Effective treatments for non healing diabetic ulcers

With diabetes, glucose absorption is disrupted, so its level in the blood increases. If the diet is not followed and there is no treatment, complications can develop that significantly aggravate the course of the disease and prevent the patient from living a normal life. One of these complications in diabetes is ulcers on the legs.

Why do ulcers appear on the legs?

This pathology occurs due to a prolonged increase in sugar, so it is so important to follow all the recommendations of the attending physician.

Being in a high concentration, glucose begins to crystallize, and the crystals damage blood vessels and nerves. Vascular damage is called diabetic angiopathy. First of all, small blood vessels are affected, they thin out, become brittle and lose elasticity. Later, large vessels also suffer, and atherosclerotic plaques are formed in them.

Nerve damage is called diabetic neuropathy. They are damaged for two reasons:

The affected capillaries do not perform their function well enough, as a result, the nerves are poorly supplied with blood and experience oxygen starvation.
With constantly increased sugar, a large number of ketone bodies and other toxic substances are formed, they directly damage the nerve trunks.

The affected vessels and nerves do not cope with their work, as a result, the nutrition of tissues suffers. The skin loses elasticity, atrophies, dries, flakes, swells and itches. This is a signal that treatment is urgently needed, otherwise ulcers will begin to appear.
What does an ulcer look like?
An ulcer is a skin defect. Since in diabetes they are formed as a result of a violation of tissue nutrition, they are called trophic. In this disease, they are most often localized on the lower extremities, in the area of the shins and feet.

Ulcer

Before the appearance of the defect, the skin begins to Shine and thin, covered with spots of pigmentation, later in their place a rounded painful ulcer is formed, which gradually increases in size without treatment.

It is very important to contact specialists immediately if you experience unusual sensations in the limb, such as crawling goosebumps, numbness, or changes in the appearance of the skin. This will help prevent the development of ulcers in diabetes at the earliest stage.

The most recent complication of diabetes is diabetic foot syndrome. This is a combination of damage to the skin, soft tissues, bones and joints. Ulcers form on the foot and the joints become deformed. The danger lies in the fact that diabetes affects the sensitivity of the skin, so patients may not notice that shoes  or there is damage. In simple terms, a diabetic can miss the onset of the disease, and this is dangerous for a more severe course of the disease with the development of gangrene and amputation.

Significantly complicates the course of infection, which often accompanies ulcers. When the defect is infected, the skin around it turns red and swells, purulent contents ooze out of the wound, the body temperature may rise and the leg almost loses its supporting function. A festering ulcer requires urgent medical attention, otherwise you can lose a limb.
By the way, we recommend reading the article What is the norm of blood sugar in children and adolescents?

Trophic ulcers in diabetes have a special feature – they are very difficult to treat and do not heal well. This is due to the fact that skin defects are formed under the influence of many factors and to promote healing, you need to influence all these causes. But it is almost impossible to restore full blood flow and damaged nerves, so it is much easier to prevent the formation of ulcers than to treat them.
Complications of trophic ulcers

Ulcers that are left without attention can lead to serious consequences, which can cause you to lose a limb and even life.

Infectious complications: erysipelas, phlegmon, cellulite, thrombophlebitis, anaerobic infection, osteomyelitis, arthritis, and others. This pathology without treatment can lead to sepsis and ultimately to death.

Malignancy, that is, an ulcer defect can turn into a malignant tumor.

When passing near an ulcer of a large vessel, life-threatening bleeding can develop. First of all, this applies to deep wounds.
Prevention of formation of trophic ulcers

Every patient should know how to prevent the development of complications, this guarantees a lighter course of diabetes and a full life.

Glucometer

First of all, you need to strictly monitor your glucose levels. To do this, every diabetic must purchase a blood glucose meter. If the sugar increases, you should contact an endocrinologist to adjust the treatment.
It is necessary to strictly adhere to the rules of nutrition, when including a new product in the diet, it is advisable to consult a doctor.
Do not self-medicate and be sure to take prescribed medications.
Undergo regular medical examinations, including ultrasound of the vessels of the lower extremities.
Monitor the condition of the skin and if the first signs of damage appear, consult a doctor.
Take daily walks in the fresh air, this will improve the blood flow of the legs and saturate the tissues with oxygen. Gymnastics and massage of the lower extremities will be useful.
Wear comfortable clothing and shoes made of natural breathable fabric. Shoes should never be tight!
Be sure to maintain good hygiene of the feet and to take a daily shower.
To avoid skin damage, it is necessary to remember that any scratch with diabetes heals hard and can turn into an ulcer. For the same reason, you do not need to comb the skin when itching occurs.
Even small scratches should be treated with antiseptic solutions, such as chlorhexidine.  iodine and alcohol are contraindicated in diabetes, as they have tanning properties.
You need to stop Smoking, because nicotine causes vascular spasm, and this further disrupts blood flow and worsens the situation.
You need to examine your shins and feet daily. If you find even small defects, you should consult a doctor.
You also need to check your shoes every day to exclude the presence of crumpled insole, stones and other foreign objects. Diabetic patients may not feel this, and the constant pressure exerted on the skin contributes to the formation of ulcers.
It is desirable to normalize the weight, this will reduce the load on the legs.
It is necessary to monitor the level of cholesterol, as atherosclerotic plaques further complicate blood flow.

Diagnosis of trophic ulcers

It is not difficult to diagnose “trophic ulcer”, but it is necessary to exclude other causes of their formation, because not only in diabetes there are such defects.

It is necessary to exclude such diseases as:

  • obliterating atherosclerosis;
  • varicose veins of the lower extremities;
  • lymphostasis;
  • chronic dermatitis;
  • antiphospholipid syndrome.

To clarify the diagnosis, you need a specialist’s examination, General clinical blood and urine tests, ultrasound dopplerography, MSCT angiography, and laser flowmetry.

Treatment of trophic ulcers in diabetes

As mentioned above, the treatment of trophic ulcers in diabetes is not an easy task. It is necessary to have a complex effect on each causal factor. Also, the method of treatment depends on the neglect of the process.
General treatment

First of all, drugs are prescribed that normalize glucose levels or adjust the already prescribed scheme.

To improve nerve conduction, drugs based on b vitamins are used, they help restore fibers.

Also prescribed drugs that improve blood flow, these include Pentoxifylline, Trental, Cavinton, Actovegin and others.

When joining a bacterial infection, it is mandatory to take antibacterial drugs, first of all cephalosporins of 3-4 generations and fluoroquinolones. But it is more correct to take the contents of the wound on the backposev and choose the appropriate drug based on the results of the antibioticogram.

Antiseptics

First of all, ulcers should be washed with antiseptic solutions, such as chlorhexidine or hydrogen peroxide. After that, a sterile bandage and an ointment with an antibacterial drug (Levomekol) are applied.

When the ulcer in diabetes has stopped festering and cleared, it is advisable to start using ointments that improve regeneration and promote healing of the defect, such drugs include Solcoseril.
Physiotherapeutic treatment

As an additional treatment, physical methods of influence are used, such as laser therapy, UFO, hyperbaric oxygenation, and others. It is believed that they promote tissue renewal, accelerate healing and improve the effect of local treatment.

Badenoch
Douglas Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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