Diabetic wound care measures

Based on long-term stable sugar control, graded treatment based on wound depth and exudation, and at the same time preventing infection and avoiding secondary damage. There is no so-called "magic pill" and a plan that suits your own wound conditions is effective.

In other words, stable blood sugar is the prerequisite for all care. I met 72-year-old Aunt Zhang when I was following up patients with diabetes in the community. She broke her little toe while dancing in the square. She put a band-aid on it at home for two days but it didn't heal. Instead, it leaked pus. When she came to the doctor, her fasting blood sugar was measured at 11.7mmol/L. She also said, "I usually have higher blood pressure and I don't feel uncomfortable. I didn't expect the wound to be so big." In fact, a high blood sugar state will reduce the bactericidal ability of white blood cells and damage nerves and blood vessels. The wound will not be supplied with enough blood and oxygen, so it will naturally be difficult to grow well. Therefore, regardless of the size of the wound, you must first control the blood sugar within the standard range. It is generally recommended to 4.4-7.0mmol/L on an empty stomach and no more than 10mmol/L if not fasted. This is a hard standard and there is no room for negotiation.

After blood sugar has stabilized, let’s look at the treatment of the wound itself. There is a disagreement that has been discussed in the industry for a long time, which is whether to choose dry healing or wet healing. Many young wound specialist nurses recommend wet healing, covering the wound with foam dressings, hydrocolloids and other dressings. Maintaining a moist environment allows epidermal cells to crawl faster, heal faster, and is less likely to leave scars. However, many senior doctors with rich clinical experience feel that most wounds of patients with diabetes are leaky and prone to infection. A wet environment may breed bacteria, so it is safer to leave the wound open to dry and scab. In fact, both of these statements are correct. It depends on the situation: if it is only a very superficial skin abrasion with little oozing and no redness, swelling or pus, you can use a wet dressing after thorough cleaning and be sure to change it on time; but if the wound has reached the dermis, If there is a lot of layers, exudation, or even smelly, whitish and necrotic tissue, don't apply dressings at home. Instead, consult a doctor for debridement, scrape off the necrotic tissue, and then change the dressing according to the situation. At this time, using wet dressings will only delay things.

If you accidentally cut your nails and get a small blister, which is not serious enough to go to the hospital, don't deal with it blindly. Don’t listen to the myth that “you can rest assured by disinfecting with alcohol-iodine.” People with diabetes have sensitive skin, and many people have peripheral neuropathy and are insensitive to pain. Alcohol-iodine is too irritating and will damage the new tissue on the wound surface. Just use normal temperature saline to clean the wound and wash away the dirt on the surface, and then use iodophor (note that it is iodine, not iodine. The iodine needs to be deiodized, which is too troublesome and irritating) to gently disinfect the surrounding skin. Hey, I have seen too many people pour alcohol on their wounds. They grimaced in pain and thought it would "go away". It was completely unnecessary.

There is another pitfall that everyone often steps into, which is that "wounds need to be left open and ventilated to heal quickly." There was an old uncle who had been suffering from diabetes for more than 20 years. His heels were worn out. He deliberately walked barefoot at home, saying that he needed some ventilation. As a result, he either stepped on the ground and got dust on the ground, or accidentally bumped into the furniture and caused bleeding. It didn't heal for half a month. In fact, wound healing requires a clean environment, not direct exposure to the air. If you think about it, there are so many dust bacteria in the air, which makes it easy to get infected. Moreover, the bed sheets and sofas at home are not sterile. Rubbing them around may cause secondary damage. Later, I asked him to cover his feet loosely with two layers of sterile gauze, which can block the dirt and not make him feel stuffy. I also asked him to wear socks and loose cotton socks without constricting his feet. It took less than two weeks for the foot to grow back.

Of course, not all wounds can be treated at home. If you find that the wound is still oozing for more than 3 days, with no sign of scabbing, but the surrounding area is getting redder, swollen, hot to the touch, or even has yellow-gray necrotic tissue and smelly, or the entire foot is swollen and painful when walking, don’t hesitate to go to the endocrinology department or wound specialist of the hospital. Wounds of people with diabetes progress very quickly, and it can take ten days and a half to develop into diabetic foot. In serious cases, amputation is really necessary. There are really too many cases like this.

Oh, by the way, there is another detail that many people do not pay attention to, that is, the normal skin around the wound also needs to be taken care of. If the surrounding skin is too dry, it will easily crack and the wound will be enlarged. You can usually apply a mild lotion that does not contain fragrance or alcohol to keep the skin moisturized. You should also be careful when wearing shoes. Don't wear leather shoes or hard-soled shoes that squeeze your feet. It's best to wear new shoes at home for a few hours to get used to them. Don't wear them to go shopping as soon as you put them on. Many severe diabetic feet start with just a small blister.

Actually speaking, there are really not that many fancy operations in diabetic wound care. The core is not to be careless, don't take it seriously if it is just a small hole, and don't use folk remedies blindly. Spreading toothpaste on the wound or spreading Yunnan Baiyao without debridement will seal the dirt inside. Stabilizing blood sugar, being hygienic, and seeking a doctor in time if something is wrong are better than anything else.