“I’m sorry. We’ve done everything we can. Amputation is your only option.”
Every year, nearly 200,000 Americans are hit with this devastating news. They may have had a serious injury or require amputation to remove a malignant tumor. Yet the bulk of amputations—about 85%—are due to blood vessel and nerve damage. And a disturbing number of them begin with a diabetic skin ulcer.
What Is a Diabetic Ulcer?
An ulcer, whether it’s in the lining of your stomach, inside your mouth, or on your skin, is an open sore that is slow to heal. Diabetic ulcers generally occur on the feet and are one of the most common—and potentially serious—complications of diabetes.
According to a review article in The New England Journal of Medicine:
- Diabetic ulcers eventually affect 19–34% of people with diabetes.
- Over half of diabetic ulcers become infected.
- A third of the $176 billion spent annually on diabetes care is related to lower extremity diabetic ulcers.
- One in five moderate-to-severe diabetic ulcers require some degree of amputation.
- After years of decline, lower-limb amputation rates due to diabetic ulcers are on the rise.
Diabetic Ulcer Causes
When most of us stub a toe or get a blister, it heals in no time. For individuals with diabetes, however, these small injuries can spell disaster. Here’s why.
- Chronically elevated blood sugar damages the blood vessels that deliver oxygen, nutrients, and infection-fighting immune cells to the injury site, seriously impairing the healing process.
- Uncontrolled diabetes also injures the peripheral nerves that branch out to the organs and limbs. Nerve damage and dysfunction (neuropathy) is most noticeable in the legs and feet and causes pain, tingling, and numbness.
- Diabetic neuropathy further hinders blood flow, creating a vicious cycle of more nerve damage and worsening circulation. Diminished sensation leads to new injuries—after all, you feel no pain. At the same time, impaired circulation triggers susceptibility to infection and retards wound healing.
Prevention Is Paramount
Even when diabetic ulcers don’t progress to the point of amputation, they can be disabling. Walking is difficult, if not impossible, and you’re more prone to injuries and accidents. Furthermore, diabetic ulcers of any degree are painful, unsightly, and notoriously slow to heal.
Therefore, everyone with diabetes should be proactive about prevention:
- Control your blood sugar with diet, exercise, weight loss, berberine, and other targeted supplements.
- Get a handle on diabetic neuropathy. Supplements shown to improve pain, numbness, and other symptoms include alpha lipoic acid (600–1,200 mg/day), gamma linolenic acid (320 mg/day), acetyl-L-carnitine (500–1,000 mg/day), and vitamin D (2,000–5,000 IU/day). I also recommend a potent daily multivitamin for overall nutritional and immune support.
- Take care of your feet. Talk to your doctor if calluses, blisters, etc., crop up, as they can lead to infections and diabetic ulcers. Properly fitting shoes, including therapeutic insoles or footwear, and scrupulous hygiene are also important.
Conventional Treatments for Diabetic Ulcers
These preventive measures are also first-line therapies for existing diabetic ulcers, but more intensive modalities may also be required. They include:
- Debridement (removal of dead and infected tissue), an invasive, painful process that requires repeat visits to a clinic or wound care center, and appropriate dressings.
- Antibiotic therapy if osteomyelitis or cellulitis (serious bone or skin infection) is present.
- “Offloading” therapeutic shoes or casts to protect the wound and allow healing.
- Revascularization procedures (angioplasty, stenting, bypass) to restore blood flow.
- Hyperbaric oxygen therapy (breathing 100% oxygen in a pressurized chamber) to deliver a massive influx of oxygen to areas such as diabetic ulcers with poor blood supply, improve wound healing, and reduce amputation risk.
Amputation—from a single toe one to below the knee—is sometimes necessary. However, with appropriate treatment, three-fourths of diabetic ulcers heal within a year. Nevertheless, it’s important to remain vigilant, as recurrences are common.
A Weird, yet Powerful, Diabetic Ulcer Treatment
I want to close with an exceptionally effective diabetic ulcer treatment that is rarely used but has helped scores of my patients over the years: sugar dressings. This tried-and-true—and scientifically studied—therapy may sound weird, but it really works. That’s because sugar, as it dissolves in the fluid of an open diabetic ulcer:
- Creates a hyperosmotic, highly concentrated environment in which no bacteria or other microbes—including antibiotic-resistant “superbugs”—can survive.
- Draws fluids from the wound and reduces edema (swelling).
- Naturally debrides the ulcer’s surface, reducing the need for painful debridement.
- Encourages granulation (the formation of new connective tissue and blood vessels) and the growth of new skin cells.
- Provides a covering and filling that prevents scabbing and minimizes scarring.
Although you won’t hear about sugar dressings from your doctor, they are safe, dirt cheap, and so easy to use that you can change them yourself at home:
- Mix a couple of tablespoons of white sugar with enough glycerin to form a peanut butter-like consistency. (Glycerin, also called glycerol, simply helps the sugar stay in place. It’s sold in drugstores or may be ordered in bulk online.)
- Take a 4" x 4" piece of gauze and pull it into a long strip.
- Coat the gauze with petroleum jelly (Vaseline).
- Place the gauze around the outside of the wound. (It will act as a dam to contain the sugar.)
- Put a thick layer of the sugar/glycerin paste over the wound and cover with a sponge gauze.
- Secure with a cling wound dressing that holds the sugar in place but does not constrict.
Change the sugar wound dressing every two to four days by removing the gauze, rinsing the wound with water, saline, or hydrogen peroxide, drying it, and applying fresh sugar/glycerin.
Note: Honey (without glycerin) may be used in place of sugar, but I prefer sugar because it’s less expensive. Sugar and honey are perfectly safe to use on diabetic ulcers because they do not enter the bloodstream. They will not work on abscesses or pustules that are covered with skin. Also, do not use these sugar on a bleeding wound, as it promotes bleeding.
One of the many patients that sugar dressings have worked for is J.K., who, in a last-ditch effort to save his leg, came to see me after he was scheduled for below-the-knee amputation.
“Within a few days I could see the sores were starting to get better and the swelling had gone down. At first the leg was almost all black. Then it started to get pinkish. It was just amazing how it continued to feel so much better. I wouldn’t be walking today if it weren’t for sugar dressings. I’ve often thought about sending a card to the doctor who wanted to amputate, with a picture of my leg, saying, ‘I still have it!’”