Will better blood glucose control prevent further foot ulcer damage?

  1. 0
    I have a question regarding my school project. Basically, my patient has a diabetic foot ulcer (stage III) and we are coming up with interventions to help prevent further damage to her foot. We realize that this patient will probably never have a normal foot again, so our goal is focused on prevention. If this patient were to improve her blood glucose monitoring and correction, would this prevent further damage to her foot ulcer? Or is it too late for this patient to prevent damage to her foot ulcer with blood glucose monitoring? Is good blood sugar control only good for prevention of the foot ulcer in the first place?

    Thanks,
    Kim
    (P.S. I'm sorry if this is in the wrong section. I was torn between students and diabetes nurses, but I figured you guys may have more information on the subject.)

    (P.P.S. Sources for this would be appreciated. I couldn't find anything about this online but then again it's very hard to find a good keyword to search for this.)
  2. 8 Comments so far...

  3. 2
    I believe you are on track. Yes the damage is done to the foot, but more tissue damage can occur because of poor BS control. With any diabetic patient BS control is a major key factor to their health. There is a lot of dynamics to the BS control and ulcers, one thing to remember bacteria loves sugar and if patients sugar is sky high its a bacteria playground. Diabetic patients do not heal wounds easily, and a high sugar makes it worse for healing. Patient needs tight glycemic control, meaning sugars needs to be monitored closely and treated aggressively while the wound is trying to heal. I would add daily skin inspection of the ulcer and proper care of the wound. Patient probably has neuropathy from their diabetes and cant feel their extremities or the ulcer for that matter until it was too late. Dont forget patient education as an intervention. Hope this helps.
    Last edit by CEBRN on Dec 4, '11 : Reason: more information added
  4. 0
    Quote from CEBRN
    I believe you are on track. Yes the damage is done to the foot, but more tissue damage can occur because of poor BS control. With any diabetic patient BS control is a major key factor to their health. There is a lot of dynamics to the BS control and ulcers, one thing to remember bacteria loves sugar and if patients sugar is sky high its a bacteria playground. Diabetic patients do not heal wounds easily, and a high sugar makes it worse for healing. Patient needs tight glycemic control, meaning sugars needs to be monitored closely and treated aggressively while the wound is trying to heal. I would add daily skin inspection of the ulcer and proper care of the wound. Patient probably has neuropathy from their diabetes and cant feel their extremities or the ulcer for that matter until it was too late. Dont forget patient education as an intervention. Hope this helps.
    Thank you thank you! This is what I was thinking.

    Also I was wondering if the patient had an amputated foot already if there would be any benefit to the skin itself in improving glucose control? If the patient had a foot amputated, could it be possible that the patient would need to be amputated higher up on the already amputated foot if blood glucose was not stabilized, or is there is a significantly smaller chance that the wound would get infected if the patient was able to control her blood sugar better?

    Thank you in advance, this is helping a lot
  5. 0
    Definitely there would be a benefit to the skin. This patient has a lot going on and unfortunately their poor health related to their diabetes has taken a toll on several areas of their body. My biggest advice to you as a student is to start training your brain to look at the whole picture. Its like a detective putting all the pieces together, figuring what caused this whole process for the patient- critical thinking. If you treat the main problem most of the secondary issues will usually improve. So if you treat their diabetes by aggressively controlling their sugars their overall health will begin to improve, the skin will heal better, they will have more energy and be more active, but the biggest thing is you will improve any further damage. Unfortunately, this can be complicated because most diabetics, who have major secondary issues to their diabetes are usually non compliant in their care. That is why teaching is so important with these patients. Some times compliance is not the issue, it is just a knowledge deficient. You are on the right track though, by controlling their sugars future skin issues will be less likely. That is why daily skin inspection is equally important. Like I said earlier about patients have neuropathy, they are still at risk for more wounds to develop like if they cant feel that their prosthetic is not fitting right, they might develop a sore. If they are controlling their sugars the sore will heal quicker than if they had poor sugar control.
  6. 1
    In short, better BS control decreases the suitable growth environment for bacteria by:

    • decreasing available glucose
    • decreasing microvessel stasis (improves circulation)
    • preserves sensation by the above
    • speeds healing by increased circulation
    classicdame likes this.
  7. 0
    while increased BS definitely will increase risks of complications, normal range BS definitely MIGHT decrease those risks. Who can say?
  8. 1
    Diabetic foot ulcers normally do not use the terminology of "stage" but "grade" There is a differencing in staging and grading using the Wagner Scale. Just an FYI.
    wink4clover likes this.
  9. 0
    Maintaining proper blood glucose levels after surgery, especially in diabetic patients, also has a huge effect on wound healing. I took care of a patient who developed an abdominal wound dehiscence following surgery primarily due to consistently high blood sugar levels. She had to be transported immediately to the OR to have emergency surgery!
  10. 0
    Hyperglycemia seems impair wound in several ways. High glucose levels inactivate complement, an important factor in allowing white blood cells to recognize bacteria. In addition leukocytes are inhibited in consuming and neutralizing bacteria and debris. High glucose levels impede deposition of collagen in the wound bed, and decrease the effectiveness of growth factors to stimulate healing.
    Here a reference on wound healing in diabetes:
    Brem, H., Tomic-Canic, M. (2007). Cellular and molecular basis of wound healing in diabetes. The Journal of Clinical Investigation. 117(5), 1219-1222.


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