We know you sometimes have burning questions that can best be answered by a pharmacist. Our feature, Ask Your Pharmacist, seeks to address some of those issues. Send your questions to healthandwealth@jamaicaobserver.com.

Question: I know that my cuts take longer to heal because I am diabetic, but why is this so?

Answer: Diabetic wound healing is a serious matter. Poor wound management leads to more serious infections, amputations, and even death. Let’s look at the changes that occur in the body that make wound healing so difficult in diabetics.

Circulation problems

Diabetic patients very often develop peripheral vascular disease. This is a condition in which your blood vessels stiffen and narrow, particularly in your hands and feet. This reduces blood flow to the limbs and prevents red blood cells from passing through the vessels easily. When blood sugar is high, it makes the blood thicker, making it even harder to pass through the narrowed blood vessels.

In order for wounds to heal properly, they require a good consistent supply of blood which brings nutrients, oxygen, and immune cells. If the blood supply is compromised, these vital elements will not be in adequate supply at the site of the wound. Hence, the wound healing process will be slower.

Nerve damage

Diabetes can cause diabetic neuropathy. This is where the nerves, especially in the hands and feet, get damaged and become less sensitive to external stimuli. That means if a diabetic person gets a cut on their hands or feet, they may not feel it because the nerves just don’t work as well as before. In addition, if the person is aware of the cut, they may not feel any pain in the area to signify that the cut is getting worse or infected, for example. So, the wound might get infected without the person being aware that it needs specialised treatment, and this makes the recovery process even longer.

Immune system problems

White blood cells are the fighter cells of the immune system. When we get a wound, the body sends white blood cells to the area to fight off any infection and to see to the healing of the wound. High blood sugar levels impair the function of the white blood cells. High blood sugar also affects the immune system activation. The number of immune fighter cells sent to heal wounds, and their ability to take action, is often reduced. When the immune system does not function well, the body is not able to effectively fight off infections and close the wounds.

In diabetics, there is a lot of extra sugar floating around in the bloodstream. This is the perfect environment for bacteria to grow and thrive. Hence, diabetics are more prone to infections. So, the environment is a feeding ground for infections and the immune system is not working well… that is a recipe for disaster. Those factors compromise wound healing.

Diabetic patients should carry out regular self-inspections to detect wounds and/or care for them properly. They should carefully examine hands and feet, between fingers and toes, the palms of the hands, the soles of the feet, and all over the body. Patients can also get family members involved to help with the inspection because it is not easy to inspect all the areas of our bodies. In the absence of family members who can help, patients can utilise mirrors to help them inspect their bodies. Regular inspection of the body is vital to detect any breaks in the skin that can get infected and turn into hard-to-heal wounds. Even something as simple as a mosquito bite is a risk factor. Imagine that a patient gets a bump on the skin from a mosquito bite and he scratches the bump, maybe unconsciously, until the skin is broken. If this patient does not treat the mosquito bite, it can develop into an infected wound that can prove very difficult to manage.

In conclusion, scrapes, grazes, cuts, and wounds happen all the time. They are just a part of life. And for most of us, we don’t take minor grazes too seriously. However, for diabetics, even minor scrapes have to be inspected and cared for meticulously in order to facilitate complete wound healing and prevent further complications. Wounds definitely take longer to heal in diabetic patients, but with proper management they can be healed completely.

Novia Jerry Stewart, MSc, RPh, is a pharmacist who specialises in diabetes care. She may be contacted for diabetes care coaching sessions at diabetescarepharmacist@gmail.com