Diabetes is a chronic disease that occurs when blood glucose (blood sugar), is high. This occurs when the body’s immune system attacks and destroys the pancreatic cells that produce insulin leading to Type 1 Diabetes or Type 2 diabetes whereby the body doesn’t produce enough insulin, or the body doesn’t respond to the insulin produced.
Recent statistics from WHO indicate that diabetic individuals globally stand at approximately 830 million out of which approximately 2.3 million patients are in Kenya, a worrying figure, according to the International Diabetes Federation.
Diabetes was previously believed to be a disease of the rich, a myth, which was demystified. Studies are showing an increase in diagnosis made of the same in younger persons, as well as the elderly.
Apart from genetic predisposition, lifestyle changes and some status affecting glycemic controls are among some reasons one can be diabetic.
Diabetes has many complications shutting down several systems and organs if not managed appropriately.
Among these complications, wound healing can be problematic leading to amputations. It is sad that, globally, an amputation is done every 30 seconds due to related complications.
Diabetic ulcers and subsequent ulcer-related complications can be prevented and managed. Three most common ways diabetic ulcers occur, include ischemia, which is less than normal blood flowing to an area leading to tissue death.
Neuropathy is when there is loss of sensations, especially to the foot. Then thirdly, there are infections, which gain entry into the tissues after trauma, skin cracks and fissures. They rapidly spread, breaking down more tissues advancing deeper making the wound to enlarge and become complex.
All diabetic individuals are at risk of developing these ulcers.
The onset of these ulcers are different ranging from cuts especially during toe nail clipping, pressure on the foot from footwear and feet abnormalities leading to poor foot pressure distribution, gangrene may start as painful small blisters or regional dark patches, which enlarge over time.
Without proper care, these simple wounds normally get infected, enlarge and involve underlying structures such as the bones, tendons and muscles.
Adequate prevention starting with self-care and lifestyle adjustments, such as good personal hygiene, proper nutrition, recommended physical assessments, glycemic controls and proper footwear, among many others.
Identification with a diabetic clinic for follow-up is critical. Glycemic and other checks, physical assessmenta, medications and any specialised treatment required is also done from these setups.
Good glycemic (blood sugar) controls alone are not sufficient to get the situation safe. Appropriate management is done by a multidisciplinary team whose aim is to ensure the patient’s different systems will make it conducive for healing.
This means one should not feel intimidated by being referred to different specialists, doing several tests and scans and having dressing changes or surgical interventions as appropriate.
For wound healing to occur, there has to be sufficient blood flow to the region, no non-viable tissues, no infection and adequate moisture balance. These statuses are always compromised by the complications of diabetes.
As an advanced wound care specialist, I form part of the team, I identify and remove barriers of wound healing, plan and implement initial and subsequent management until the wound heals.
There is technology and management techniques available to ensure diabetic wounds heal faster than ordinary management. We do proper assessment and discuss management and outcomes with the patients and family.
As per the assessment outcomes, available options may include use of negative pressure wound therapy, hyperbaric and transcutaneous oxygen therapy, growth factor concentrate injections, surgical and maggot debridement, WelTek Heal and WelTek Neuro, appropriate indicated dressing materials and a structured and affordable follow up plan in our clinics.
Risks of diabetic-related complications during festivities are high due to laxity in self-care and closed medical facilities, among other reasons.
I would recommend self-consciousness, purchase of medications in time, blood sugar monitoring and management, follow ups as necessary and seeking care in time, in case of need.
Dr Omondi is an advanced wound care specialist
