Diabetic Foot: Infection

Infection is a common and serious complication of diabetic foot wounds. Infection leads to formation of microthrombi, causing further ischemia, necrosis, and progressive gangrene.

Massive infection is the most common factor leading to amputation. Because infection in the diabetic foot can be complex, consultation with an expert in infectious disease may be beneficial.

Response to infection is often altered in the patient with diabetes. Infection-fighting capability is often diminished because of impaired leukocyte function. Impaired leukocyte function is significantly influenced by the degree of hyperglycemia; therefore, tight blood glucose control is extremely important when infection is present.

In addition, patients with diabetes and severe foot infection often do not respond to the infection with elevation of body temperature and/or white blood cell (WBC) count.

Leichter et al have reviewed laboratory data in a large series of diabetic patients with serious pedal infections. Despite significantly elevated sedimentation rates, the mean WBC count was 9,700/10²/mm³.

 Gibbons and Eliopoulos have also documented the absence of temperature elevation, chills, or leukocytosis in two thirds of the patients with limb-threatening infection, including abscesses and extensive soft tissue infection. Similarly, Eneroth et al^[ found that approximately 50% of patients with foot infection had temperatures under 37.8°C and WBC counts under 10,000/10²/mm³.  Given these findings, the clinician should not depend on elevated WBC counts and/or temperature elevation alone as indications of the severity of a diabetic foot infection.

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Dental Care and Diabetes

The Importance of Dental Care With Diabetes

     Diabetes is a disease that can affect the whole body, including your mouth. Dental care is particularly important for people with diabetes because they face a higher than normal risk of oral health problems due to poorly controlled blood sugars. 

The less well controlled the blood sugar, the more likely oral health problems will arise. This is because uncontrolled diabetes impairs white blood cells, which are the body's main defense against bacterial infections that can occur in the mouth.

People with diabetes face a higher risk of:

 

Dry mouth. Uncontrolled diabetes can decrease saliva flow, resulting in dry mouth. Dry mouth can further lead to soreness, ulcers, infections, and tooth decay

Gum inflammation (gingivitis and periodontitis). Besides impairing white blood cells, another complication of diabetes is that it causes blood vessels to thicken, which slows the flow of nutrients to and waste products from body tissues, including the mouth. When this combination of events happens, the body's ability to fight infections is reduced. Since periodontal disease is a bacterial infection, diabetics with uncontrolled disease may experience more frequent and more severe gum disease.

People with diabetes who smoke are at even a higher risk -- up to 20 times more likely than nonsmokers for the development of thrush and periodontal disease. Smoking also seems to impair blood flow to the gums  which may affect wound healing in this tissue area.

 How do I know if I have damage to my teeth and gums?

If you have one or more of these problems, you may have tooth and gum damage from diabetes:

• red, sore, swollen gums
• bleeding gums
• gums pulling away from your teeth so your teeth look long
• loose or sensitive teeth
• bad breath
• a bite that feels different
• dentures-false teeth-that do not fit well