What is diabetic wound care?
Diabetic trauma and subsequent infection are due to risk factors inherent in hyperglycemia:
- Neuropathy (desensitization to pain from damage to nociceptive nerves): Especially in the feet and lower extremities
- Peripheral vascular disease: Impedes the health of tissue and the healing from trauma or infection
- Hyperglycemia: Encourages both the neuropathy and the peripheral vascular disease
Care of wounds in the diabetic center on both the infection aspects and the tissue damage, both of which must be scrupulously attended to prevent the relentless progression that is often seen.
The integrity of all tissue is negatively impacted by hyperglycemia, and nerve tissue is no exception. Nociceptors are pain receptors that fire off (depolarize) along the nerves that ultimately reach the brain where all pain is perceived. When the nerves are damaged by hyperglycemia, a condition called hypoalgesia begins. This essentially raises the nociceptive threshold beyond which pain sensation is generated.
Numbness and decreased pain response to trauma put the lower extremities and feet at significant risk for unnoticed (unattended and untreated) injury in diabetics.
Peripheral Vascular Disease (PVD)
Low oxygen (hypoxia) is the end-result of diseased blood supply to tissues. PVD thereby affects both the nerves in their function and the tissue negatively impacted by repeated trauma: healing is significantly impaired. Both the arteries and veins in diabetics are affected, and infection from venous involvement is prone to rapid progression.
There is a directly proportional relationship between chronic glucose elevation and neuropathy and peripheral vascular disease, making strict glycemic control the mainstay of prevention and treatment.
Other comorbidities will impact the neuropathy, peripheral vascular disease, and hyperglycemia that results in diabetic risk of trauma and infections:
- Dyslipidemia (abnormal cholesterol and triglyceride levels).
- Drug abuse
Types of Diabetic Wounds
The most common diabetic wounds are pressure ulcers and those from lower extremity trauma. Untreated diabetic wounds result in extension of infection and tissue damage, the end-point of which includes sepsis, the need for amputation, and death.