Diabetes mellitus is a disease that takes hundreds and thousands of lives every year. The most dangerous complications of this disease: among them quite often diabetic gangrene, which is a severe form of diabetic foot syndrome. According to statistics, gangrene occurs in 30-35% of patients. At the same time, about 10% of them need an operation to ampute the affected fingers or even a whole limb. Why does diabetic gangrene develop and what good habits will help to avoid undesirable consequences?
Diabetes: why gangrene occurs?
Sugar diabetes – This is an endocrine pathology, the development of which is directly related to absolute or relative insulin deficiency and impaired glucose uptake. For the disease is characterized by chronic progressive course, as well as disorders of fat, carbohydrate, protein and water-salt exchanges. Gangrene is a local death of a part of the body. Lower limbs are most often affected: fingers and feet. The characteristic symptoms of the complication are: pain, discoloration of the skin, impaired sensitivity and blood circulation in the affected area.
The main reason for the development of the disease – severe diabetes. Disorder of glucose metabolism often leads to vascular and neurological changes, resulting in gangrene. The main factors that increase the likelihood of developing gangrene include:
- Foot deformation
Uneven distribution of the load on the foot (when wearing heels, tight shoes), limited limb mobility leads to impaired blood circulation. This contributes to the appearance of the smallest wounds, cracks, sores and scuffs. Further necrosis areas are formed.
- Decompensated diabetes
Long-existing hyperglycemia is the basis of vascular and neurological disorders. Gangrene is the result of insufficient blood supply and tissue hypoxia.
- Decreased immune system activity
In patients with congenital or acquired immune deficiency, there is a lack of protective mechanisms. Patients become extremely vulnerable to the smallest wounds and damage to the skin.
- Presence of concomitant pathologies
It is known that gangrene is most often diagnosed in patients with diseases of the cardiovascular and nervous system. The risk group also includes people over 65 who suffer from severe renal pathologies.
- Socio-economic factors
Often, the development of complications is associated with a lack of patient adherence to treatment. They forget to take drugs, do not diet and do not get rid of bad habits.
The main mechanisms of gangrene formation
The basis of the development of diabetic gangrene are angiopathy and peripheral neuropathy. It is known that hyperglycemia leads to changes in large and small vessels: the capillary membrane thickens and stratifies, the processes of filtration and diffusion of liquids are disturbed. The tissues do not receive oxygen and nutrients in the right quantity, but there is a violation of excretion of metabolic products.
The formation of atherosclerotic plaques causes narrowing or complete obstruction of the lumen of the arterial vessels of small or medium caliber. This creates the conditions for the formation of necrotic and destructive changes. Due to lack of oxygen and nutrients, the cells die. If this process proceeds gradually, the tissues are mummified: this is how dry gangrene is formed. When attaching bacteria develops wet gangrene due to decay.
Pain and other signs of diabetic gangrene
For dry gangrene is characterized by the defeat of a limited area, necrosis does not extend beyond its limits. Initially, at the stage of ischemia, severe pain occurs, the skin becomes bluish-pale, sensitivity is reduced, tingling and itching may occur. A demarcation line is formed, which separates healthy and damaged tissues. Gradually, the affected area becomes dark brown or black, the dead tissue shrinks and dries out, which often leads to spontaneous spontaneous amputation.
For moist gangrene is characterized by pallor of the skin, the formation of bubbles with bloodworm. In the affected area, dilated veins and decreased sensitivity are observed. The tissue swelling progresses rather quickly, the pain increases. When wet gangrene necrosis spreads to neighboring areas, resulting in aggravated course of the disease. Gradually, the skin becomes gray or black, with palpation you can hear a sound resembling a crunch. Phenomenon of intoxication is also expressed: fever, weakness, occasional vomiting and nausea. The danger of this form is that it can lead to the development of sepsis and infectious-toxic shock.
Disease treatment: antibiotics or surgery?
Treatment of this complication is carried out in a surgical hospital. First of all, doctors need to compensate for diabetes mellitus: the dose of insulin and other medications is adjusted. Drugs to improve blood circulation and microcirculation (angioprotectors), as well as agents that dissolve blood clots (anticoagulants) are widely used.
When dry gangrene is used a conservative tactic. Bandages are performed, dead skin tissues are gradually removed. In order to cleanse the wound surface, topical preparations are prescribed. Wet gangrene requires urgent surgical intervention: this avoids the involvement of unchanged tissues in the pathological process. Also a mandatory stage of treatment are antibiotics wide acting. These drugs help prevent secondary infection.
Prevention: how to form good habits
Diabetes mellitus is a serious disease, careless treatment of which can lead to disability and even death of the patient. To avoid the development of gangrene, it is necessary to instill in itself simple and useful habits, which include:
- timely medication and constant monitoring of blood glucose levels;
- wearing comfortable and high-quality shoes;
- treatment of associated diseases, as well as wounds and skin lesions of the feet and fingers;
- regular foot examinations;
- personal hygiene and treatment of feet and fingers with an emollient cream.