Types of Diabetic Wounds Providers Should Know

Diabetic patients have elevated risks for a number of health concerns, one of the most common and life-threatening being diabetic wounds. What begins as a simple cut can quickly devolve into a chronic wound that fails to heal and can result in infections or even amputations. Providers need to be sensitive to the potential of diabetic patients developing wounds, particularly on their feet where they cannot see or feel them.

Prevention is, of course, the best course of action. Education, regular monitoring, and prompt treatment can help patients live longer, healthier lives. And in the case that dangerous wounds do develop, quick and effective treatment is necessary.

What Are Diabetic Wounds and Diabetic Foot Ulcers?

Due to poor circulation, nerve damage, and high blood sugar levels associated with diabetes, patients are at an increased risk of developing dangerous wounds. One of the most common types of diabetic wounds is the diabetes induced foot ulcer, which typically appears on the bottom of the feet and poses significant health risks. These types of wounds are most commonly found on the feet and lower legs, are slow to heal, and can quickly develop further complications. For people with diabetes the lifetime risk of developing a wound on their foot is 19-34%, and of that, 20% will have such severe and unhealed ulcers that they will require amputation.

Reoccurrence of foot wounds is particularly high in diabetic patients and can lead to a wide range of complications and additional health risks. There are several types of diabetic wounds that practitioners will see, like:

• Diabetic foot ulcers. The most common place for these wounds is the bottom of the feet, but they can appear anywhere on the foot. Because of the nerve damage associated with diabetes, patients do not feel pain sensations and, therefore, do not seek treatment of these kinds of wounds quickly enough. Slow blood flow also hampers healing which can lead to life-threatening consequences.
• Venous stasis ulcers. Blood can collect in the lower legs because of the slow blood flow in diabetics. This stagnant blood increases the pressure on the skin and breaks down healthy skin, creating ulcers that are slow to heal.
• Ischemic ulcers. In some cases, blocked or constricted arteries mean not enough blood reaches a patient’s extremities, resulting in ischemic ulcers from lack of healthy blood flow. These commonly appear on bony areas or the lower legs and are often cold to the touch due to lack of essential nutrients from the blood.
• Pressure injuries. Sedentary patients are especially susceptible to pressure injuries that appear over boney areas like the hips and heels. When pressure is applied to the same area of skin over extended periods of time, like when a patient is immobilized in a bed, the blood flow is restricted, and the skin breaks down.
• Traumatic wounds. Having diabetes means that normal injuries like cuts, scratches, or blisters can turn into major medical problems. Uncontrolled blood sugar, a reduced immune response, and slow blood flow impairs the typical healing process, putting patients at risk of complications.

What Causes Diabetic Wounds?

As we have seen, slow or restricted circulation is a major cause for diabetic wounds in patients with diabetes. But it is not the only reason these ulcers develop. In the US, about 11.3% of the population, equal to about 37 million people, have diabetes. Elevated blood sugar levels cause arteries to stiffen which makes blood vessels constrict. When blood flow is reduced to any area of the body, less oxygen and red blood cells arrive. White blood cells become less effective in this situation, making healing times longer and exposing the patient to additional risks in relation to the wound.

Uncontrolled blood glucose levels also lead to diabetic neuropathy, or damage to nerves outside of the brain or spinal cord. Information usually relayed to the brain via these nerves never arrives, causing numbness or unusual sensations. A patient could easily develop a blister or get a small cut they do not notice because the nerves cannot communicate pain signals to the brain. Wounds that are ignored or overlooked can get worse because of reduced blood flow before a patient even realizes there is a problem.

Peripheral vascular disease is another condition that complicates blood flow, further increasing the risk of wound development in diabetic patients.

Diabetes also affects the immune system, making it less effective in fighting off infections and protecting the body from developing dangerous wounds. Additional enzymes and hormones are produced in response to high blood sugar levels that also stall healing processes. This leaves diabetic wounds open to infection and eventually, gangrene. to high blood sugar levels that also stall healing processes. This leaves diabetic wounds open to infection and eventually, gangrene.

How to Prevent Diabetic Patients from Developing Chronic Wounds

Thorough education and awareness are the first and most important preventative measures for diabetic patients. Make sure your patients understand their risk as well as what to look for to indicate that wounds are developing. If they have a diabetes diagnosis, they should regularly be examining their feet and extremities for signs of broken or damaged skin.

Although they may not be able to feel wounds developing, a close examination of what the skin typically looks like and being able to quickly identify potential areas of concern can be a major factor—and an easy routine—in preventing life-threatening complications. Educating patients on proper foot care and regular monitoring can significantly promote wound healing and prevent complications.

Diabetic patients should also be referred to a podiatrist for regular appointments. Every one to six months depending on risk factors, a podiatrist can thoroughly examine the feet for any signs of damage or concern. The support of this medical professional as part of the diabetic treatment team can prevent diabetic wounds from forming or becoming a serious health concern.

Other preventative measures include:

• Keeping feet dry, clean, and moisturized.
• Wearing shoes at all times that fit correctly.
• Keeping blood sugar levels within normal range.
• Not smoking.
• Treating all wounds immediately with clean bandages and recommended topical treatments.
• Exercising regularly to reduce inflammation.
• Eating a healthy diet to support all internal systems.
• Maintaining a healthy weight.

