Diabetes

How does diabetes affect wound healing?

Diabetes can cause wounds to heal more slowly. This raises the risk that someone with diabetes will develop infections and other complications.

A person who manages their diabetes well can improve wound healing and reduce the chances of developing a serious infection.

Diabetes and wound healing

Burn wound slowly healing because of diabetes under plaster.
Those with diabetes may find that different types of wounds are slow to heal.

Minor wounds, cuts, and burns are a part of life, but for people with diabetes, they can cause serious health issues.

Many people with diabetes develop wounds that are slow to heal or never heal. Wounds that do not heal well can become infected.

An infection can spread locally, to surrounding tissue and bone, or to further away areas of the body. In some cases, they may even be fatal.

Diabetic foot ulcers affect 15 percent of people with diabetes. These are painful sores that can ultimately lead to foot amputation.

Even when a wound does not become infected, it can affect a person’s health and quality of life. Cuts or injuries on the feet or legs can make it difficult to walk or exercise without pain.

Keeping diabetes under control can reduce the risk of slow-healing wounds and complications, including foot ulcers.

A 2013 study found a clear correlation between blood glucose and wound healing. People undergoing surgery for chronic diabetes wounds were more likely to fully heal if their blood glucose was well-controlled at the time of surgery.


Why does diabetes affect wound healing?

Diabetes makes it more difficult for the body to manage blood glucose levels. When blood glucose remains chronically high, it impairs the function of white blood cells, resulting in an inability to fight bacteria.

Diabetes, particularly if uncontrolled, is also associated with poor circulation. As circulation slows, red blood cells move more slowly. This makes it more difficult for the body to deliver nutrients to wounds. As a result, the injuries heal slowly, or may not heal at all.

Nerve damage is another factor affecting wound healing. Uncontrolled blood glucose can damage the body’s nerves, which means that people with diabetes may sustain trauma to their feet more easily without being aware that they are injured. This can prevent them from seeking treatment, allowing a wound to become even worse.

Impaired sweating, dry and cracked skin, toenail infections, and foot deformities are more commonly found in people with diabetes, increasing the risk of a bacterial infection.

Research is consistently uncovering other ways that diabetes affects wound healing, including:

  • weakened production of hormones associated with growth and healing
  • decreased production and repair of new blood vessels
  • weakened skin barrier
  • decreased collagen production

Complications

People who exhibit poor wound healing due to circulatory and neurological effects of diabetes may have other complications as well. These include heart disease, kidney disease, and eye problems.

A wound left untreated may become infected, and the infection may spread locally to muscle and bone. This is called osteomyelitis.

If the infection spreads into the bloodstream, it is called sepsis and can be life-threatening. Deep infections may sometimes become severe and require amputation.


Prevention

Woman applying moisturizing lotion to her feet.
Maintaining good foot hygiene by washing and moisturizing daily may help to promote wound healing.

Strategies that can prevent slow-healing wounds due to diabetes include managing blood glucose, proper foot care, and treating wounds promptly.

Proper foot care includes:

  • washing feet daily
  • patting dry and applying moisturizing lotion
  • avoiding walking barefoot
  • carefully trimming toenails
  • wearing comfortable shoes
  • inspecting feet and looking inside shoes daily
  • having a doctor check feet at each visit

People with diabetes should carefully monitor their wounds. While it is normal for diabetic wounds to heal slowly, it is not normal for them to remain open for several weeks, to spread or ooze, or to be extremely painful.

People with well-managed diabetes are less likely to suffer from serious wounds that do not heal.

People with type 1 diabetes must take insulin for life. Those with type 2 diabetes have more options for controlling their blood glucose, including several anti-diabetic drugs and insulin.

Both types of diabetes benefit from a carb-controlled diet. In the case of type 2 diabetes, lifestyle interventions, such as diet, exercise, and weight loss, may substantially improve blood sugars and may even allow a person to manage their diabetes without medication.


Outlook

A wound that does not heal can quickly become life-threatening. A positive outlook for slow-healing wounds depends on receiving prompt treatment.

People with diabetes should immediately contact a doctor when they develop serious or painful wounds, or if a wound appears infected, causes a fever, or does not heal after several days.

A combination of aggressive antibiotic treatment, cleaning the wound, surgical treatment to remove dead tissue, and better glucose control can help. If the wound does not respond to treatment, such as with a severe or extensive diabetic foot ulcer, amputation may be necessary.