Diabetic gangrene is characterized by obstructed supply of blood due to tissue damage or death of the body tissues. It is caused due to an underlying injury, infection or illness resulted from poor blood supply to the body parts. Diabetic gangrene usually affects the extremities like fingers, toes and limb but can also occur inside the body damaging muscles and organs.
About one in three diabetic individuals will surely develop a foot ulcer during their lifetime, which if left untreated may develop into diabetic foot gangrene. About 85 percent of all limb amputations in diabetic individuals are followed by foot ulcers. Every 30 seconds, a lower limb amputation is carried out due to diabetes throughout the world. The mortality rate due to diabetic foot gangrene is just next to cancer death rate.
Gangrene can be either dry or wet.
Wet gangrene: It is caused by infection and necessitates emergency care and treatment.
Dry gangrene: Diabetic individuals are more prone to dry gangrene, involving restricted blood supply, and the initiation site is often the toes of the feet.
Gangrene is a condition characterized by obstructed blood supply that causes death of the tissue. It can occur in any part of the body but typically starts in the extremities like feet, fingers and hands. Diabetics are more prone to gangrene because they are exposed to several other problems as well.
Diabetes by itself or in combination with hypertension (high BP) and high cholesterol can cause significant damage to the arteries. Large arteries are narrowed by partial or complete obstruction. This reduces blood pressure and normal flow of blood to the extremities. Smaller arteries along with capillaries get thickened and can totally prevent oxygen supply to the affected areas. If blood flow is decreased below a threshold level, gangrene can occur.
Lack of awareness and negligence is the major contributing factor for worsening cases of diabetic foot in developing countries like India. Diabetic foot is one of the most costly complications of diabetes and is the main cause of hospitalization for people with diabetes. Without appropriate treatment at the right time, tissue death may spread progressively and may require amputation of the limb. Therefore, initial signs and symptoms of gangrene should not be ignored.
Symptoms of diabetic gangrene:
- Pain in the affected area
- The affected area turns cold
- Change in colour of the affected area from pale or red to brown or black
- Development of blisters on the foot
- Loss of sensation or numbness in the affected region
- Sometimes, the affected region may be extremely painful as gangrene advances
- Discharge of foul odor from the blisters
Gangrene can be treated only if the signs and symptoms are recognized at an early stage, before it progresses to complete death of tissue.
Vascular surgery: Dry gangrene is often treated by restoring the blood flow to the affected area. The surgery involves repairing obstructed blood flow by placing a tiny balloon in the blood vessel to open it up. A tiny metal tube, called as a stent, may also be placed into the artery to keep it open.
Bypass surgery: In this surgery the blood flow is redirected to a healthy artery by connecting or grafting one of the body’s healthy veins to it. This allows blood flow to bypass the blockage and reach the affected area.
Nutritional Revascularization: It involves use of natural and essential nutritional supplements in specified amounts to correct deficiencies and nutritional imbalances known to cause circulatory problems. Gangrene Clear-G Formula, developed in Canada, is one of the effective methods used to treat dry foot gangrene all over the world; however, very less is known about its use in India. It contains 120 nutrients and phytonutrients (plant nutrients) that keep the blood flow in check.
Since tissue death cannot be reversed, surgical removal of the affected tissue (debridement) or amputation of the limb is the only treatment option left when gangrene has advanced.
Debridement: After the removal of the affected tissue a reconstructive surgery may be performed, which involves grafting healthy skin tissue from another part of the body to cover the affected area.
Amputation: Worldwide more than 70 percent of limb amputation takes place due to diabetes. Amputation is the last resort for treating gangrene when it has progressed beyond repair.
Advances in treatment of diabetic gangrene that can avoid limb amputation.
Hyperbaric oxygen therapy (HBOT): In January 2013, a diabetic patient was successfully treated with hyperbaric oxygen therapy (HBOT), a therapy that involves healing of diabetic wounds with supply of oxygen to dead tissues, in India.
Although the doctor had to amputate the patient’s gangrenous toe at first, further spread was prevented by fast wound healing using oxygen breathing at high atmospheric pressure. Studies have shown that HBO treatment can drastically reduce the risk of leg amputations in diabetic patients suffering from wounds. Read more about HBOT
Diabetic Foot Care: It is estimated that amputation rates can be reduced to 45-85 percent with the adoption of proper diabetic foot care. Foot problems in diabetics are complex and they do not have simple solutions.
Therefore, diabetes education and understanding the nature of foot complications is essential for diabetics. Diabetic individuals should be aware of self management of diabetes to further reduce the risk of complications. Read more about the need for diabetic foot care
There are a lot of things that should be taken care of after the treatment of gangrene:
- The affected area should be kept clean and dry
- Antibiotic treatment should be continues as prescribed
- Physical activity should be reduced
- If an amputation is performed, recovery may take a while
Here are some self care tips for people with diabetic foot to prevent diabetic gangrene -
- Inspect your feet daily to check for cuts, sores, wounds or change in colour
- Keep the feet clean and trim your toe nails regularly
- Wear loosely fitting socks and comfortable shoes to avoid risk of blisters
- Follow a healthy lifestyle and keep your sugar levels under control