or don’t heal at all.
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How can we tell if a wound is infected or healing?
If your wound is discharging but a small amount of pus, then it’s a positive sign. But if it is changing color, smells bad, or continuously drains, then it’s not a good sign as the wound is more likely to get infected.
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Do wounds need air to heal?
In most cases airing the wound is not a wise choice as it needs the air to heal. Besides, circulating the wound can dry the new cells that will slow the healing process and slow down the healing process.
References:
- Diabetes and wound healing: Causes, complications, and prevention. (2021). Retrieved 19 September 2021, from https://www.medicalnewstoday.com/articles/320739
- Orenstein, B., & Cynthia Haines, M. (2021). Tips for Diabetes Wound Care – Diabetes Center – Everyday Health. Retrieved 19 September 2021, from https://www.everydayhealth.com/type-2-diabetes/treatment/tips-for-diabetes-wound-care/
- How To Recognize If A Wound Is Infected or Not. (2021). Retrieved 19 September 2021, from https://www.woundcaresurgeons.org/blogs/how-to-recognize-if-a-wound-is-infected-or-not
- Wiggins, C. (2021). The hidden healing power of sugar. Retrieved 19 September 2021, from https://www.bbc.com/future/article/20180328-how-sugar-could-help-heal-wounds
- Save Time and Improve your Marks with CiteThisForMe, The No. 1 Citation Tool. (2021). Retrieved 19 September 2021, from https://www.citethisforme.com/
- Wound-healing Abnormalities in Diabetes and New Therapeutic Interventions. (2021). Retrieved 19 September 2021, from https://www.touchendocrinology.com/diabetes/journal-articles/wound-healing-abnormalities-in-diabetes-and-new-therapeutic-interventions/
- Wound Healing In Diabetes (WHy) Study – Full Text View – ClinicalTrials.gov. (2021). Retrieved 19 September 2021, from https://clinicaltrials.gov/ct2/show/NCT01002521
- Diabetes and Wound Healing: Why Is It Slower?. (2021). Retrieved 19 September 2021, from https://www.healthline.com/health/diabetes/diabetes-and-wound-healing
- 3 reasons diabetic wounds are slow to heal. (2021). Retrieved 19 September 2021, from https://www.geisinger.org/health-and-wellness/wellness-articles/2017/11/08/20/05/3-reasons-diabetic-wounds-are-slow-to-heal
- Contributor, N. (2021). Diabetes and its effect on wound healing and patient care | Nursing Times. Retrieved 19 September 2021, from https://www.nursingtimes.net/clinical-archive/diabetes-clinical-archive/diabetes-and-its-effect-on-wound-healing-and-patient-care-21-10-2003/
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