The Challenge of Diabetes and Wound Healing

Among the many challenges associated with diabetes is diabetic wound healing. For most people, a minor cut, scrape or wound, while unpleasant, can heal without serious complications. However, if you have diabetes, a diabetic wound can result in serious health issues.

To understand why diabetic wound healing takes so long, you need to know the root cause.  Diabetes is a result of the body’s inability to produce or use insulin, which is the hormone that enables your body to turn glucose into energy. If your body cannot sufficiently metabolize glucose, your blood sugar levels will remain high. And that is the culprit. High blood glucose levels affect healing a diabetic wound, most of which are found on the feet and legs.

How high glucose levels affect diabetic wound healing

Uncontrolled diabetes may affect circulation, which causes blood to flow more slowly, making it more difficult for the body to deliver nutrients to wounds. As a result, a diabetic wound may heal slowly or may not heal at all. [1]

Also, permanently high blood glucose impairs the function of white blood cells, which are central to the role of the immune system. The body is less able to fight bacteria and close wounds when white blood cells are unable to function correctly. [2]  Left untreated, an infection can spread to the muscle and bone and progress to gangrene.

Neuropathy impacts diabetic wound healing

Peripheral neuropathy indicates a problem within the peripheral nervous system. When peripheral nerve cells, called neurons, become damaged or destroyed, neuropathy disrupts the way they communicate with each other and the brain. Symptoms include burning, numbness, shooting pain, tingling and muscle weakness or atrophy.  Peripheral neuropathy typically affects the feet and legs and sometimes affects the hands and arms.

Peripheral neuropathy is very common among diabetics. The National Institute of Health (NIH) National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) estimates about one-third to one-half of people with diabetes have the condition due to high blood glucose or blood sugar.[3] That’s because high blood glucose or blood sugar and high levels of fats in the blood from diabetes can damage nerves and the small blood vessels that nourish nerves, leading to peripheral neuropathy.

Since peripheral neuropathy can cause numbness, if you have diabetes, you might not feel a diabetic wound when it occurs. If you are not aware of an injury, you may not receive the treatment necessary for healing a diabetic wound. A combination of slow healing and reduced sensation in the area significantly increases the risk of infection.

Aid diabetic wound healing

If you have a diabetic wound, here are steps to follow to help the healing process:[4]

• Check feet regularly: The key is to catch wounds early to avoid infections and complications. Check your feet each day to look for new wounds. Make sure to check in between and under your toes.

• Remove dead tissue: Diabetic wounds can result in dead cells (necrosis) and excess tissue. The dead tissue can promote bacteria and toxins and increase the wound infection.  Your doctor will be able to help with removing the dead tissue.

• Change dressings regularly: Keep wounds clean and properly dressed. By changing dressings, you help to reduce bacteria and maintain proper moisture levels in the diabetic wound. Your doctor will be able to recommend any special wound care dressings.

• Keep pressure off area: Pressure can cause wear and tear that damages skin and leads to the wound becoming even deeper.

Also, being barefoot can increase the risk of infection. It is better to wear shoes and socks, especially if a wound has developed.

Know if diabetic wound healing is not progressing

A diabetic wound can take some time to heal, but it should start to improve within a few weeks. If redness and swelling around the wound is not gone after about a week, something is preventing healing. Also, if the wound or surrounding skin displays the following signs of infection, talk to your doctor: [5]

• Tender, painful or hot to the touch
• Pus or liquid is oozing
• Unusual color or dark at the edges
• Bad smell

Prevent a diabetic wound

Managing blood glucose level is key to preventing a diabetic wound. Eating a healthy diet that includes fiber-rich foods, protein-rich foods, fruits, vegetables and healthy fats, and avoiding processed carbohydrates and added sugars, will help control blood sugar.  Also start exercising, if you have not done so already. Harvard Health also points out that for people with diabetes, exercise has the added benefit of lowering blood glucose levels and boosting the body’s sensitivity to insulin to counter insulin resistance. [6]

Take these preventive steps to reduce the risk of a diabetic wound. If you should get one, follow the steps for diabetic wound healing and see your doctor if healing takes too long or an infection sets in.

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[1] Villines, Zawn, “How Does Diabetes Affect Wound Healing,” Medical News Today, May 24, 2023. https://www.medicalnewstoday.com/articles/320739

[2] IBID

[3] “Diabetic Neuropathy,” NDDK, Accessed August 23, 2024. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies

[4] Dening, Jedha, “How diabetes affects your body,” healthline, April 19, 2022. https://www.healthline.com/health/diabetes/diabetes-and-wound-healing

[5] “Diabetic wounds that won’t heal? Learn why you’re healing slowing and how to speed up the process,” HealthPartners, Accessed August 23, 2024. https://www.healthpartners.com/blog/why-diabetic-wounds-wont-heal-and-tips-to-treat-them/

[6] “The importance of exercise when you have diabetes,” Harvard Health Publishing,” February 3, 2021. https://www.health.harvard.edu/staying-healthy/the-importance-of-exercise-when-you-have-diabetes