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Suggest treatment for open wounds while treating type-1 diabetes

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Posted on Fri, 22 May 2015
Question: Hi, I am asking in regards to my mother who has T1 diabetes. Her feet problems started two months ago and she was treaded in Sweden about a week ago by getting teo larger blood vessels in her leg expanded.

Now, the open wounds according to photos are left and I am looking for recommendations on the best treatment possible.

Best regards,
Concerned son
doctor
Answered by Dr. Munish Sood (1 hour later)
Brief Answer:
Diabetic foot/fot ulcer

Detailed Answer:
Dear
Thanks for contacting with the health concern and following is/are the recommended schedule:

1.Since she is a known diabetic (type 1) thus following is/are the possibilities:

a. Is she on oral hypoglycemic drugs or on Insulin or both?
b. Whether she is lean or overweight?
c. Is her fasting blood sugar and post prandial blood sugar abnormal or only one is high?
d. Any associated risk factor for developing foot ulcer: overweight,high blood pressure, high cholesterol,sedentary lifestyle and any retinal changes?

2. Care of the feet:

a. Wash the feet daily,dry them,inspect them and then sprinkle lot of talcum powder.
b. Avoid walking barefoot,even at home.
c.Wear soft cotton socks & canvas shoes. Avoid tight fitting shoes & chappals.
d. Cut nails very carefully, and always after bath, when they are soft.

3. Since she has already developed diabetic foot thus feet care can be incorparted once her blood sugar becomes normal and healing phase has started.
PS. since in diabetic patients there is sensory loss (diabetic neuropathy) where there is loss of pain sensation thus daily examination of feet becomes necessary, especially the interdigitial spaces and soles.

4. Do let me know about the points raised in serial numbet 1, so that dietary regime and better management of wound caring can be imparted.

Dr. Munish Sood
Consultant & Physician
Naimittika
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Munish Sood (16 minutes later)
1a She is in insulin infused by insulin pump, daily dose is about total 50 units including bolus and basal, about 50/50.
1b Normal body thus slightly overweight due recent inactivity.
1c High recently since the wounds started to appear.
1d She is treated for high cholosterol since 10 year

Thanks for reply .
doctor
Answered by Dr. Munish Sood (1 hour later)
Brief Answer:
Management of diabetic complication

Detailed Answer:
Dear
Thanks for reverting back.

1. If you can afford prefer Human imsulin from beginning, since dose of human insulin is 30% less than bovine insulin.

2. If slightly overweight control on Biguanides, diet and weight reduction, add Sulfonyl urea if required.
PS. In either case, if diabetes is not controlled ny maximum dose of tablet, add Insulin.

3. In presence of infection, insulin requirement will much higher, till infection is controlled.

4. Apart from Nicotinic Acid which causes decreased glucose tolerance, no other cholesterol lowering drugs causes abnormal blood sugar level.

5. Presently surgical debridement is necessary before antibiotic therapy can be effective.
PS. check Neurological and Vascular status for accurate assessment of wound.

6. Looking at the pictures, gangrene is there, so best option is amputation of the dead toe. (unless your attending surgeon believes that:
. controlling the high blood sugar
. improving the microcirculation and
. proper dressing and adequate antibiotic therapy can save the LIMB.

7. GIVE: oatmeal, brown rice,wholegrain, spinach,green beans,broccoli,amla, turmeric, pomegranate,apple,pears,tomato, lady's finger,cauliflower,brinjal,cucumber.

AVOID: weight bearing activities,milk, jaggery,alcohol,sugarcane,daytime sleeping, cold water/drinks,sweets in any form.

8. Additional prescription:

a. B complex + zinc : long standing diabetes with peripheral neuritis.
b. Antioxidant: for elderly diabetics with dyslipidemia,high blood pressure.
c. Omega-3 fatty acids: to delay microvascular complications (neuropathy & retinopathy)
d. ACE inhibitor if she needs antihypertensive medication.

Dr. Munish
Naimittika

(You can contact me directly on: bit.ly/drmunishsood
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
Answered by
Dr.
Dr. Munish Sood

Ayurveda Specialist

Practicing since :2003

Answered : 3600 Questions

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Suggest treatment for open wounds while treating type-1 diabetes

Brief Answer: Diabetic foot/fot ulcer Detailed Answer: Dear Thanks for contacting with the health concern and following is/are the recommended schedule: 1.Since she is a known diabetic (type 1) thus following is/are the possibilities: a. Is she on oral hypoglycemic drugs or on Insulin or both? b. Whether she is lean or overweight? c. Is her fasting blood sugar and post prandial blood sugar abnormal or only one is high? d. Any associated risk factor for developing foot ulcer: overweight,high blood pressure, high cholesterol,sedentary lifestyle and any retinal changes? 2. Care of the feet: a. Wash the feet daily,dry them,inspect them and then sprinkle lot of talcum powder. b. Avoid walking barefoot,even at home. c.Wear soft cotton socks & canvas shoes. Avoid tight fitting shoes & chappals. d. Cut nails very carefully, and always after bath, when they are soft. 3. Since she has already developed diabetic foot thus feet care can be incorparted once her blood sugar becomes normal and healing phase has started. PS. since in diabetic patients there is sensory loss (diabetic neuropathy) where there is loss of pain sensation thus daily examination of feet becomes necessary, especially the interdigitial spaces and soles. 4. Do let me know about the points raised in serial numbet 1, so that dietary regime and better management of wound caring can be imparted. Dr. Munish Sood Consultant & Physician Naimittika