Gangrene in diabetes mellitus: causes, symptoms, treatment

Patients with diabetes mellitus are prone to ulceration and the development of gangrene. Ulcers on the lower extremities appear in every tenth patient. Many are interested in how long they live with such a disease, how to avoid it, how to treat it, and whether it can be treated at all. The death and decay of tissues is caused by a lack of blood supply or a bacterial infection. Most often, the disease affects the toes, hands and limbs. Patients and their loved ones need to know the causes of gangrene, as well as the first symptoms of the disease, in order to be able to prevent its development or have time to notice early manifestations.

Causes of gangrene in diabetes

High glucose levels in the body can damage nerves and blood vessels. The main cause of gangrene in diabetes mellitus is the difficulty in moving blood through the body. The role of blood in transporting nutrients, oxygen and antibodies is enormous. Without nutrition, oxygen and antibodies that are indispensable in the fight against harmful bacteria, cells begin to die off. This is how the disease begins. Sometimes an infection develops. In more rare cases, gangrene becomes a consequence of trauma. A decrease in immune defenses in diabetes mellitus makes it more difficult for the body to fight off attacks from viruses and bacteria. The presence of at least one of the following factors determines a person in the risk group for the disease:

  • diabetes;
  • weakness of the immune system, malnutrition, the presence of HIV, undergoing a course of chemotherapy;
  • atherosclerosis;
  • excess weight;
  • smoking;
  • recent trauma or surgery.

Types of gangrene

There are two main types of gangrene in diabetes mellitus: dry and wet. Wet gangrene is the most dangerous type and has three subspecies: gas, internal, and Fournier’s gangrene .

Dry gangrene

Dry gangrene is the result of an impaired blood supply to the affected area. It most often develops in patients with diabetes mellitus, people with weakened immunity or diseased blood vessels. Diabetes is dangerous because high sugar levels can cause hypoglycemia of blood vessels, their oxygen starvation. This damages blood vessels, obstructs blood flow, as a result of which starving cells are damaged and die off. Usually the fingers of the upper and lower extremities are affected, less often the heels. Since the cells of the body cannot live without oxygen, the violation or cutoff of the blood supply inevitably causes their death. The area that has suffered from poor blood supply becomes brownish, purple, even dark green or black, and the skin can dry out due to lack of oxygen.

Wet gangrene

Wet, or wet gangrene, rapidly spreads in the body, threatens human life and, due to inadequate treatment or lack of it, leads to death from septic shock. This type is characterized by swelling of the affected area, the appearance of blisters, moisture due to the accumulation of pus. Often, wet gangrene in diabetes mellitus develops even after a minor injury to a leg or arm, such as a burn or injury from low temperatures. Diabetics have problems with the blood supply, so the injured area heals slowly and can easily become infected. The skin turns red, which is an indicator of the body’s struggle against infection. In healthy people, blood flow can be disrupted due to trauma, which also sometimes leads to infection. Types of wet gangrene:

  • Gas gangrene, which develops due to infection in the muscle. It is the result of trauma and infection with bacteria that release toxins. These toxins remain inside the muscle, the skin above it turns pale, and when pressed, it emits a characteristic “popping” sound. At the same time, it is known exactly how long the patient will live without medical assistance: no more than two days.
  • Internal gangrene occurs when the blood supply to the organ is disturbed, which can happen, for example, with inflammation of the appendix;
  • Gangrene Fournier rare. It is caused by an infection in the genital area. Immediate medical attention in this case is necessary to avoid getting the infection into the bloodstream.

Signs and Symptoms of Gangrene in Diabetes

People who are at risk of developing the disease, as well as their loved ones, should know the signs of gangrene for the timely detection and successful treatment of the disease. Dry gangrene symptoms 

  • the skin of the affected area is dry, wrinkled;
  • skin color changes from light brown and blue to dark green, purple and black;
  • the skin is unnaturally cold, numb;
  • pain may be absent or severe, disappearing as the area becomes numb;
  • There is a distinct line between the affected area and the surrounding skin.

It is important to remember that dry gangrene can become infected, which can cause wet gangrene to develop.

Wet gangrene symptoms :

  • swelling of the affected area;
  • redness of the skin, which then turns brown or black;
  • sores, sores, or blisters that drain pus;
  • unpleasant odor of discharge;
  • fever and general weakness;
  • with gas gangrene, the skin of the affected area is blanched. Cracking or crunching is heard when pressing on the skin;
  • with internal gangrene, there is severe pain in the body.

Even one of the above signs can be a symptom of an incipient disease, therefore, if they appear, you should immediately consult a doctor.

Symptoms of life-threatening septic shock include:

  • low blood pressure;
  • heart palpitations;
  • fever;
  • confusion of consciousness;
  • labored breathing;
  • dizziness.

It is very important that the symptoms of septic shock are known to all those close to the patient with diabetes mellitus and those people who are often around him, for example, at work. In this case, they will have time to react in time by calling emergency help, since the patient himself may be in a helpless state.

Gangrene of the legs in diabetes

Patients with diabetes mellitus are especially susceptible to the development of gangrene of the foot and toes of the lower extremities. The legs bear the bulk of a person’s weight, so they often suffer from circulatory disorders and subsequent complications. Vessels damaged by high glucose levels and hypoglycemia do not work well. Collagen synthesis, which is needed to heal ulcers and wounds, is reduced. Small vessel thrombosis has a negative effect on the blood supply to the lower extremities. A diabetic foot with ulcers or gangrene that has already begun should be examined immediately by a doctor, who will decide on the method of treatment. Infection is a serious threat to the patient’s life, therefore, when an infection develops, the doctor may immediately recommend amputation of the diabetic foot so as not to risk the patient’s life. Treatment depends on the area occupied by the ulcer on the foot, its depth, blood supply, the presence of infection, and the sensations experienced by the patient in the area of ​​the ulcer. In many cases, gangrene of the lower extremities requires surgical intervention.


Without timely treatment, any type of gangrene, one way or another, will lead to the complete death of the affected area of ​​the upper and lower extremities. In mild cases, the patient remains scars due to the removal or death of dead tissue. In advanced cases, amputation is inevitable. Wet gangrene is dangerous because it quickly spreads to other parts of the body, and without medical assistance, a person dies due to septic shock, that is, a sharp drop in blood pressure.

Treatment of gangrene in diabetes mellitus

Amputation is the most radical method of getting rid of gangrene. Complete amputation of the affected area is performed in order to remove dead tissue and prevent further necrosis. The amputation prevents the infection from spreading throughout the body, which prevents the development of life-threatening sepsis. In most cases, the disease can be stopped early. The following methods are used for treatment:

  • Antibiotic treatment . This method is effective in treating at an early stage, when tissue necrosis has not yet begun. Antibiotics kill the infection by stopping the damage to cells.
  • Hyperbaric oxygenation , or oxygen therapy . This method is used without surgery for gas gangrene. Damaged, but not yet dead, areas are repaired with oxygen therapy. For this, the patient is placed in a special pressure chamber, into which air is supplied under pressure. As a result, the body, together with the damaged area, receives the required amount of oxygen, and the destruction of cells stops. 
  • Surgical intervention . The operation is aimed at the reconstruction of damaged blood vessels to restore blood access to the affected tissues.
  • Larva therapy is used to treat gangrenous wounds. The method, used several centuries ago, is to place fly larvae in the wounds, which eat up dead tissue. Thus, the wound is cleared of dead flesh, while the living tissue is not affected by the larvae. Maggots secrete Saracen, which disinfects the wound. When treating a disease in this way, larvae are used, bred only for these purposes. It is dangerous to apply maggots on your own due to the possible infection of tissues with pathogens. 

If the patient decides to supplement the prescribed gangrene treatment with folk remedies, then it is necessary to choose natural methods. Before using traditional methods, you need to consult a doctor. This does not include ointments for ulcers that can worsen. The following drugs are safe and do not worsen the patient’s condition:

  • green tea (no more than two cups a day) is used as a support to the main treatment; 
  • slightly warm water (about two liters per day) helps healing and improves digestion, and it is better to refuse cold water, as it slows down the intestines; 
  • Fresh vegetable juices tone the body and help fight infection. 

Any kind of gangrene is curable at an early stage, when no need to resort to amputation.

Prevention of gangrene in diabetes mellitus

People with diabetes can successfully reduce the risk of tissue death. General rules for disease prevention:

  • in the cold season, do not expose the skin to hypothermia;
  • quit smoking;
  • fight excess weight under the supervision of a doctor;
  • buy comfortable shoes, do not wear them on bare feet, do not go barefoot;
  • wash the lower limbs daily with warm water and wipe dry, paying attention to the area between the fingers;
  • undergo a medical examination at least once a year;
  • do physical education for the upper and lower extremities.

Patients who closely monitor their health significantly reduce the chances of developing unpleasant complications of diabetes. Another important factor in the prevention of gangrene in diabetes is diet. The following foods containing saturated fat should be limited or completely avoided in order to lower blood cholesterol levels:

  • fat meat;
  • fat;
  • butter;
  • sweets like cookies and candies;
  • food containing coconut and palm oil.

Changing your diet reduces the risk of developing the unpleasant consequences of diabetes, including diabetic foot.

Most cases of diabetic gangrene can be avoided by changing diet, monitoring blood sugar levels, exercising, and taking medications. At the slightest suspicion of gangrene, seek medical attention. Lower limb care includes daily washing with clean warm water, careful selection of shoes, prevention of foot injuries. Patients with diabetes mellitus must undergo a medical examination at least once a year. By following these rules, any diabetic will say goodbye to pain and discomfort.

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