According to the Centers for Disease Control (CDC), around 30.3 million people in the United States have a type of diabetes, and many of these people experience complications caused by infected wounds. For individuals with diabetes, all wounds are a serious health concern and require careful attention. Even small cuts and insect bites can cause wound healing difficulties in patients with diabetes.

Because of diabetic peripheral neuropathy, skin cuts and blisters often go unnoticed until they become more complicated to heal. In addition, internal wounds such as ingrown toenails, skin ulcers, or calluses can cause breakdown of tissue and an increased risk of infection. Even small cuts and insect bites can cause wound healing difficulties in patients with diabetes. Here are common factors of diabetes that impact wound healing:

1. Blood Glucose Levels
Diabetes does not allow the body to effectively handle glucose, so patients frequently have problems maintaining an optimal blood sugar level. Although the disease can be controlled through lifestyle, diet, and insulin, many patients experience difficulty adapting their lifestyle and diet enough to control their blood glucose levels effectively. The result of elevated glucose levels is damage to many body systems. High blood glucose causes stiffening of the arteries, narrowing of blood vessels, and diabetic neuropathy, which is nerve damage throughout the body, particularly the limbs. The effect of these body changes causes increased risk of wounds as well as more complications in diabetes wound healing.

2. Neuropathy
Neuropathy is both a major cause of injury in individuals with diabetes, and also a reason for complications in diabetes wound healing. When high blood sugar destroys nerves, they do not regenerate; thus many patients with diabetes are increasingly less sensitive to pain in their limbs. With this loss of sensation, patients don't feel developing blisters, infections, or existing wound changes. That means that wound healing is complicated not only by the fact that patients don't feel wounds as they occur, but they also have no pain to alert them that a wound is getting worse or infected.

For many with diabetes, injuries are only noticed with careful daily skin checking. However, limited mobility can make it difficult for some individuals to check the most vulnerable areas, such as the bottom of their feet. For these reasons, it is important that diabetics, especially those with neuropathy, wear well-fitting shoes to eliminate cuts, scrapes, blisters, and ulcers. Of the 18 million people in the United States who have diabetes, about 15 percent will develop a foot ulcer wound.

3. Circulation Problems
Circulation of blood at the wound site is critical for wound healing. As a result of narrowed blood vessels, diabetic wound healing is impaired because less oxygen can reach the wound and the tissues do not heal as quickly. In addition, elevated glucose levels decrease the functioning of red blood cells carrying nutrients to the injured area and limit the effectiveness of white blood cells fighting infections.

4. Immune System Inefficiency
High blood sugar levels also lower the body's ability to fight infections. The immune cells don't function as effectively in diabetic wound healing, which causes an increased risk of bacterial infections. Research suggests that one of the specific problems in wound healing is this: enzymes and hormones produced by the body in reaction to high blood sugar levels can shut down the effectiveness of the immune system.

5. Chronic Inflammation
Inflammation is one of the natural stages of wound healing, but in diabetic wound healing, the inflammation stage frequently lasts too long and the wound can become chronic. In chronic wounds, the balance between producing and degrading collagen is lost and the wounds don't heal.

6. Increased Infection
Slower movement of white blood cells in the wound site, along with less effective immune responses and wounds stuck in the inflammation stage, means that infection risk is higher in diabetic wound healing. Also, some diabetics are desensitized by neuropathy, which prevents them from recognizing that their wound is infected and getting worse. Since diabetics heal much slower, the wound site is open longer, leading to an increased chance of infection. Unfortunately, individuals with diabetes have a much higher risk of gangrene, sepsis, or bone infections like osteomyelitis. In fact, infected diabetic ulcers are the number one reason limbs are amputated in the United States.

Healing wounds in individuals with diabetes can be difficult, slow, and prone to serious infections. Because of the impact of diabetes on wound healing, it is important to take special care in treating even minor wounds of patients with diabetes and to urge them to do careful self-inspection daily.

The Best Treatment Is Prevention
People with diabetes can use specific strategies to improve the time it takes for a wound to heal. These include managing blood glucose, thorough foot care, and treating wounds as they occur.

People with diabetes should immediately contact a doctor when they develop serious or painful wounds that do not heal after several days, or if an infection seems to have developed.

References:

• "3 Reasons Diabetic Wounds Are Slow to Heal." Geisinger, 2020, www.geisinger.org/health-and-wellness/wellness-articles/2017/11/08/20/05/3-reasons-diabetic-wounds-are-slow-to-heal.
• "How Diabetes Impacts Wound Healing." WoundSource, 4 Dec. 2017, www.woundsource.com/blog/how-diabetes-impacts-wound-healing.
• "National Diabetes Statistics Report 2020." Centers of Disease Control and Prevention, 2020, www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.
• Prelipcean, Maria, and Zawn Villines. "Diabetes and Wound Healing: Causes, Complications, and Prevention." Medical News Today, MediLexicon International, 2019, www.medicalnewstoday.com/articles/320739.