1.5 million Americans are diagnosed with diabetes every year. Diabetes leads to an array of other debilitating problems, such as neuropathy, heart disease, and above all, a weakened immune system.
As a result of neuropathy-related nerve damage, this condition can also lead to one of the most common problems for diabetics, diabetic foot infections. It means that there are diminished sensations in the legs and feet, so patients don’t feel blisters or ulcers developing in those regions until it becomes septic, and the infection progresses to an advanced stage.
One such infection is called diabetic cellulitis, which penetrates the deeper layers of the skin causing moderate to severe problems. Keep reading to learn more about diabetic cellulitis treatment and diagnosis, along with other common diabetic infections of the foot, and how you can prevent them.
Diabetic foot infections – What are they and why do they occur?
As with other infections, diabetic foot infections occur when bacteria enter the body through a wound on the foot. Everyday things like scrapes and blisters can lead to diabetic ulcers. Bacteria enter the bloodstream through these ulcers and cause an infection. Non-diabetics can feel the blisters and treat them before they get infected while diabetics cannot, and the infection can spread causing serious damage like necrosis, sepsis, and can even lead to amputation.
Diabetic foot infections occur due to two major reasons:
Neuropathy is nerve damage, which is a common result of diabetes and sensory diabetic neuropathy is due to uncontrolled diabetes. It disturbs the sensations in the legs and feet of a diabetic patient. Hence, they may not feel blisters and other wounds on their feet if they get hurt or foreign materials such as pebbles enter their shoes. If they don’t remove the source of injury, it can lead to a laceration and allow bacteria to enter the wound.
Peripheral artery disease
Diabetes weakens blood flow to parts of the body so, without sufficient blood flow, wounds or cuts may take longer to heal. People with diabetes are not aware of their injuries due to damaged nerves, and insufficient blood flow further slows down the healing. Thus, they are at a risk of ulcers and severe foot infections.
Diabetes cellulitis – Diagnosis and treatment
Cellulitis is an infection of the deeper skin layers, occurring almost anywhere in the body, however, the foot is the most vulnerable area for diabetics. It is due to Streptococcus and Staphylococcus bacteria which exist symbiotically on the skin. However, if they enter the body through a cut, they can result in an infection.
Cellulitis ranges from mild to severe levels; mild cases mostly appear as redness in a localized area, while severe cases can lead to sepsis. The extent of the spread depends on the person’s immune system. In diabetics, high blood sugar levels weaken immunity, while neuropathy and impaired blood flow increase vulnerability to diabetic infections.
If you delay diabetes cellulitis treatment, it can lead to various complications. You may develop permanent swelling in the affected area, or the bacteria may spread to the bones, muscles, or even the heart. It can also lead to sepsis, which is a life-threatening condition. Sepsis symptoms include fever, low blood pressure, pale skin, dizziness, and a rapid heartbeat.
Diagnosing diabetes cellulitis
It is best to seek professional help and let a physician examine the infected area and assess other symptoms. The infected area is usually red, swollen, tender, and warm. Lymph nodes may also swell up around the body, such as the groin if the leg or foot is infected.
The doctor may take a sample for biopsy to determine which bacteria are present. Identifying the correct bacteria helps prescribe an effective treatment for diabetes cellulitis.
Treatment for diabetes cellulitis depends on the severity of infection in each individual. If the infection is mild or in its initial stages, treatment is possible at home with oral antibiotics for one to two weeks. Your doctor may also prescribe a long-term, low-dose antibiotic as a preventive measure.
However, in severe cases, treatment for diabetes cellulitis incurs a hospital stay. Such patients usually experience high fever, vomiting, or persistent cellulitis. It is also necessary if the symptoms get progressively worse or if the patient is not responding to current treatment. In the hospital, they’ll receive a combination of antibiotics intravenously.
Other diabetic infections
Diabetic foot infections are not limited to diabetic cellulitis. Other pathogens may also enter the wound, causing the following:
Myositis is an inflammation in the muscles due to disease or infection. Diabetics are more predisposed to myositis due to susceptibility to infection.
Staphylococcal bacteria are responsible for abscesses. White blood cells travel to the site of infection, which causes inflammation and tissue death. This creates a cavity that fills with pus to form an abscess.
Diabetes is associated with necrotizing fasciitis, also known as flesh-eating disease. People with diabetes are susceptible to necrotizing fasciitis caused by polymicrobial infection or K. pneumoniae.
Septic arthritis is a joint infection caused by pathogens traveling to the joints from other parts of the body. In people with diabetes, germs entering from foot ulcers can travel to the joints to cause infection.
Osteomyelitis is a common complication in a diabetic patient’s foot. It’s the result of a soft tissue infection that spreads to the bone.
Diagnosis and treatment
Other diabetic foot infections can be diagnosed by looking out for infected areas which become red, swollen, and tender. It may hurt, and the wound seeps pus. Once the infection develops, you may experience systemic symptoms like fever, chills, and shortness of breath.
People with diabetic foot infections may also develop gangrene around the ulcer or wound. The lack of blood flow causes the tissue to die and turn black. Not noticing the injury early only causes the infection to worsen, leading to amputation. Thus, it is critical for people with diabetes to examine their feet regularly for signs of infection.
The doctor will look for these signs and conduct a physical exam. They may also clean the wound, dress it in iodine or sulfadiazine cream, and remove necrotic tissue. In some cases, the doctor may order an X-ray if they suspect bone infection. Along with antibiotics, they may also prescribe anti-clotting medicines if your diabetic foot infection is severe. Some people have to undergo surgery to treat diabetic ulcers. In worst cases, amputation may be necessary to stop gangrenous tissue from spreading to other parts of the body.
You can take the following preventive steps to avoid diabetic foot infections:
- Keep any cuts or wounds clean to reduce the risk of infection.
- Avoid scratching any bites or wounds as germs from your fingernails can enter through them.
- Moisturize your feet regularly as it prevents your skin from cracking.
- Manage your diabetes and keep your blood sugar levels within the recommended range. Follow your physician’s advice about nutrition, medication, and exercise.
- Check your feet for sores, calluses, blisters, or ulcers, especially if you have neuropathy.
- Do not walk barefoot and wear well-fitting shoes. Check your shoes to ensure that there are no objects inside that might hurt your feet.
- Put your feet up while sitting or wiggle your toes to keep the blood flowing to your feet. It is advised not to sit crossed-legged for long periods.
The final word
It is possible to cure diabetic foot infections if you seek timely treatment. Delaying treatment can cause the infection or gangrenous tissue to spread to other parts of the body and may result in an amputation. If pathogens enter the blood, they can cause sepsis, which is a life-threatening condition. Thus, you must regularly examine your feet for blisters and wounds and treat them immediately to prevent infection.
If you are seeking help for diabetes testing or in managing your glucose level, you may get in touch with our diabetes specialists at Family Medicine Austin