A Condensed Overview of Diabetic Skin Ulcers, Cause and Prevention
by Kendra Koch
Spring Dyer, a licensed nurse from San Antonio, Texas, who specializes in wound-care has seen it all when it comes to wounds. "Most of the wounds that I see are secondary to a disease process." She says of her experience. "I care for diabetic ulcers, pressure ulcers, post-surgical wounds-even radiation injuries." While ulcerated and infected wounds can occur in all of these areas of injury and disease, Dyer finds that most of the chronic skin ulcers occur in her patients with diabetes, stating that, "half of my diabetic patients have difficult-to-heal wounds."
National statistics seem to confirm this. Nearly 21 million Americans live with the complications of diabetes. According to the National Institute of Health, 15% of these patients will develop a lower extremity ulcer during the course of their disease. These ulcers are not only inconvenient, painful, and financially burdensome, but they can also lead to foot or leg amputation. In fact, complicated, diabetic ulcers are the leading cause of lower extremity amputation in the United States.
What causes these wounds? And, once they have occurred, why won't they heal?
Diabetics have two primary factors that cause ulcer, and then later exacerbate the ulcer, by slowing the healing process. These two factors are nerve damage (neuropathy) and low blood flow (peripheral vascular disease). The combinations of these two symptoms can lead to countless situations that invite and further diabetic ulcers.
Consider this scenario. Mrs. Jones, a diabetic for nine years, buys new walking shoes. They seem to fit well, so she decides to wear them to her granddaughter's birthday picnic the next day. After wearing the shoes all day her numb feet feel fine, so she wears the same shoes the next day, and the next day, and the next. What Mrs. Jones does not notice is that she has developed two bright red blisters on the back of her heel. She does not notice the blisters because her diabetes has caused a loss of sensation, a numbness in her feet.
By the time that Mrs. Jones finally notices the blisters, they are infected. Although her health care provider prescribes an antibiotic, the wound refuses to heal. Instead it worsens and begins to ulcerate. This is because of the low blood flow to Mrs. Jones' legs and feet. When the body is injured, the blood provides oxygen, protein, and nutrients that allow the wound to heal. If blood flow is low, healing is hindered.
Blisters are one of many conditions that can quickly cause diabetic ulcers. Corns, athlete's foot, sores, calluses, ingrown toenails, insect bites, scrapes, plantars warts, fungal nail infections, cracked skin, and cuts can also lead to ulcers.
Dry, cracked skin presents a particular challenge to the diabetic. When blood glucose is elevated, your body loses more fluid. And when your body loses more fluid, your skin becomes dry. Also nerve damage (neuropathy mentioned above) can decrease the amount that you sweat, which further decreases moisture to your skin.
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