Diabetic Foot Treatment

1. Normalization of carbohydrate metabolism.

The majority of patients with ulcerative lesions stop marked hyperglycemia, and one of the conditions conducive to healing, is to normalize blood glucose levels. Keep in mind that in infectious inflammation and fever in patients with diabetes type 1 require higher doses of insulin.

Diabetes type 2 in inadequate compensation for the background diet and taking tablets recommended transfer to insulin therapy in non-healing ulcers of the foot.

2. Treatment of diabetic neuropathy and angiopathy.

Apply non-pharmacological (diet, etc.) and drug therapies, as set out in the thematic sections of diabetic neuropathy, treatment of diabetic neuropathy, atherosclerosis and coronary heart disease, coronary heart disease, clinical nutrition and atherosclerosis.

Of great importance is the normalization of blood pressure with concomitant hypertension and slow progression of the complications of diabetes like nephropathy.

These areas of treatment are interrelated, although each has its own peculiarities. Thus, it is a difficult task effects on different mechanisms for development, but, in some degree, interdependent co-morbidities and complications of diabetes. Particularly difficult choice of only those necessary and demonstrably effective drugs, which would preclude excessive medical treatment, leading to drug overload the body and excessive material costs.

Therefore, patients should not self-medicate based on information received from the media - popular magazines, newspapers, and radio and television.

3. Unloading of the affected limb.

In the past, patients recommended increasing physical activity in relation to the concept of leadership in the development of vascular diabetic foot.

Currently, discharge of the affected limb or part of it is considered a prerequisite of treatment of purulent-necrotic lesions in all forms of diabetic foot problems of any severity. Lack of, or at least limit load reduces inflammation and swelling, slows the growth of corns around the ulcer, increasing the regenerative processes in tissues. Unloading of the affected limb is particularly effective for neuropathic ulcer of the foot.

Increased physical activity is shown for ischemic, and partly neuroischemic form of diabetic foot (with no necrotic effects). In this case, dosed walking in combination with aspirin can reduce the pain of movement.

Enforcement of unloading is not always easy to be done. Preferred almost complete abandonment of walking and maintaining an elevated position of the limbs. However, bed rest is applicable only for a short period of time and only in some patients. A simple method of unloading is the use of crutches, but for many patients, this method is difficult and affects the quality of life. More convenient for some patients is a wheelchair.

Permissible to use a special shoe that provides unloading of fingers or toes.

At home, like orthopedic device can be made out of old sneakers. Specialists of the St. Petersburg Diabetes Center are among the most effective ways to discharge under the application of bandages of ulcers from synthetic materials during solidification acquiring greater strength than plaster casts, but with less weight. An example of such material is tsellokast, which can be purchased at pharmacies. Studies conducted in several countries indicate a decrease in the duration of treatment of diabetic foot ulcers (4-8 weeks) when using this method. However, in the form of ischemic lesions of the lower extremities, this method of treatment should not be used.

After healing, the ulcer treatment discharge, or at least limiting distance shall be maintained for 2 - 4 weeks. It is necessary to create conditions for the restoration of full tissue in place of the former ulcer.

4. Local treatment of ulcers involves the removal of (most often with a scalpel), hyperkeratosis and corns around the ulcer in order to reduce pressure on the affected area. Another method of local treatment is the removal of necrotic, nonviable tissue as a source of infections and toxins, and the healing is stimulated.

For moist ulcers using moisturizing dressings, dry - dry.

In the first phase of wound healing dressings are used for dampening solutions furatsilina, yodovidona, yodopirona, chlorhexidine, dioksidina, lavasepta or other antiseptic.

Do not use this alcohol solutions, including cologne, iodine tincture, "manganese", "green fodder," hydrogen peroxide

The frequency of dressings depends on the amount of discharge from the ulcer - usually 1 - 2 times a day. In the second phase of wound healing (after cleansing ulcers) use a variety of wound coverage (based on collagen), oil (sea buckthorn, shipovnikovoe oil) and hydrogel dressings. The patient and his household should learn how to make dressings for ulcers.

5. Antimicrobial drug treatment. Used mainly antibiotics, type, route of administration, dose and duration of which is determined only by a physician, based on the severity of the process and speed healing of ulcers.
However, patients should have some understanding of the principles of antimicrobial therapy of diabetic foot syndrome, namely:

Prophylactic antibiotics is not appropriate for long-existing ulcers, and even I II degree (see table diagnostic criteria for different forms of diabetic foot syndrome in the thematic section neuroischemic form on an information portal on vital diabetunet.ru) in providing local care, discharge in the absence of foot and signs of intoxication of the infectious process;

Antibiotics should have a broad spectrum of antimicrobial action, since the majority of infections in ulcers associated with several types of microbes. For a correct choice of antibiotic is desirable laboratory to determine the sensitivity to it of microbes isolated from affected tissues;

For ulcerative lesions without involvement of bone or joint and marked signs of intoxication acquitted of infectious oral antibiotics for 7 - 14 days. In a severe infectious process antibiotics administered intramuscularly or intravenously. From the set used for diabetic foot ulcers, antibiotics to select-amoksiklav, azithromycin (sumamed), moxifloxacin (aveloks) tsiprofloksvtsin (tsifran), ertapenem (invanz).

At the same time we note once more - the choice of antibiotic in each case decides physician.

Nor can we ignore the financial side of choice due to the cost of new imports of antibiotics;

Complications of antimicrobial therapy is most common intestinal bacteria overgrowth - the disruption of its micro-organisms.

For the prevention and treatment of intestinal dysbiosis probiotics and prebiotics are used relating to the biologically active additives to food or drugs.

Another complication of treatment with antibiotics are fungal infections of the mucous membranes of the mouth, intestines, vagina. As antifungal agents used for systemic effects of fluconazole (Diflucan, diflazon), which suppresses the most common cause of fungal infections - yeast-like fungi Candida genus.

If the vaginal fungal infection in women using natamycin (pimafutsin) - topically in the form of suppositories and oral.

6. Surgical treatment.

In severe lesions of the lower extremities, which are not disposed of the above therapeutic methods of treatment, surgical intervention is necessary - removal (amputation) of non-viable limb to save the remaining part of it and / or the patient's life.

Surgical techniques used for the restoration of blood flow in severe limb ischemia, as well as for the closing of large tissue defects with the use of plastics at the expense of their own or artificial skin.

To surgery also includes excision and vaporization of the affected tissue with a laser beam further grafting the wound with local tissues.