By the WoundSource Editors
Chronic wounds pose an ongoing challenge for clinicians, and there needs to be a clearer understanding of the pathophysiology of wound chronicity and treatment modalities available.
Holly Hovan MSN, RN-BC, APRN, CWOCN-AP
Diabetes is extremely prevalent in the United States. The Centers for Disease Control and Prevention (CDC) report that over 10% of the US population has this chronic disease, and 26.8% of older adults (65 and over) are impacted by diabetes, both diagnosed and undiagnosed.1
Diabetes is a disease that results in abnormally high levels of blood glucose. Diabetes occurs when the pancreas does not produce enough (or any) insulin or when the body cannot properly use the insulin that is being produced. Some signs of diabetes may include increased urination, thirst, and hunger. Numbness and tingling in the legs and feet (also known as neuropathy) may occur. Loss of sensation (impaired sensory perception) may also occur in the lower extremities, most commonly below the knees. Dry skin, fatigue, and delayed wound healing can also be signs of diabetes. As with most medical conditions, these signs and symptoms can also indicate other illnesses, so it’s always best to follow up with your medical provider if you’re experiencing anything out of the ordinary.
In addition to diabetes, many patients have comorbidities, as well as complications of this chronic disease. Diabetes can impact major organs, especially when it is untreated or poorly controlled, and it may lead to damage of the nervous system, heart, kidneys, eyes, skin, and feet, among other issues.
Diabetic patients, especially older adults, are at risk for skin complications of diabetes, specifically diabetic foot ulcers (DFUs). As a result of neuropathy and impaired sensory perception, patients with diabetes may not always feel an initial injury, an ill-fitting shoe, or minor trauma from nail trimming or callous cutting. These issues can trigger a DFU.
The best treatment for DFUs, as with many chronic illnesses, is prevention. Checking your patient’s feet and encouraging them to routinely check their own feet are the best ways to prevent a DFU or to keep a small injury from turning into a DFU. Routine skin checks, hygiene, appropriate fitting footwear, and not going barefoot are just a few ways to prevent DFUs.2 Additionally, routine exams should be scheduled for diabetic foot care as needed, with prevention of skin issues being the goal.
It is important to teach patients the correct way to check their feet, routine foot hygiene, and when to call their provider. If a skin issue arises, it is important to follow-up with a medical provider as soon as possible – early intervention is also key.
As nurses, it is important to understand the link between diabetes and foot care, risk factors, prevention, and evidence-based practices. Nurses with an interest in foot care, prevention, and diabetes education are able to seek out certifications in these specialties and be designated as experts in the field.
As with any chronic disease or illness, controlling the cause and managing it appropriately are key. Prevention is the best practice, but not everything is preventable. With foot care and diabetes, skin checks cannot be emphasized enough in terms of prevention of additional complications.
1. Centers for Disease Control and Prevention. National Diabetes Statistics Report 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-stat.... Accessed November 18, 2020.
2. Centers for Disease Control and Prevention. Diabetes and Your Feet. https://www.cdc.gov/diabetes/library/features/healthy-feet.html. Accessed November 18, 2020.
About the Author
Holly is a board-certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.