Gangrene – a significant danger for people with diabetes

1. February 2016

Among patients seen by Veronika Palmiste, vascular surgeon of the East-Tallinn Central Hospital, there are a number of those who need to be reminded of the basics. Even the tiniest of blisters on the leg requires great attention because blood flow problems accompanying diabetes may give rise to the worst case scenario, or gangrene.

According to Dr. Palmiste, diabetic patients have to pay attention to even a foot blister because diabetes is a disease which in the long term damages the whole body and various organ systems. People with diabetes are more inclined than others to develop blisters because their sensitivity level is lower – they simply do not feel when their shoes are rubbing or when there is a grain of sand in a sock. They will notice it only in the evening when they see that the sock is wet with fluid from a popped blister. Generally, this is not a problem, but because arterial circulation of the leg is also impaired as a complication of diabetes, the body lacks the ability to heal the blister wound – as would quickly happen with the rest of us. So, a tiny blister may turn into a stubborn ulcer.

Why diabetic patients?

Why do diabetic patients have an increased risk of gangrene? “The main culprit is diabetes, a chronic disease the normal progression of which involves damage to various organs. Therefore it is very important to keep the chronic condition under control and correct risk factors as early on as possible. Risk factors include smoking and the selection of appropriate footwear,” explains Dr. Palmiste.

According to Dr. Palmiste, as a rule, foot problems in people with diabetes tend to have a sudden onset, occurring out of the blue – yesterday everything was okay and in a week’s time all is out of control. However, when talking to the patient, it appears that early warning signs indicating the circulation disorder and the development of neuropathy were present. “For example, for quite a long time the patient has not been able to walk a long distance because crural muscles get tired and the patient needs to take breaks. Or the patient accidentally cuts into the nail wall when trimming toenails because he/she has simply lost sensitivity in this area,” says the vascular surgeon, giving examples of some early warning signs.

Wound care station provides help and relief

How should a person proceed after a blister or ulcer has formed? Who should be consulted and what kind of help should be sought? “When a blister or ulcer on a foot refuses to go away in a reasonable time or gives reason for concern, consult first with your family doctor or family nurse. At the East-Tallinn Central Hospital, patients can visit the wound care station. The nurse at the wound care station sees patients five days a week and there are no long queues. When there is no risk of sepsis, there is generally no need to visit the department of emergency care,” adds Dr. Palmiste.

She says that not all diabetic patients will suffer from losing their legs before they die; other common complications include heart attack, stroke, blindness or loss of kidney function. Still, there is no way to predict which complications will affect a diabetic patient at some point in the future. But one thing is for sure: it is vital to stick to your treatment routine, refrain from smoking, select appropriate footwear and regularly get a therapeutic pedicure to minimise complications or postpone their onset.

East-Tallinn Central Hospital’s team working together for the same goal

According to Dr. Palmiste, doctors of the East-Tallinn Central Hospital attend to cases of diabetic patients when things get extreme, that is, when simply dressing their wounds is not enough and administering medication is ineffective. Such patients are primarily in need of aggressive and invasive treatment to improve their blood circulation. Vascular surgery treatment options include commonly used shunt surgeries as well as intravascular opening of occluded arteries, or endovascular treatment.

“To ensure a high success rate, the cooperation of patients and their family members is a must. Blood flow restoration is a highly technical task and for permanent results, the patient must strictly follow treatment guidelines and undergo regular check-ups. Because vascular surgery is powerless against arterial calcification, in some cases repeated operations or procedures are required – all of this in the name of saving the patient’s legs. Although we do our best to help our patients, in reality it is only them who can contribute to treatment success by fully cooperating with us,” says Dr. Palmiste, adding that people with diabetes who want to lead a normal life despite their condition must not only stick to an appropriate treatment routine, but also refrain from smoking.