Other long term effects of hyperglycemia include angiopathy, neuropathy, and impaired nutritional status. Similarly, tobacco and alcohol use, as well as certain medications such as corticosteroids, can inhibit wound healing. The obvious treatment is to control elevated blood glucose levels by either oral hyperglycemic agents or insulin. Patients should be advised to see their primary physicians for diabetic medical management. The presence of a diabetic foot infection will not only impair wound healing, but it may also cause limb loss.
Diabetic infections can vary from acute to chronic.
The etiology of diabetic infections is similar to that of diabetic foot ulcerations. Once again, neuropathy, angiopathy, and immunopathy secondary to hyperglycemic state are involved. A non-healing ulcer will more likely be caused by a chronic infection such as chronic osteomyelitis. A thorough examination of the diabetic wound determining the extent of the ulcer, the presence of any deep space abscesses, and whether the ulcer probes to bone must be performed. In addition to the common practice of obtaining aerobic, anaerobic, and fungal cultures of the soft tissue, biopsies of bone for culture and pathology should performed in non-healing ulcers to identify the specific microorganisms for antibiotic therapy.