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What’s Involved in Wound Care?

separator If you have diabetes, you have to be especially careful with any little cut, blister or sore. Even a small blister can become infected and turn into a serious wound. In a healthy immune system, white blood cells fight infection by attacking bacteria, viruses and fungi. But the extra blood sugar in someone who has diabetes causes poor circulation, which in turn makes the healing process slower. The infection-fighting white blood cells have a harder time reaching their target. Healing nutrients and oxygen are not allowed to flow easily to the wound. To add insult to injury, some of the infection-causing germs actually feed on the extra blood sugar, which makes the wound worse.

If the wound isn’t treated extremely quickly, bacteria can flourish there and cause an infection. The bacteria destroy layers of skin and bone, which can create a hole. The hole can go to the bone and cause an infection there too. When infections become impossible to control, amputation is often necessary.

Nerve damage makes wounds harder to notice
A condition called diabetic neuropathy causes nerve damage that can make it difficult to notice when you have a blister or sore. The legs and feet are most prone to this condition, although it can occur in other areas of the body as well. A tiny stone in your shoe can create a blister that you don’t feel. If you don’t check your feet, that blister can quickly become infected, and before you know it, that infection can reach the bone.

Treat wounds immediately
If a blister or sore doesn’t get better within 24 hours, see your doctor right away. If it’s a foot wound, you should also avoid putting pressure on it until you see your doctor. If the wound has not had a chance to progress too far, your doctor may prescribe an antibiotic for you and also bandage the wound. Be sure that you understand everything your doctor tells you about taking care of the dressing. Ask questions until you’re completely certain about danger signs to look for, when to call the doctor, etc.

If you have what’s called a foot ulcer, you may need to relieve pressure on the area until the ulcer heals. Crutches or wheelchairs are often used. There is also something called “pressure reduction footwear.” Special shoe inserts and casts can reduce pressure on certain areas of your feet. If your doctor recommends a device like this for you, be sure to wear it exactly the way it’s been prescribed.

Removal of unhealthy tissue
If there’s unhealthy tissue in the bed of the wound, your doctor will probably remove it by performing what’s called “debridement” Unhealthy tissue can be yellow, tan or black, and it can be wet or dry. Doctors perform debridement on this tissue by using one or more of several techniques:

  •  Surgical removal of the tissue with scalpels or scissors
  • Moist wound dressings, which allow the body to heal the wound on its own
  • Topical ointments and simple dressings
  • Gauze dressings that adhere to the top layer of the wound and then are removed, taking tissue with them

Your doctor will decide which technique is appropriate for you based on the amount of unhealthy tissue in the wound, the extent of the wound, your medical history and your current health status.

Good nutrition important during healing
Caring for your wound is important, but it’s also important to eat well when you’re recovering from a wound. Your healthcare providers may talk to you about good nutrition during this time. If they don’t bring this up with you, then you should bring it up on your own. Ask your doctor or diabetes educator whether your current food plan will promote healing of your wound. If not, ask whether you should take any supplements or whether you should make changes to your diet.

Do your best to prevent wounds
Obviously, you want to do your best to prevent a wound from occurring in the first place. To do that, you should

  • Control your blood sugar
  • Stop smoking
  • Exercise regularly
  • Follow a healthy food plan
  • Check your feet regularly

To read about daily foot care for prevention of wounds, read “What to Check for When You’re Checking Your Feet,” in the May/June issue of this magazine.

American Diabetes Association Complete Guide to Diabetes, Alexandria Virginia, 2002; C. Guber, B. Thorpe. Carol Guber’s Type 2 Diabetes Life Plan, Broadway Books, New York, 2002; National Institute of Diabetes and Digestive and Kidney Disorders; Wounds
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