According to the 2017 National Diabetes Statistics Report, it is estimated that 30.3 million Americans have diabetes, a medical condition in which the body cannot effectively process sugar. Individuals with diabetes lack the ability to convert sugar to fuel efficiently, causing elevated blood sugar levels. Only 23.1 million of these individuals have been diagnosed, while an alarming 7.2 million are are not aware that they have diabetes.1 Complications due to diabetes can affect almost every biological process performed and many organs including the eyes, kidneys, nerves, and feet. Diabetes can also cause heart disease, stroke and even the need to remove a limb due to chronic wounds and poor circulation. This article will focus on how diabetes affects wound healing.
Diabetes can slow, halt, or even reverse the body’s natural wound healing process. Proper wound care in individuals with diabetes is critical to recovery and often needs close monitoring by a health care provider. Even stable wounds can suddenly and quickly worsen in those with diabetes. Why does this happen?
Blood Sugar Levels & Circulation
Elevated blood glucose levels over a long period of time can lead to narrowing of blood vessels and stiffening of the arteries, a type of blood vessel that carries blood to the rest of the body. This can cause wounds to form and prevent biological healing processes. High blood sugar activates a biological protein called protein kinase C, which causes constriction of blood vessels. When blood vessels become narrowed, the decrease in blood flow may cause a wound to form or perpetuate an existing wound. Blood cells also carry nutrients to tissues that are necessary to recover and fight infection. Reduced blood flow to the wound and subsequent decrease in oxygen supply can lead to wound infection that may become chronic and difficult to treat. Often times, infections can occur and/or worsen rapidly in individuals with diabetes and poor circulation.
Suppressed Immune System
Diabetes has been linked to immune system impairment, increasing individual susceptibility to frequent infections.2 Studies have shown that the immune system is affected in several ways by diabetes including decreased function of white blood cells, a reduction in ability to recognize foreign pathogens (due to reduced complement factor 4), and an increase in biological inflammatory chemicals called cytokines (specifically TNF-α, IL-6 and IL-8). In short, high glucose levels causes the body’s immune cells to function poorly. This results in an increased risk of infection in patients with diabetes.3
A common complication of diabetes called diabetic neuropathy occurs due to nerve damage. Symptoms of this condition vary among individuals and range from extreme temperature sensations to stabbing/shooting pains. Elevated blood sugar damages nerves through two main mechanisms: glycation of the nerves (chemical reactions between sugar and surface proteins of nerve cells), and chronic inflammation due to elevated inflammatory chemicals (especially TNF-α). Diabetic neuropathy has its own list of complications including pain, increased risk for falls, reduction in mobility and independence, and increased risk of wound development. An individual with diabetes may have such an extreme loss of sensation that they do not feel an injury or blister. A small wound or blister may quickly become more severe and such changes can go unnoticed, leading to complications with healing and infection.
Complications of Infection
We have discussed infection quite a bit already including the risk factors specific to those with diabetes. To summarize, elevated blood sugar levels can lead to poor circulation, a reduction in immune system function, and complications of diabetic neuropathy. Infection itself presents with its own list of challenges and complications.
Some complications of infection specific to those with diabetes and wounds include reduced healing time, development of gangrene, limb amputation, sepsis (condition in which the body releases damaging chemicals into the bloodstream to fight the infection), infection of bones (called osteomyelitis).
What Can You Do to Promote Wound Healing?
The most important thing that an individual with diabetes can do to promote wound healing and prevent wounds is to control blood sugar levels. Some healthy lifestyle tips can aid in the process:
- Eat a well-balanced, healthy diet- It is important to regulate carbohydrate intake while maintaining adequate dietary vitamins and nutrients. Dietary and herbal supplements can aid in wound healing and help fill in the gaps in nutrition. Nutritionists and dieticians often specialize in diabetes and can help to identify appropriate foods and herbal supplements for general well-being and diabetes maintenance. Regular follow-ups with a healthcare professional can assist in management of diabetes. It is also important to seek the counsel of a pharmacist to assist with your medication therapy.
- Stop smoking immediately. Consult your pharmacist regarding support programs and over-the-counter medications that can help you quit today. Many medications may even be covered by your prescription health insurance. Your pharmacist can help you decide which option is safest and best for you based upon your current health status and medication list.
- It is especially important to check your feet regularly for wounds, blisters, and calluses if you have diabetes and/or neuropathy. If you have a wound currently, watch for signs of infection including:
- Increased drainage that has become cloudy, green or has an odor
- Running a fever
- Decreased appetite
- Feelings of malaise (tiredness or lack of energy)
- Increased pain
- New or worsening redness or swelling
- Warmth of the skin surrounding the wound
If any such signs of infection occur, seek medical attention right away. Regular visits to a podiatrist can help to prevent formation or worsening of wounds by identifying potential areas at risk for wound development and early intervention.
- If you are able to perform exercise safely, regular aerobic exercise is health practice that can help with weight maintenance and cardiovascular health. This is an important factor when it comes to keeping blood sugar levels in check and promoting healthy circulation.
- If you have a wound that does not seem to be healing, please consult a medical professional as the wound may require prescription therapy to be implemented. It is important to follow a strict bandage change and wound cleaning schedule if your wound is chronic. Proper wound care should be overseen by a healthcare professional and is imperative to recovery and prevention of infection. Preventing further trauma to the area is also important and efforts should be made to reduce weight-bearing activities that directly place pressure on the wound if applicable. If cleaning your wound and changing your dressings is difficult or painful, talk to your healthcare professional to discuss options for assistance in doing so. Many programs are available to help individuals who are living at home and need help with wound care.
- Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017.
- Moutschen MP, Scheen AJ, Lefebvre PJ. Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab. 1992 May-Jun;18(3):187-201. Review. PubMed PMID: 1397473.
- Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999 Dec;26(3-4):259-65. Review. PubMed PMID: 10575137.