Diabetic necrosis is a severe complication of diabetes, involving the irreversible death of body tissue. It can lead to serious health consequences, including the potential for amputation. Understanding its causes is important for individuals managing diabetes, as it underscores the impact of long-term high blood sugar levels and the need for proactive care.
What is Diabetic Necrosis
Necrosis is the process where cells and tissues die due to injury, infection, or metabolic problems. In individuals with diabetes, this tissue death is primarily driven by prolonged high blood sugar, which damages blood vessels and nerves. This damage contributes to reduced blood flow, impaired wound healing, and increased susceptibility to infection.
High blood sugar levels can lead to endothelial dysfunction and atherosclerosis, narrowing arteries and compromising blood circulation, especially in the lower extremities. This reduced blood flow, known as peripheral artery disease (PAD), means tissues do not receive enough oxygen and nutrients. Simultaneously, diabetic neuropathy, or nerve damage, diminishes protective sensation, making it difficult to notice minor injuries like cuts or blisters.
When minor injuries go unnoticed, poor blood flow and unaddressed trauma create an environment where tissue breaks down. The body’s ability to fight infections is also compromised in diabetes, allowing bacteria to multiply rapidly and accelerate tissue death. Necrosis can manifest as dry necrosis, characterized by dry, shriveled, black tissue from lack of blood flow, or wet necrosis, involving bacterial infection of dead tissue, appearing swollen, blistered, and foul-smelling.
Recognizing the Signs
Identifying signs of potential necrosis early is important for prompt treatment. Changes in skin color are a noticeable indicator, ranging from pale gray or blue to purple, dark red, or black. The skin’s texture may also change, becoming dry, leathery, or waxy in dry necrosis, or wet, soggy, and draining with wet necrosis.
Individuals may experience sudden, severe pain that later turns into numbness in the affected area, particularly if diabetic neuropathy is present, which can mask symptoms. Swelling and blisters are also common, often indicating underlying tissue damage that can rupture and lead to infection. A foul-smelling discharge from a sore is a strong sign of infection and tissue death, especially with wet necrosis.
Other signs include coldness in the affected limb, indicating poor circulation, or unusual warmth, which can point to an infection. Unhealed ulcers or wounds that do not improve over time are a serious concern, as they can become infected and progress to tissue death. Persistent pain or soreness, a shiny appearance of the skin, or a sudden increase in blood sugar levels may also signal an underlying issue needing medical attention.
Treatment Approaches
Treating diabetic necrosis involves several medical interventions aimed at removing dead tissue, controlling infection, and restoring blood flow. Wound care is a primary step, including regular cleaning and dressing changes to maintain a moist environment and manage discharge. Saline dressings are often used to keep the wound moist and reduce bacterial colonization.
Debridement, the removal of dead or infected tissue, is a necessary procedure to promote healing and prevent infection spread. This can involve surgical removal of nonviable tissue and bone, or other methods like hydrosurgery systems that debride while preserving healthy tissue. Weekly debridement may be needed as part of routine wound care.
Antibiotic therapy is administered to combat bacterial infections, which are common in necrotic tissue. Initial antibiotic choices are often broad-spectrum, later adjusted based on specific culture results from the wound. Revascularization procedures, such as angioplasty or bypass surgery, may be performed to improve blood flow to the affected limb, necessary for healing and for antibiotics to reach the infected area.
When tissue damage is extensive, infection is uncontrolled, or other treatments are unsuccessful, amputation of the affected limb or digit may be necessary. This prevents further infection spread and preserves overall health. The goal of treatment is to accelerate healing and reduce infection risk, ideally preventing the need for amputation.
Preventing Its Onset
Preventing diabetic necrosis centers on diligent self-care and medical management of diabetes. Strict blood sugar control is paramount, as consistently high glucose levels damage nerves and blood vessels, contributing to necrosis. Regular monitoring of blood sugar and adherence to prescribed medications are important for maintaining healthy levels.
Daily foot examinations are also recommended for individuals with diabetes. This involves checking the top, bottom, and between the toes for any cuts, blisters, redness, swelling, or changes in skin color. Using a mirror can help inspect the soles, and if eyesight is poor, a family member or caregiver can assist.
Proper foot hygiene plays a role in prevention. Feet should be washed daily with lukewarm water and mild soap, then thoroughly dried, especially between the toes, to prevent fungal infections. Moisturizing the tops and bottoms of the feet can prevent dry, cracked skin, but lotion should not be applied between the toes. Toenails should be trimmed straight across to avoid ingrown nails, and professional help from a podiatrist is advisable for individuals with nerve damage.
Wearing appropriate footwear is also important; shoes should be well-fitted, comfortable, and protective, with custom orthopedic shoes often recommended to reduce pressure points and friction. Individuals should always wear socks, preferably those made of synthetic fabric or wool to wick away moisture, and never walk barefoot, even indoors. Avoiding smoking and managing other risk factors like high blood pressure and cholesterol further improves circulation and reduces complication risk.