Additionally, patients should be able to identify when seemingly innocent cuts, scrapes, or blisters need additional treatment.

If any of the following symptoms are present, patients should seek care immediately:

• Drainage from the wound
• Redness or discoloration
• Wound and surrounding area is firm to the touch or warm
• Swelling
• Fever or chills

How to Treat Diabetic Wounds

A provider will first have to determine the current stage of the diabetic wound with a scaled system used to categorize these wounds. It ranges from Grade 0, where the skin has no damage, to Grade 5, where the entire foot is infected with gangrene. Diabetic patients often face wound healing complications, such as infections and prolonged healing times, which require careful management.

A treatment plan will be developed in accordance with the grade of the wound and the general health of the patient. Treatment may include any of the following.

1. Clean and dress the wound: Keep the diabetic wound clean with soap and water. Covering the wound protects it from infection and encourages healing. Wound dressings designed specifically to treat diabetic wounds may be recommended. These could include silver-impregnated dressings, skin substitutes, biological dressings, or dressings with antibiotic properties.
2. Keep pressure off the wound: This can be difficult if the wound is on the bottom of the foot. Providing a patient with medical equipment like crutches or a brace will prevent irritation and offload pressure.
3. Use topical medication: In addition to wound dressing, topic treatments like saline, growth factors, or infection fighting antibiotics can be helpful.
4. Prescribe antibiotics: Depending on the grade of the wound, oral or intravenous antibiotic therapy may be necessary.
5. Debride the wound: Providers can remove any dead tissue in and around the wound so healthy tissue is exposed and can heal the rest of the region. This is often not a one-time treatment; instead, the infected tissue may need to be removed regularly via debridement practices or a daily ointment.
6. Surgery for realignment: Because protrusions, bunions, and boney areas are more prone to diabetic wounds, surgery to realign bone structure will relieve pressure and prevent further wound advancement.
7. Vascular surgery: A vascular surgeon can use angioplasty or stints to improve circulation in any limb or extremity. This opens restricted veins or reroutes the blood flow to a healthier area of the limb.
8. Amputation: For advanced grade diabetic wounds, amputation may be necessary to prevent the spread of infection or gangrene. While this is a treatment of last resort, 25% of patients with unhealed diabetic ulcers will require amputation, making it a significant health risk.

Risk Factors that Put Diabetic Patients at Higher Risk for Serious Wounds

Having diabetes itself is a huge risk factor for developing dangerous wounds that are slow to heal and kick-start other health issues. Patients with these risk factors are more likely to develop severe wounds that require advanced medical treatment. Additional factors providers should screen for that put patients at even higher risk for diabetic wounds include:

• Being male. Prevalence of type 2 diabetes was 14.6% in men compared to 9.1% in women. Women also experience less severe neuropathy, more joint mobility, and lower foot pressure, making them less likely than their male counterparts to develop foot ulcers.
• Advanced age. The risk for diabetes increases as patients age, immediately putting them at greater risk for additional health complications such as diabetic wounds. Incidents of pressure ulcers are five to seven times higher in patients over the age of 80 than for those between 65 and 70.
• Being an ethnic minority. The risk for Black and Native American populations developing diabetic wounds is higher than those for white patients. While it is not clear if this is a biological difference—it may be more likely related to socioeconomic status and access to quality healthcare—steps should be taken to ensure all populations can access prevention services and comprehensive care and education to prevent life-threatening wounds.
• Smoking or drinking alcohol. Both substances further inhibit blood circulation, lowers oxygen levels, and impair the normal function of immune cells.
• Obesity. Obesity often limits mobility and decreases the amount of time patients spend doing aerobic exercises, which can improve and maintain blood flow. It also reduces the heart’s efficiency, decreasing cardiovascular health and the availability of health oxygen and blood cells to the extremities.
• Comorbid cardiovascular or kidney disease. Obviously, cardiovascular disease reduces the flow of healthy blood cells through the body. In addition, a common symptom of kidney disease is uncontrolled blood sugar levels, which compound the health issues related to healing wounds.
• Length of disease. The longer bodily systems suffer under poor circulation, fluctuating blood sugar levels, and nerve damage, the more likely a patient will be to develop diabetic wounds. Prolonged disease continues to damage circulation and the nervous system, leaving patients exposed to infection and constricted blood flow.

The Necessity of Treating Types of Diabetic Wounds Efficiently

With the elevated risk of negative events related to even minor injuries, scratches, or cuts, it is essential for both patients and providers to monitor their feet and extremities regularly and thoroughly. Technology is incredibly useful for identifying, tracking, and treating diabetic wounds. Efficient diabetic wound healing is crucial to prevent severe complications and improve patient outcomes. Advanced analytics and artificial intelligence have made significant changes in a provider’s ability to identify problems and pinpoint the most effective treatment.

Take advantage of the technology that will save lives, prevent serious complications, and reduce the amount of time you spend assessing wounds. AI-powered wound care software and tissue analytics technology supports physicians and enables better outcomes for patients..