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Is Your Diabetes Under Control?

September 03, 2013

Washington Hospital Seminar Focuses on Preventing and Treating Foot Sores

If you have diabetes, you know how important it is to keep your diabetes under control. The chronic disease raises the risk for a number of health complications, including foot sores. That may not seem like a big problem, but diabetes-related ulcers can lead to amputation and studies show that people with diabetes who develop ulcers are at much greater risk for premature death.

"Patients who have a diabetic foot ulcer that results in amputation have the same chance of premature death as someone with lung cancer," said Dr. Prasad Kilaru, a local plastic surgeon and medical director for the Washington Center for Wound Healing and Hyperbaric Medicine. "The best medicine is prevention. Keeping diabetes under control significantly reduces the risk of developing foot ulcers."

Dr. Kilaru will offer other tips for preventing foot sores when he presents "Treatment and Prevention of Diabetes-Related Ulcers" on Thursday, September 5, from 7 to 8 p.m. The seminar is part of Washington Hospital's free monthly Diabetes Matters education series and will be held at the Conrad E. Anderson, M.D. Auditorium, 2500 Mowry Avenue (Washington West), in Fremont.

Diabetes is a chronic disease that occurs when the body does not produce enough insulin or is not able to use it properly. Insulin is a hormone needed to convert sugars and starchy foods into energy. When this process doesn't work properly, glucose in the blood can get too high and lead to complications.

High glucose levels in the blood can damage nerve fibers over time, particularly in the legs and feet, making it difficult to feel sensation, Dr. Kilaru explained. This nerve damage is called diabetic neuropathy. Diabetes can also decrease circulation and immune response, increasing the risk for ulcers.

The feet are the most common area for ulcers to develop, although they can occur on the legs and other parts of the body. With a decreased ability to feel pain, people with diabetes often can't feel when a sore is developing.

"They might get a pebble in their shoe or maybe their shoe rubs, but they can't feel it," he said. "Also, when diabetic neuropathy gets bad, the foot starts to collapse, and now parts of the foot are under pressure that they weren't under before. The decreased circulation and immune response makes it much harder for wounds to heal."

Stay Vigilant

Preventing foot sores is the best way to avoid amputations and premature death. Dr. Kilaru said it's important for people with diabetes to stay vigilant and check their feet regularly.

"It's best to set a regular routine of checking their feet before bed or after their shower in the morning," he added. "They need to look for cracks in the skin or sores, looking between the toes and examining both the tops and bottoms of the feet."

People with diabetes also need to keep their blood glucose levels under control to reduce the risk of diabetic neuropathy and other health complications. They need to test their blood glucose regularly and take their medications as prescribed, he said.

Diet is also critical. People with diabetes need to reduce their intake of carbohydrates, salt, and saturated fat through proper portion control. They may want to work with a dietitian to create a meal plan that works for them, he suggested.

Physical activity can help to maintain a healthy weight. Even moderate
weight loss can help to reduce blood glucose levels, Dr. Kilaru said.

He will also talk about the treatment of diabetes-related ulcers. They must be treated aggressively to reduce the risk of amputation.

"Almost all amputations start with a foot ulcer," Dr. Kilaru said. "Catching these ulcers early and treating them aggressively helps to ensure the wound will heal successfully."

The first line of treatment is to cut out the dead skin and treat the infection. If the wound won't heal, Dr. Kilaru may use more advanced therapies such as skin substitutes or hyperbaric oxygen therapy.

The skin substitutes are grown in a lab. They contain growth factors that stimulate healing and skin growth, he explained. The substitute skin is placed over the wound.

With hyperbaric oxygen therapy, the patient breathes pure oxygen inside a pressurized chamber. The chamber has clear sides to avoid feeling closed in.

"High concentrations of oxygen get into the bloodstream, which helps to increase the body's own natural wound-healing capabilities," he said. "We are having a lot of success with these treatments. But I will stress at the seminar that the best way to avoid these types of treatments is to prevent diabetic-related ulcers in the first place."

To learn more about Diabetes Matters and other diabetes programs at Washington Hospital, visit www.whhs.com/diabetes. For information about the Washington Center for Wound Healing and Hyperbaric Medicine, visit www.whhs.com/wound.