How to Care for Wounds
If you don’t have nerve damage or circulation problems from diabetes, Kavros recommends cleaning a small cut or blister with soap and water. Cover it with gauze -- not an adhesive bandage -- so it can breathe. “If it doesn’t improve in a day or two, seek professional help,” he says. Your primary doctor may treat it or send you to a podiatrist or wound care specialist.
If you have neuropathy or circulation problems, see a doctor for even a small wound, says Farhad Zangeneh, MD, assistant professor at George Washington University School of Medicine and medical director of the Endocrine, Diabetes and Osteoporosis Clinic in Sterling, Va. How small? “One of my patients put on jeans without putting them through fabric softening,” Zangeneh says. “The jeans were abrasive, and this caused ulcerations to the skin. He got an infection and was in the hospital for a week.
“I’d rather have a doctor look at it, even if that person ends up saying that it’s just superficial,” Zangeneh says. “Especially if it’s a big wound, don’t let the sun set without someone looking at it." Be sure to tell the doctor that you have diabetes.
Why It’s Important to See a Doctor
Zangeneh and Kavros say the most dangerous mistake people with diabetes make is letting a wound go for days or even weeks without seeing a doctor. “Sometimes people try to do self-medication at home or they do foot soaks, which are totally inappropriate,” Kavros says. People with nerve damage or circulation problems may develop a serious skin infection called cellulitis, which Kavros describes as "a rip-roaring infection that travels up your leg and needs to be treated in the hospital.”
Often it takes a coordinated approach to deal with the underlying problems that prevent a wound from healing. “Sometimes a patient will come to me and say, ‘I’m on my third antibiotic, but it’s not helping,’” Zangeneh says. “Well, even a small infection raises your blood sugar level and that makes it harder for your immune system to fight infection. So you also need to make sure your blood sugar level is normal. And you need to have a good blood supply in order to get the oxygen there to heal. A wound care specialist can coordinate all of this.”
The bottom line, says Kavros, is not just preventing amputation. “When you lose a leg, your chance of losing the other leg within three years is 50%. And the chance of dying from cardiovascular disease within three years is 40% to 50%. So if we can prevent the loss of a limb, we’re basically also giving people a longer life.”