The foundation for new tissue is red blood cells. These blood cells then create collagen, which in turn becomes new tissue. Once this new tissue is formed it leads to new skin growing over the tissue. At the point that the wound finally heals, the edges then pull inward and the wound will begin to get smaller.

Unfortunately, Diabetes is a common problem in this country. In fact, according to recent data from the Centers for Disease Control and Prevention CDC Without proper medical attention, this can result in wound infection among other serious health issues.

During the second stage of healing, wounds are inflamed. A wound is considered chronic when it lasts for six months or longer. Because diabetes limits the body from handling glucose, one of the most important things that diabetics need to worry about is maintaining a healthy blood sugar level.

Blood sugar levels are a major determining factor in how efficiently your wounds heal. When these levels are too high, in people with diabetes, for example, it can interfere with how the immune system functions, prevent nutrients and oxygen from energizing cells, and increase inflammation.

All of which, can interfere with efficient wound healing. High blood glucose can also cause the arteries to become stiff, which can lead to narrow blood vessels and diabetic neuropathy. Diabetic neuropathy occurs when nerves become damaged all over the body.

It causes tingling and numbness in the limbs, which makes it difficult to be aware of whether or not you are injured. This can lead to new wounds and complications in overall healing.

The legs and feet are most commonly affected by diabetic neuropathy. Additional Tip: People who suffer from diabetic neuropathy should ensure they wear shoes that fit properly and avoid cuts, blisters, and any type of activity that may cause ulcers. Wounds heal much quicker when there is a good circulation of blood throughout the body.

Diabetics typically have poor circulation due to narrowed blood vessels and are more likely to develop poor circulation conditions like peripheral vascular disease.

The reduced oxygen in those suffering from diabetes can result in slower tissue development and in turn, wound healing. High blood sugar levels decrease red and white blood cell function, which reduces nutrients being sent to the wound site to fight infections.

This is also due to a diabetic body producing certain hormones that make the immune system less effective.

Additional Tip: Some doctors recommend wearing white socks at all times in order to be able to see any blood or pus if an injury occurs. This can help alert you if there are cuts, blisters, or another type of wound. Diabetic patients have a slower movement of white blood cells than the average person.

This means that there is less of an immune response, which leaves wounds to be more inflamed. This combined with numbness from neuropathy can lead to the wound getting worse.

As referenced above, with an open wound that heals slower than it normally would, there is an increased chance of infection. This often leads to higher rates of gangrene, sepsis, and infections like osteomyelitis.

Out of all of the limbs amputated each year, diabetic ulcers are the number one cause. If not carefully monitored and treated, wounds can be very serious and quickly lead to infection.

Fortunately, wound care specialists are trained and equipped with the expertise to help ensure wounds are cared for properly and healed efficiently. Your wound care specialist will work with you to help prevent the wound from getting bigger and avoid potential infection.

They may also conduct debridement which helps remove unhealthy tissue from the wound and facilitate healing. While most diabetic wounds are better addressed through a specialist, there are a few steps you can take to help the recovery process and even prevent wounds from surfacing:.

We provide high quality, full spectrum wound care services to patients wherever they reside. We also welcome you to come visit our new Wound Center in Fresno where our wound care physicians help treat the complete range of wound types and skin concerns including diabetic wounds and ulcers.

Contact us today to book an appointment and let us help you get on the path to recovery. Email: info westcoastwound. This can promote a poor surgical outcome. Excessive glucose levels may lead to reduced complement activity, exacerbation of inflammatory pathways, modifications in the innate immune system, impaired endothelial and hepatic mitochondrial functions, protein glycosylation and elimination of ischemic preconditioning.

When there is stress hyperglycemia on a multi-organ level, acute complications may range from increased susceptibility to infections and polyneuropathy to impaired microcirculation, cardiovascular risk and renal failure.

This is important to note when considering potential surgeries for patients with diabetes. Overall outcomes, healing time and risk for limb loss are increased in either prophylactic, elective, emergent or curative surgeries. It is prudent to educate patients on proper glycemic control before undergoing any surgical intervention.

The surgeon must take appropriate measures to coordinate a multidisciplinary approach in optimizing the patient. Accordingly, the role of the primary care provider, endocrinologist and other specialists are crucial. In the presence of infection, most diabetic foot surgery falls into the categories of emergent or curative surgery as it often involves a limb-threatening infection.

Fluctuating glucose concentrations and hyperglycemia are often associated with poor healing, increased rates of surgical infection, myocardial infarction, stroke and death.

The nature and urgency of the surgery in question often dictates the ultimate protocol. In order to optimize outcomes, the surgeon must take several principles into consideration in the perioperative management of the hyperglycemic patient.

Identify the type of diabetes, the current diabetes treatment plan and resultant effectiveness as well as the proposed surgical procedure. Tight glucose control requires frequent measurement almost hourly of glucose concentration along with insulin therapy if warranted in an effort to further control blood glucose levels.

Patients with type 1 diabetes are more prone to developing ketoacidosis or hyperosmolar hyperglycemia nonketotic syndrome.

Those with type 2 diabetes who use insulin may require similar management. Consider the use of short-acting and rapid-acting insulins. Routes of administration include intravenous as a bolus or continuous infusion and subcutaneous.

Be aware of glucose- and potassium-containing solutions and their effects on hyperglycemia, but keep in mind these may be required to address hypoglycemia when warranted. Additional insulin may be necessary in the perioperative setting due to insulin resistance that may occur as a result of the stress of surgery.

No specific guidelines are currently in place regarding whether to proceed with emergent surgical intervention in the presence of infection when addressing the infection is critical.

However, it is important to manage hyperglycemia in the perioperative period and understand managing protocols via a team approach. In our experience, emergent or curative surgeries often require a more aggressive surgical approach to eradicate infection risk and help prevent limb loss.

In elective or prophylactic procedures, it is best to proceed with caution and make certain all parameters for healing are optimized.

This would involve a stable fasting blood glucose level or HbA1c along with appropriate assessment of vascular integrity and indicators of long-term healing potential. It is crucial to make all patients with diabetes aware of the risks surrounding surgical outcomes and the role their blood glucose levels play in the overall healing process.

Hadi is attending faculty at the Louis Stokes Veterans Hospital in Cleveland and the Akron Community Based Outpatient Clinic CBOC in Akron, Ohio. She is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Foot and Ankle Surgery. Duggan EW, Carlson K, Umpierrez GE.

Perioperative hyperglycemia management-an update. Cheng HQ. Perioperative management of endocrine diseases. In: Papadakis MA, McPhee SJ, Rabow MW, eds. Current Medical Diagnosis and Treatment New York, NY: McGraw-Hill; Preiser J, Ichai C. Glycemic control.

In: Hall JB, Schmidt GA, Kress JP, eds. Principles of Critical Care. Frykberg RG, Wittmayer B, Zgonis T. Surgical management of diabetic foot infections and osteomyelitis. Clin Podiatr Med Surg. Beauchamp LC, Mostafavifar LG, Evans DC, Gerlach AT.

Sweet and sour: impact of early glycemic control on outcomes in necrotizing soft tissue infections. Surgical Infect Larchmt. Kotagal M, Symons RG, Hirsch IB, et al. Perioperative hyperglycemia and risk of adverse vents among patients with and without diabetes.

Ann Surg. DeCou J. Perioperative assessment of diabetes. In: Johnson KB. Clinical Pharmacology for Anesthesiology. Shakya S, Wang Y, Mack JA, Maytin EV. Hyperglycemia-induced changes in hyaluronan contribute to impaired skin wound healing in diabetes: review and perspective.

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