Posts Tagged ‘Diabetic Wound Care’

Diabetes: Eight Reasons to Get It Under Control Now!

Friday, January 12th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Patients with diabetes are more likely to suffer many serious health issues besides foot wounds and amputations. This makes it imperative that they resolve to get their blood glucose levels under control.

Diabetes: 8 Reasons to Get It Under Control Now!


All of the lawsuits I review have a common theme. The plaintiff suffers from a chronic wound and some degree of malnutrition and/or dehydration. I have started to notice that in addition to these problems, the plaintiff also quite often has diabetes. This trifecta of problems leads to pain, suffering, disability, and discontent.

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

People with diabetes are 10 to 20 times more likely to have a lower extremity amputation than those without diabetes.1 This is a scary statistic compounded by the fact that people with diabetes may not even notice a foot wound developing because they cannot feel it because of neuropathy. A foot ulcer is the initial event in more than 85% of major amputations that are performed on people with diabetes.2 Knowing this should provide enough motivation for patients to get their diabetes under control, but some people need even more reasons. Here are eight more consequences you can discuss with your patients. Hopefully, one will hit home.


Urgent! Risks and Diagnosis of Diabetic Foot Infections

Friday, January 8th, 2016

For effective diabetic wound management, clinicians must know the risk factors for foot infections, and be able to diagnose them properly – and as soon as possible.

Diabetic Foot Infections

Wound care clinicians deal with foot infections all the time, but when the patient is also diabetic, an infection can progress rapidly to a critical state. In fact, it is estimated that around 56% of diabetic foot ulcers become infected, and an infected foot wound precedes about two-thirds of amputations.  Being able to treat diabetic foot infections promptly – before they progress too far – helps prevent amputations, which is why your role is so crucial to a patient’s well-being.

What are the risk factors?

If you are treating a diabetic patient with a foot infection, there are a number of risk factors to consider. These include:

  • 30-day-old wounds
  • Wounds that go down to the bone
  • Recurrent foot infections
  • Peripheral vascular disease
  • An etiology from trauma

In particular, be on high alert with your diabetic patients for what they call an occult (hidden) infection. A diabetic foot ulcer could clearly have an infection, but fail to show any of the classic signs and symptoms that you traditionally look for, like erythema, heat, pain and purulence.

Because a diabetic patient’s immune system is compromised, you might be on the lookout for typical signs but not see any of them at all. This does not mean that an infection isn’t there; only half of diabetic foot ulcer patients will show classic signs, which means we also need to work our patients up for infection.

The best approach? Be persistent and keep looking for more signs, like:

Free Webinar - Diabetic Ulcers

  • Serous exudate (thin, clear, watery)
  • Delay in healing
  • Friable (fragile) granulation tissue
  • Discolored granulation
  • Odor
  • Pocketing in the wound bed

How do we diagnose infection?

Diagnosing infection in any wound, particularly with diabetic patients, is a clinical one (versus a lab diagnosis). So if you ever hear a colleague say, “We’re going to wait for the lab results to see if our patient has a wound infection,” it’s time to stand up and emphatically say, “No!” Why? Because lab results, specifically the swab cultures that are most commonly used, are often inconclusive in the presence of biofilm. Instead of waiting for the results, you need to act immediately.

That’s not to say that lab results aren’t useful. They can sometimes help us confirm infections and target which antibiotic we want to use. But again, most infections are polymicrobial (containing more than one kind of bacteria), and swab cultures don’t pick up everything. We need to use our clinical judgment and supplement with lab and cultures.

The Final Word

As wound care professionals, prevention is obviously our first line of defense against any wound complications from infections. But when caring for diabetic patients, clearly understanding the risk factors for foot infections, and then being able to diagnose conditions as soon as possible, are crucial for effective treatment.

What do you think?

Have you had experience in treating diabetic patients with foot infections? Have you been able to identify the infection in a timely manner? Is there a particular case that was exceptionally challenging or difficult? Please tell us about it, and leave your comments below.

Wild On Wounds National Conference Registration is Open!

Wednesday, March 18th, 2015


We as clinicians are responsible for the care of our patients’ skin …   SKIN IS IN!

Come join us at the Wild On Wounds National Conference September 2 – 5, 2015 in Las Vegas where you will learn the current standards of care in skin and wound management.  Choose from a variety of essential to advanced educational sessions which include hands-on workshops, “learn it today and do it tomorrow” training, and interactive sessions.

Spend 3+ days with onsite industry experts who will provide answers to your challenging wound healing questions, one-on-one product demonstrations and hands-on training.

Take advantage of the early discount rate and receive a $100 discount off the standard $550 rate when you register by May 1, 2015.


  • Access to educational sessions over 3 ½ days
  • Access to product experts during the exhibitor showcase
  • Lunch on each registered day
  • Poolside get-together with a robust buffet
  • Free cyber café with internet access to check emails and more
  • Complimentary collectible event T-shirt
  • And MORE!

register now  send a brochure






Questions? call 1-888-318-8536 or email



“Footnotes on Selecting Diabetic Footwear”

Monday, January 28th, 2013

There are a lot of shoes out there, but not all of them would be appropriate selections for our diabetic patients.  In fact, selecting improper footwear could actually harm our diabetic patients and lead to diabetic foot ulcers and possible amputations.  Statistics show that 50% of amputations of our diabetic patients are directly related to improper footwear!amputation

Diabetic Wound Certified clinicians need to know how to check the footwear of our patients as well as the staff caring for our patients.  What are we looking for in a shoe for our diabetic patient?  The shoe should offer a firm snug fit.  The heel should be less than 1 inch, the greater the heel the greater the pressure on the ball of the foot and this could lead to callus formation and ulcerations.  The shoe should have laces, buckles or elastic to hold it in place.  When the diabetic is wearing slip on shoes the toes must curl to hold the shoe on and this can lead to calluses on the top of the toes and potential ulceration.  The shoe should have 1cm between the longest toe and the end of the shoe when the patient stands, we don’t want added pressure to the tips of the toes or on the toenails.  The sole of the shoe should be smooth without seams and cushioned to absorb shock and reduce pressure on the feet.  The shoe should be made from a material that “breathes”, avoid plastic and vinyl as they can encourage fungal infections.  The shoe should have a protective function; a closed toe shoe is imperative for our diabetic patient.  Look closely at the patients foot and the shoe – they should be the same shape, pointed toe shoes cause corns, calluses and ulcerations! Be sure the shoe width is appropriate, has a wide toe box that allow toes to move and accommodates any foot deformity.  The heel of the shoe should also be firm, you can check this by holding the sides of the heel of the shoe between your thumb and forefinger, try to push them together, if the heel compresses, its to soft and won’t give the patient good enough support when walking.

We also need to teach our patients and their family members instructions on checking for proper fit of their shoes and how to shop for new shoes.  They should be re-measured each time, shop late in the day, try on both shoes and walk around in them to ensure they are comfortable, be sure there is a thumbs width of space at the end of the longest toe, try the shoe on with the socks they will be wearing, be sure the heel is less than an inch, and be sure the shoe has laces or velcro closures.  If the patient has serious foot problems or deformities they should be referred for specially molded inserts and or shoes.

Following the above recommendations may just prevent a patient from developing a diabetic foot ulcer and an amputation!  Patient and caregiver education is a key factor in preventing diabetic foot ulcers!