As a doctor, I have the responsibility to tell the majority of diabetic friends the correct strategies to prevent and treat diabetic foot through popular science articles:
Why does diabetic foot happen, how to prevent it and how to treat it correctly?
Why does diabetic foot happen?
The main cause of diabetic foot is high blood sugar, combined with neuropathy and vascular disease. Once diabetic foot occurs, it progresses very quickly.
If the treatment of diabetic foot is not standardized, the condition will deteriorate sharply.
Some time ago, the department received a diabetic patient, Li Moumou, who was admitted to the hospital for 2 months because he found that his blood sugar had increased for 20 years and his left foot was ulcerated and gangrenous.
Li is a patient. He usually uses insulin to control his blood sugar, but his blood sugar is not well controlled. /kloc-lived in a foreign hospital 0/month ago, and was diagnosed as "type 2 diabetes: diabetic peripheral neuropathy, diabetic peripheral angiopathy and septicemia". After active treatment, the patient's condition did not improve significantly, foot gangrene worsened, and the infection could not be controlled. There were indications for amputation, but the patient and his family refused.
I was admitted to our department for further treatment. The temperature is 39, and the front end of the left foot is black, red and swollen, accompanied by purulent exudation and foul smell. Blood routine examination showed that white blood cells were significantly increased, and blood culture was positive, suggesting blood infection. Angiography showed that the blood vessels in the distal extremity were occluded, and it was obvious that the patient had enough diabetes to need amputation.
Patients and their families refused to amputate again, thinking that "parents were affected by physical skin injury", did not dare to hurt, refused to amputate, or refused to amputate for other reasons. After repeated persuasion, they asked to be discharged again. After a week's follow-up, the patient's condition deteriorated further, and his left foot was completely gangrenous, which was a great pity.
How to prevent diabetic foot
1. Regular examination of diabetic foot: Diabetic foot emphasizes that "prevention is more important than treatment". Diabetic foot is difficult to treat, but prevention is more effective. All diabetic patients should have a comprehensive foot examination once a year to evaluate the symptoms of neuropathy (pain, burning sensation, numbness and abnormal sensation) and vascular diseases of lower limbs (fatigue and claudication of lower limbs), so as to determine the risk factors of ulcer and amputation.
2. Understand the prevention of diabetic foot: Systematic health education can reduce the occurrence of diabetic foot ulcer, reduce the recurrence rate and amputation rate of diabetic foot, reduce medical expenses and improve the quality of life of patients.
3. Identify the risk factors of diabetic foot: regularly check whether the patient has the risk factors of diabetic foot, whether the foot has deformity, callus, ulcer and skin color change; Pulse, skin temperature and abnormal sensation of dorsal foot artery and posterior tibial artery.
4. Pay attention to daily life care: the water temperature should be appropriate when washing feet, lower than 37; It is not advisable to directly warm your feet with hot water bottles, electric heaters and other items; Avoid trimming calluses yourself or treating calluses or toenails with chemicals; Check the shoes for foreign objects or abnormalities before wearing them; Do not wear tight or raw socks or shoes; Cut toenails horizontally; Remove calluses or hyperkeratinized tissues by professionals.
Once diabetic foot happens, how to treat it
First, control blood sugar, glycosylated hemoglobin, blood pressure, blood lipid and other indicators;
Secondly, once the foot ulcer occurs, it is necessary to seek medical attention in time, and the nature of the foot ulcer should be evaluated by a professional doctor. Complete debridement of diabetic foot ulcer is beneficial to ulcer healing;
Third, regular treatment, early detection, early diagnosis, early treatment, do not rush to the hospital, delay treatment.
Fourth, don't hesitate to amputate. Amputation is a serious disabling operation. In order to save or prolong the life of patients, patients will lose some limbs and functions after amputation, which will cause some defects for the rest of their lives.
Indications for amputation:
Li Moumou, a patient mentioned at the beginning of the article, was diagnosed as diabetic foot complicated with foot gangrene, accompanied by foot abscess, septicemia and vascular occlusion at the distal end of lower limbs. There is no improvement after conservative medical treatment, and there are indications for amputation. The patient and his family refused amputation for various reasons and were discharged after repeated persuasion, which is very regrettable.
Here, we remind the majority of diabetic patients that we must pay attention to the prevention of diabetic foot, regularly check whether patients have risk factors of diabetic foot, pay attention to daily life care, and seek medical treatment in time if diabetic foot is found, and don't delay diagnosis and treatment.
Reference: Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition).
Author: Mei Gaocai, chief physician.
SETTING: Department of Nephrology and Endocrinology, Huaihua Second People's Hospital (Huaihua Cancer Hospital)
Huaihua diabetes professional Committee
Huaihua endocrinology professional Committee
Huaihua diabetes rehabilitation association