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New Ways to Heal
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Breakthroughs in treating diabetic skin problems
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By Kalia Doner
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Diabetes Focus
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One of the most dreaded repercussions of diabetes—amputation—centers
around problems associated with wound healing that develop
from chronically elevated glucose levels. Excess sugar in
the blood causes immune cells to become less effective and
triggers circulatory problems and nerve disease, both of
which render the body unable to deliver sufficient supplies
of oxygen, growth factors and immune system components to
a wound. When the body’s healing mechanisms are not
working properly, a minor cut or irritation, such as a blister,
can become an ulcer (a nonhealing wound). People with diabetic
neuropathy (nerve disease) are almost twice as likely to
develop a foot ulcer as the general population. And if you
have had a foot ulcer, your risk of developing another
one is 36 times greater.
According to the Centers for Disease Control and Prevention,
around 12 percent of all adults with diabetes have a history
of foot ulcers. Even with aggressive wound treatment, ulcers
can lead to amputation—each year around 87,000 people
with diabetes lose a lower extremity. One study found that
80 percent of nontraumatic lower-extremity amputations are
preceded by foot ulceration, which provides a portal for infection.
Basics of self-care
For good foot care, the American
Diabetes Association recommends following these steps:
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Work with your health-care team to achieve consistently
healthy glucose levels. |
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Do a daily foot check—look for red spots, cuts, swelling and blisters. |
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Make physical activity a part of your everyday routine. |
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If you are prone to foot irritation or ulcers, ask your health-care provider about special shoes. |
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Wash your feet daily and always dry them completely, especially
between the toes. Damp areas can lead to infections. |
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Moisturize every part of the skin each day, particularly the
feet (but not between the toes). |
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Keep nails trim and clean; use a nail file to trim them.
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Don’t go barefoot—ever. |
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Guard against burning the skin on your feet by avoiding putting
them into hot water without testing the temperature first with
your hand. |
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Keep blood circulating through your legs and feet at all times—elevate
feet when sitting, and wiggle toes and move ankles frequently.
Do not cross your legs. |
Treatment breakthroughs
The newest techniques used to promote healing can create
dramatic improvements and heal even the most chronic wounds. “Our
understanding of the underlying principals of wound healing
has led to new techniques that are improving the success
and speed of healing wounds associated with diabetes, peripheral
vascular disease, obesity, aging and infections such as gas
gangrene,” says David B. Kay, M.D., research director
of the Wound Center at Akron General Medical Center in Ohio.
Among the recent advances:
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A human skin equivalent can be made from
cells harvested from the foreskin of circumcised newborns.
It is applied directly on ulcers and helps fresh tissue
to grow underneath it. |
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Animal-derived tissue can be put in a wound; it acts
as a bed for the body’s growth of new cells. |
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Designer drugs, including a growth factor found in
the blood’s platelets, are used to stimulate
closure of diabetic foot ulcers. The growth factors
attract immune cells and proteins to fight infection
and recruit other cells to help reweave the injured
tissue and increase the blood supply to the area. |
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Hyperbaric oxygen therapy is also used to help heal
chronic wounds. The British Journal of Surgery reported
in January of this year that the therapy greatly reduced
the risk of amputation among those with diabetic foot
ulcers. |
The treatment involves placing people with chronic wounds
in a one-person or multiperson hyperbaric oxygen chamber,
where the air inside is compressed to two to three times
that of atmospheric or sea-level pressure. While inside,
patients wear oxygen delivery masks or hoods that provide
100 percent oxygen. They typically spend 90 minutes in the
chamber and receive daily treatment for 20 to 40 days, depending
upon their diagnosis and response rate.
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