Why diabetes slows your healing

When many people think about diabetes, food and insulin come to mind­—not cuts or scrapes. But did you know that having diabetes can result in poor wound healing? Being aware of poor wound healing gives you the knowledge to keep minor injuries from becoming serious and affecting your life. Read on to learn more about how diabetes affects healing, wound treatment options, and how to prevent diabetic wounds.

What is a diabetic wound?

Cuts, scrapes, scratches: These are all wound types. Poorly controlled diabetes results in slow wound healing and also increases the risk of complications.

While all wounds should be treated immediately, the biggest cause for concern are diabetic foot wounds, explains Rachel Trippett, MD, a physician with the U.S. Public Health Service Indian Hospital in New Mexico. That’s because what begins as a small issue, like blisters or calluses, can easily become a foot ulcer. Mild injuries are easy to miss at first. These wounds can become infected and may require amputation if left untreated. About 15% of people with diabetes develop foot ulcers, and 40% to 70% of all nontraumatic lower limb amputations occur in diabetic patients.

People with diabetes are more prone to wounds and poor wound healing for two reasons: high blood sugar levels and diabetic neuropathy. 

High blood sugar levels

Blood sugar affects your body’s ability to heal from wounds. When blood sugar levels are too high, it reduces the flow of oxygen and nutrients from your blood into cells. This affects different systems in the body, including those cells that are in control of helping your body heal. This poor blood flow can result in more delicate skin that can be more easily harmed by routine contact. Elevated blood sugars also cause wounds to heal slower (and increase the risk of infection), as your cells aren’t transporting nutrients as efficiently. 

High blood sugar also weakens the immune system, which can slow the healing process.

Diabetic neuropathy

Peripheral neuropathy is an umbrella term to describe damage to the peripheral nerves, including diabetic neuropathy. Chronically high blood sugars cause nerve damage, especially the nerves at the end of the body like the fingers and toes.

 Diabetic neuropathy often presents as tingling and numbness, says Dr. Trippett. People lose the protective functions of pressure and temperature sensation. That means you’re less likely to notice when you’ve injured yourself, when a shoe is ill-fitting, or when a wound has turned into an infection.

Signs of infection and poor wound healing

It’s a good idea to be on the lookout for signs of infection or slow healing. The way the wound looks usually offers good insight. Infected diabetic wounds may be painful, have pus and/or redness, and don’t seem to improve, even after medical attention. People with diabetes who have peripheral neuropathy may have no pain. 

Because lower extremity wounds are the most common wounds in people with diabetes, it’s important to check your feet daily. Look for calluses, redness, or skin breakdown. Jot down any redness, swelling, cuts, or other changes that you notice so you’re able to monitor if symptoms worsen. If you can’t see the bottom of your feet, use a mirror or enlist the help of a willing family member. As you might have less nerve sensitivity, be sure you can see your entire foot.

RELATED: Diabetic foot care tips

When to see a doctor

When it comes to diabetic wounds, it’s better safe. Seek medical attention if you experience burning, tingling, ongoing pain, swelling, or if a wound is not improving, says Dr. Trippett.

Additionally, your risk of having slow healing wounds is greater with fluctuating or chronically elevated blood sugar levels. Other risk factors that slow healing include neuropathy, poor circulation, existing foot conditions like bunions, and previous diabetic foot ulcers. If you fall into these categories, see your doctor about any new wounds. Sometimes people feel funny about calling their doctors with these kinds of ailments, said Robert J. Samuelson, MD, a primary care doctor at Horizon Medical Group, but honesty is key.

Diabetic wound care tips

Despite being careful, you’re only human. Wounds occur commonly. Whether it’s a small cut or burn or a large gash, it is critical to do appropriate wound care to keep it from getting infected or getting worse. Take these wound treatment steps:

• Wash and clean the area with soap and water. Then, apply a topical antibiotic ointment. Avoid an ointment with polysporin in it, as it is a common allergen and can make wounds look infected when they are not.
• Cover the wound with a sterile dressing, which you can find at local pharmacies. Depending on the type of wound, your doctor may recommend a particular type of dressing, like a moist one.
• Keep any wound dressings clean and change them two to three times a day to reduce the risk of bacteria growing. This is important.  Dirty dressings on a wound may be worse than no dressing.
• Let your healthcare provider know if you’re in pain. Pain can restrict blood vessels, which will slow healing. They might recommend acetaminophen as a pain reliever. Ibuprofen is often best avoided as it is metabolized by the kidneys and people with diabetes commonly have kidney issues.
• Tell your provider and pharmacist if you’re taking any medications. Some drugs, including steroids and anti-inflammatory, can interfere with your body’s healing response.
• Avoid putting pressure on healing wounds. Make sure shoes are well-fitting, and socks are clean and not bunched up. 
• Check to see if your physician needs to remove any damaged, infected, or dead tissue or skin—debridement—around the affected area. This reduces bacteria and chances of infection.
• Eat well when you have a healing wound. Your body will be expending energy repairing itself. Focus on a diabetic diet that includes lots of lean proteins, low GI carbohydrates, and healthy fats like olive oils and avocados, will help provide your body with the nutrients it needs to help you heal.  

RELATED: The best diet for diabetes

How to prevent diabetes wounds and infections

Like with most things in the medical world, prevention is better than treatment when it comes to diabetic wound healing. Some of the best things you can do to help prevent wounds are:

1. Keep blood sugar levels controlled. Blood sugar levels that are consistently high contribute to wounds and poor healing. The single most important thing you can do to counteract this, says Dr. Trippett, is to closely monitor your blood glucose levels and keep them as close to optimal as possible.
2. Check your feet regularly. Don’t skip this! Foot care is essential for people with diabetes. Take notice of any new scrapes or cuts, and keep toenails trimmed.
3. Don’t go barefoot. Wearing soled shoes, including indoors, adds an extra level of protection for your feet so that if you have neuropathy and step on a sharp object your foot is not harmed.
4. Get your feet checked professionally. At your medical visits, have your doctor check your feet to check for wounds and neuropathy (decreased sensation). You may also want to do an annual podiatrist visit, where they can do a more thorough exam and appropriately trim nails.
5. Wear well-fitting shoes. Shoes that are too tight can cause friction with your feet, increasing your risk of foot wounds. Try on your shoes in the late afternoon when feet are at their most swollen.