Diabetics and wound care - what you don't know about diabetes

Posted November 21, 2019 5:00 a.m. EST

While a slow-healing wound is an inconvenience to most, for diabetics, it can lead to infection and even be fatal. (Fahroni/Big Stock Photo)

This article was written for our sponsor, 3HC.

Of the millions of Americans with diabetes, the elderly population may be at the greatest risk.

More than a fourth of Americans aged 65 and older have diabetes, according to the American Diabetes Association. The number is troublesome considering the effects of aging greatly accelerate the progression of the disease's complications.

"Older diabetics are more susceptible to cognitive dysfunction, which can be seen as a decrease in the ability to do basic tasks such as self-care and balancing a checkbook, or can be as severe as dementia and memory loss," said Dr. Dimitrios Lintzeris, a wound specialist in Goldsboro.

While it's common knowledge that diabetics may experience increased thirst, fatigue and numbness associated with nerve damage, they also experience lesser-known symptoms that affect their hands and feet.

The effects of autonomic neuropathy, for example, are subtle, changing sweat and oil production on the skin. It's not uncommon for a diabetic to experience dry skin on the feet and hands, making them more susceptible to wounds. Motor nerves are also affected by diabetes, which can cause deformities in these areas as strength decreases.

"Changes in the normal anatomy of the foot can cause abnormal pressures to accumulate over bony areas and lead to wounds, which are very hard to heal, particularly in the bottom of the foot," Lintzeris warned.

Most of us take for granted the incredible healing processes of our bodies, but diabetics experience neuropathy (nerve damage that affects parts of the body), atherosclerosis (build-up of fats in the artery walls), and neutrophil dysfunction (bacterial and fungal infections in deep tissue sites). This unfortunate combination makes healing more challenging.

Of course, minor wounds, cuts and burns are an unavoidable part of life. While a slow-healing wound is an inconvenience to most, for diabetics, it can lead to infection and even be fatal.

For this reason, Lintzeris said preventing foot wounds is essential for elderly diabetics whose skin already has a decrease in water content as a natural side effect of aging.

"Daily foot examinations to look for breaks in the skin, red 'hot spots,' and foreign bodies that may have been stepped on but not noticed due to lack of sensation," he said, are important.

Gentle cleanings every day with lukewarm water followed by a moisturizing cream can soften dry diabetic skin. Clean, dry socks and non-slip shoes should always be worn, even indoors. Blood sugar control is also key, and Lintzeris recommended monitoring cholesterol and blood pressure as well.

When a wound does occur, acting quickly is crucial. According to the American Podiatric Medical Association, foot wounds precede 85 percent of diabetes-related amputations.

"Immediate medical attention is required," Lintzeris said. "Eighty percent of lower leg amputations start with a diabetic foot ulceration, so early evaluation and treatment can prevent a devastating infection and loss of limbs."

The primary goal of treatment is to promote healing as fast as possible. Wound care centers are trained to understand the unique challenges associated with wounds and implement techniques to aid in healing, identify blood flow problems, and prevent infections.

Treatments focus on taking pressure off of the area to reduce irritation and speed the healing process, and may also involve removal of dead skin, topical medication, dressings and tightly controlling glucose levels.

"If a wound has been treated by your primary doctor, but has not shown improvement or healed after four weeks, you should seek the assistance of a wound care professional," Lintzeris advised.

Elderly diabetics and their caregivers should be aware of infection symptoms, which include redness, warmth, swelling and tenderness, and alert their doctors immediately if one is suspected. Mild infections can typically be overcome with an oral antibiotic. Severe infections may require hospitalization and possibly amputation.

Additionally, home health nursing is an option for people with severe wounds. Lintzeris refers patients to home health centers when the wound requires consistent medical treatment to promote healing. In some cases, home health physical therapy is also used to help support patients with balance and strength building after long periods of rest and elevation have made these things more challenging.

When individuals and their caregivers are knowledgeable of the wound risks associated with diabetes, and are proactive and consistent in prevention strategies, these wounds, infections, and life-threatening situations can typically be avoided.

This article was written for our sponsor, 3HC.