Minor Wound Care for Diabetic Patients

US Pharmacist. 2001;26(11) 

In This Article

Diabetic Neuropathy

Following a diagnosis of diabetes, 40%-50% of patients will develop neuropathy within 10 years.[4] Both the incidents and severity increase proportionally as the disease progresses.[2] While neuropathy can lead to such problems as unsteadiness, impotence, bladder dysfunction, fecal incontinence and ataxic gait, the neuropathic sequela that is most relevant to this article is a gradual loss of sensation in areas supplied by peripheral sensory nerves.

Peripheral sensory neuropathy begins in the distal lower extremities in most cases and gradually progresses to the distal upper extremities in a pattern known as the "stocking-glove distribution."[2] Patients may initially complain of heightened sensation or tingling and burning sensations, or they may be initially asymptomatic (fewer than 50% of those who experience detectable neuropathy develop symptoms). Eventually, the patient realizes that a feeling of numbness or heaviness has developed, leading to the observation that their foot or arm feels dead or like a block of wood. They may state that they feel as though they are walking on a cloud or on air, as they can no longer sense the considerable impact of their feet hitting hard surfaces during ambulation. Hypoesthesia (i.e., lack of tactile sensations) in the fingertips may be so profound that the non-sighted diabetic is unable to learn Braille.

Diabetic neuropathy also causes loss of the ability to perceive temperature. It is easy to understand why the diabetic patient with these symptoms may have difficulty sensing that a wound has occurred, as well as difficulty preventing minor burns and avoiding the friction and trauma that can lead to wounds.


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