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Recently my grandmother suffered a fall in her home resulting in a gash on her leg and hospitalization.  When I heard the news, several things ran through my head.  I was concerned about what may have caused the fall, whether she broke a hip, if she hit her head, etc.  All of the concerns that I expressed were important ones, but there was one that entered my mind first.  My primary concern was infection.  My grandmother has diabetes, and with that, injuries are more concerning.

My grandmother’s poor balance was no doubt a primary factor in her fall, but we have already covered the topic of balance in relation to falls in a previous blog so that will not be todays focus.  Diabetes was also discussed in a prior blog around this time last year; however, our previous blog addressed some of the basics about diabetes and the effect that exercise can have on this condition.  Todays entry is geared toward understanding the increased risk that individuals with diabetes face when they get injured.  Diabetes has been known to increase ones risk of fall injury related hospitalization.  This increased hospitalization statistic is partly due to increased balance deficits in relation to decreased sensation in the feet, but also due to the nature of wound healing in this population.  Wound healing is significantly slowed in individuals with diabetes.  There are several factors that play a roll in the nature of wound healing for someone with this condition.  These factors include: blood glucose (sugar) levels, poor circulation, diabetic neuropathy, immune system deficiency, and infection.

Lets start with blood glucose levels and poor circulation.  When blood sugar levels are elevated, the arteries stiffen resulting in atherosclerosis (hardening of the arteries).  This process decreases circulation which in turn makes wound healing take even longer.  The natural healing process requires oxygen and nutrients to be transported via red blood cells to the wound area, but when blood glucose level are high the function of the red blood cells is decreased.  When the red blood cell circulation is impaired, white blood cells that fight infection also become less effective.  This lack of circulation not only prolongs healing, but it can be a primary cause for a wound to develop.

Diabetic neuropathy is a condition that develops when the nerves become damaged due to uncontrolled blood sugar levels.  This occurs most often in the feet.  Once the nerves are damaged, they can no longer feel the sense of touch normally.  This means that, if a person has a wound on his/her foot, they may not be able to feel that it is present or if a wound is getting worse.  Visual examination is then the only means of monitoring the skin for injury or monitoring a wound for further progression.

The immune system does not function properly in the presence of diabetes due to the fact that high blood glucose levels make immune cells (certain enzymes and hormones) less effective in their functioning.  As a result of a weakened immune system, infection becomes more likely.  Infection slows healing time and, if left untreated, can result in gangrene, sepsis, or a bone infection.  Each of these complications can lead to amputation which is why diabetes is the leading cause of limb amputation in the United States.

The best means of managing this condition and improving wound healing are as follows:

  • Eat a healthy diet
  • Be aware of your body including regular skin checks
  • Keeping pressure off of a wound while it heals
  • Exercise regularly to decreased chronic inflammation and improve circulation
  • Stop smoking or performing any other action that impairs circulation.

If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.

Resources:

http://www.woundcarecenters.org/living-with-wounds/how-diabetes-affects-wound-healing.html

http://care.diabetesjournals.org/content/early/2013/10/09/dc13-0429.abstract

http://www.ncbi.nlm.nih.gov/pubmed/2179891

http://www.cell.com/cell-metabolism/abstract/S1550-4131(12)00490-1

http://www.diabetes.org/

 

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