CARE OF SWEDEN

Wound Care Management for Diabetic patients

All wounds heal with time, but sometimes it takes too long that it becomes a hindrance to normal life. Wound care management can never be complete without addressing the needs of the patients at risk. Today we explore one such category- diabetic patients. India is home to 77 million cases of diabetes, the second-highest globally. This means that a little less than 9% of the Indian population is a diabetes patient. But how does diabetes relate to wound management?

The answer lies in the incapability of the diabetic person’s body to produce insulin which leads to higher sugar levels. A higher sugar level in the bloodstream often inhibits the immune system from working efficiently and leads to increased inflammation in cells. These effects directly impact a person’s capability to heal while assisting the progression of wounds. Thus, it delays the time required for healing.

Among diabetic patients, the feet are one of the most common areas for a wound that gradually develops into a foot ulcer. If left untreated, the consequence could be as worse as an amputation. As distasteful as that may be, smaller wounds are not a desirable consequence either. Obesity, alcohol consumption, and smoking have also been observed to increase the chances of developing an ulcer. Hence it is imperative that we go the extra mile in ensuring diabetic patients are free of wounds or blisters.

Some challenges arise in diagnosing a wound or an ulcer in diabetic patients. For instance, conditions like peripheral neuropathy that hamper sensation and peripheral vascular disease that reduces blood flow are very common among diabetes patients. It is the combination of a wound and these conditions that make a deadly combination as the patient is often unaware of the wound. Since these conditions usually afflict the hand or feet, the high prevalence of foot ulcers in diabetes patients validates our rationale.

The treatment does not differ from that of other wounds or ulcers. However, it is important to keep the blood glucose levels under strict control to facilitate faster healing. Preventing the infection through cleaning and dressing, offloading pressure with repositioning and medical devices, debridement, and surgery when required are the common treatment procedures. 

Additionally, patients are advised to not walk bare feet and if the wound appears on the bottom of the feet, a podiatrist may ask the patient to wear special medical grade footwear or to make use of a wheelchair and crutch to avoid pressure on the foot in its entirety. A podiatrist can also check for sensation in the feet using a monofilament in a painless process. He may also employ non-invasive methods to measure blood circulation levels.

It is always best to consult a podiatrist as soon as an ulcer is noticed so that he can assess the risk faced by the patient and develop a relevant treatment strategy. Other early symptoms you can look out for include persistent pain, swelling near an ulcerated area, lack sensations, or a tingling/burning sensation. Consult a podiatrist or specialist if these symptoms linger for over a week. If there are diabetes patients in your vicinity who are prone to wounds or have a history of ulceration, then advise them to maintain a healthy diet and keep sugar levels in check. And constantly monitor them for wounds or blisters, especially in their feet.

We discussed the relevance of diabetic wound management in the Indian sub-continent, the challenges faced by diabetic patients in this regard with special reference to diabetic foot ulcer (DFU) cases, usual treatment mechanisms, and when patients or those taking care of them should seek advanced forms of care. Information that does not induce action is not knowledge at all. So pass this along to those in need and take extra care of the patients at-risk around you. Only by inculcating a culture of care in our environment can we buoy community health and ease the burden on the healthcare system.

Haanie Bilal