Diabetes

[maxsodakitty]

Hi, i am wondering what it is with T2D that actually causes patients to get venous leg ulcers?

I know that patients with T2D have deficiencies in insulins actions and that if a patient is hyperglycemic that it can lead to high levels of glucose in the blood leading to it been excreted through the urine and taking water with it leaving the patient dry.

I know venous leg ulcers are caused by venous insufficiency or the valves been damaged and not allowing blood back up in the vein and that the slowed circulation causes fluid to seep out of the overfilled veins into surrounding tissues, causing tissue breakdown and ulcers.

But how exactly does T2D cause this. If a patient had a knock to the leg why does it cause a persistant ulcer?

Thanks

[Daytonite, BSN, RN]

a number of factors contribute to a type ii diabetic getting a leg ulcer. people with type ii diabetes have poor circulation to the legs and feet as a result of the lining of the blood vessels becoming thickened. this interferes with the blood flow to this area of the body. people with type ii diabetes are also at a high risk for plaque to build up in vessel walls of their arteries which leads to high blood pressure. if they are also obese which is very common in type ii diabetes, heart disease is going to ensue making circulation to the lower extremities even more compromised. mind you, for many years a type ii diabetic many not even be aware of the changes happening to the circulation in their lower extremities. they are also at a high risk for insulin resistance which results in high insulin levels in their bodies. many diabetics also develop neuropathies along with their diabetes. it is believed that neuropathy develops because it continues undetected and along with untreated high glucose levels it results in permanently damage nerves. symptoms of neuropathy affecting the extremities are numbness and/or pain in the hands or feet. so, sensation in the extremities may be affected.

if a patient had a knock to the leg why does it cause a persistent ulcer?

poor circulation results in the poor blood flow to the area already. this may delay the inflammatory response being put into motion. if neuropathy is present the injury doesn't seem as bad as it is because the person can't sense any pain to tell them. some generalized edema of the leg is already present to some degree because of vessel narrowing already taking place and heart pathology already occurring. with an opening in the skin, cells can now swell unchecked. it is difficult for cells to heal when there is continual massive fluid swelling going on. this creates drainage which if not managed causes maceration of surrounding healthy area and makes the ulceration larger/deeper. no matter what the person is taking for blood sugar control, the blood glucose levels are never maintained at a normal range around the clock so there are times when blood sugars are elevated and this aggravates and slows down the body's attempts at healing. if bacteria are present, the high glucose levels feed the bacteria.

treatment involves giving antibiotics to treat for any microbes, controlling edema with pressure stockings, elevating the extremity to maximize circulation, keeping the ulcer dressed to catch drainage and keep it away from healthy skin, and getting the blood sugar under control.

[maxsodakitty]

Wow, thankyou so much, that was really helpful! :wink2: