Diabetic ulcers, also known as neuropathic ulcers, are the most prevalent complication of diabetes. The ulcers occur in about 5% of diabetics annually and result when the diabetic person loses their sense of perception or feeling in one of their lower extremities, which includes loss of feeling in the ankles, heels, or toes. Because the diabetic person’s lower extremities are insensate, and they cannot feel anything, pressure ulcers often develop and can go unnoticed for an extended period of time, causing significant damage. In the United States, diabetic ulcers are the leading cause of lower extremity amputation, with approximately 1% of those who develop a diabetic ulcer requiring amputation of the affected area. Nursing home staff should take care to check diabetic residents periodically for any signs of diabetic ulcers.
Classifying Diabetic Ulcers
Diabetics are predisposed to infection, as one of the complications associated with diabetes is a suppressed immune system. With an open wound that lacks feeling, such as a diabetic foot ulcer, it is easy for an infection to fester without notice. When a foot wound becomes infected, it is categorized as either limb-threatening, meaning that the infection is so severe that there is a risk that the limb may need to be amputated, or non-limb-threatening, meaning the wound can be treated and managed with a course of antibiotics and proper care and hygiene of the wound.
As with bedsores, the best course of action upon detection of a diabetic ulcer is to assess the severity of the wound in order to properly determine the appropriate course of treatment. Similar to how bedsores are classified, diabetic ulcers are also typically classified according to either the University of Texas diabetic wound classification system or the Wagner ulcer classification system. The University of Texas system uses a 4×4 grading system: the first parameter is the depth of the wound graded on a scale of 0-3. Once a depth grading is selected, the system then takes into consideration the presence of any ischemia or infection, and finally rates the wound on a scale of A-D. The Wagner system classifies the wound based on the depth of the ulcer, whether there is the presence of gangrene or infection, and the extent of any tissue death in the wound bed.
Gangrene in the Diabetic Ulcer
Gangrene is a term used to describe dead tissue in a wound bed. Gangrene tissue normally dies due to a lack of blood flow or dies as the result of an infection in the wound site. Diabetic ulcers are at a high risk of developing gangrene because they are exposed to the environment, allowing bacteria to enter with ease. In addition to having diabetes, a suppressed immune system, or being obese – all of which are commonly associated with having diabetes – there are many risk factors that can contribute to developing gangrene, such as advanced age, having a disease that affects the blood vessels, and certain medications.
If you have a loved one who has developed a diabetic ulcer while residing at an Illinois nursing home and you are concerned about nursing home abuse or neglect, please contact Robert Rooth today at (800) 350-0646.
Robert G. Frykberg, Diabetic Foot Ulcers: Pathogenesis and Management, American Family Physician, 2002 November 1, Vol. 66, no. 9, pages 1655-1663
Vincent Lopez Rowe, MD, Diabetic Ulcers