Wounds and diabetes: manage and accelerate healing

By Cristiano Antonino On Apr 1, 2023

It is now known that diabetes induces a slowdown in wound healing, making the healing process more difficult than normal

In people with diabetes, not only is the normal wound healing process compromised, but tissue healing is also slowed down

At the same time, this condition determines a greater predisposition to the development of chronic wounds, such as ulcerative lesions of the lower limbs, which, following complications caused by possible infections, could even lead to amputation 2.

In diabetes, these phenomena would seem to be caused by inflammatory processes that can derive from the body’s altered ability to modulate the release of cytokines, fundamental mediators of intercellular communication, which perform multiple functions in our body 3.

If the migration of cells responsible for tissue repair is slowed down or interrupted, the cellular intervention is hindered and, thus, a deficit already occurs at the level of the very first stages of the wound repair process 3.

In parallel, diabetic microangiopathy can be found, in which partial or total obstruction of blood vessels is observed, which in the lower limbs could reduce the ability to transport oxygen through the blood circulation and, consequently, tissue repair 4.

Furthermore, the phenomenon of epithelialization, in which the skin regenerates from the periphery to the center of the lesion, can be prevented by the lack of important growth factors (for example the keratinocyte growth factor) directly involved in this process of skin “regrowth” .

All these factors are at the basis of a slow healing of wounds, which can predispose to the development of infections: with diabetes these occur up to 4 times more frequently than when this condition is not present, probably due to lack of response neutrophils, white blood cells highly specialized in the defense against infections 4.

How to take care of wounds when you have diabetes?

It must be remembered that, in the presence of diabetes, our body is not able to keep the glucose present in the blood under control.

Since the body is unable to metabolize this sugar, its blood levels rise, resulting in hyperglycemia.

This condition, in addition to causing the well-known complications of diabetes in the long term, can complicate the healing of wounds and their care 5 .

Although lesions can occur all over the body, here are some tips on how to treat a wound in the leg of a person with diabetes or in the feet, as these are the most easily affected areas.

Check regularly

Daily monitoring is the best ally in wound care: in fact, it is useful both for detecting new wounds and for verifying how existing ones are evolving 1 .

The examination of the feet, which represent a critical area, must be carried out carefully as ulcers can develop here.

Diabetes, the importance of removing dry skin from wounds

If you notice layers of dry (or “necrotic”) skin on your body, it is best to remove them as soon as possible and with extreme caution: they could be related to the appearance of some infections, due to bacteria that manage to settle in these layers.

A doctor can intervene to remove these excess tissues or to make the person concerned autonomous and aware of this operation 1 .

Furthermore, it must be remembered that only your trusted specialist can provide the correct guidelines and indicate the appropriate precautions.

Here are some 6 of them:

Wet a gauze pad with sterile water
Put the gauze on the wound and leave it on for some time
Remove carefully. You will be able to see how the dry skin of the wound is trapped by the dressing itself

Always use a clean and fresh bandage

This aspect is fundamental: frequently cleaning the wound and changing the gauze when necessary are important practices in the prevention of possible infections 1.

Do not press the wound with bandages

When applying the dressing, it is advisable to check that the bandages do not exert excessive pressure on the wounds, otherwise they could damage the skin and, therefore, aggravate the condition of the wounds 1.

Why does diabetes complicate wound healing?

There are several reasons that must lead those with diabetes to better control of the wounds and to take special care of them, first of all the fact that, in diabetes, wound healing is an extremely slow process.

High blood sugar levels

It is the main reason why wounds heal slowly: the higher the blood glucose levels, the more inflammatory processes can increase.

Furthermore, hyperglycemia compromises the normal activity of the immune system, as well as the normal metabolism and oxidative state of our cells 5 .

Neuropathy

Neuropathy contributes to the slowing of wound healing in the presence of diabetes; it manifests itself as a consequence of high blood sugar levels and consists of damage to nerve cells, which produces a reduction or lack of sensitivity: this is why noticing a wound can be more difficult for those with diabetes, if not see with own eyes 1!

Poor blood circulation

In diabetes, poor blood circulation is often observed, due to increased blood viscosity due to excess glucose and narrowing of peripheral blood vessels 1.

As a result, red blood cells do not flow normally in the vessels, the tissues are less oxygenated and there is a reduction in wound healing.

Immune system alterations

Many people with diabetes have immune systems that fail to activate promptly.

Furthermore, the cells responsible for wound healing are reduced in number and are unable to carry out their activity efficiently.

All this results in delays in the healing process 1.

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Diabetes and wounds, the danger of infections

Compromised immune systems make infections more likely.

Furthermore, the higher the blood sugar level, the greater the risk of infections: fungi and bacteria further complicate the state of the wounds of those with diabetes and their care 2.

Should I see a doctor if I have an injury?

We have therefore clarified that the wound healing process is slower when you have diabetes, but by following the previously recommended practices, it may not be necessary to go to the doctor every time a minor injury is found.

However, even knowing how to heal a wound, it is still strongly advisable to consult your doctor or trusted specialist if you experience any of the following symptoms 1:

Constant burning sensation
Partial loss of sensation
Intense and persistent pain
Swelling in the affected area
Tingling

Ultimately, following these suggestions and using the necessary precautions, preventing the development of infections, can contribute to better and faster healing of wounds in cases where it is altered and slowed down, such as that which occurs in those with diabetes.