What is diabetes and can it make lymphedema worse? People with diabetes cannot regulate the amount of glucose in their blood properly. After eating a meal, the glucose in the blood increases as the food is digested. In response, the pancreas produces insulin which helps the cells in the body take glucose in from the blood. People with diabetes are unable to transfer glucose in the blood into the cells. There are different types of diabetes. In type I, the levels of insulin are low. In type II, the levels o f insulin are normal, but the cells do not respond to the insulin properly. In either type, the result is increased glucose in the blood.

Over many years, the increased levels of glucose in the blood can damage the blood vessels, connective tissue, nerves and organs. In the blood vessels, atherosclerotic plaques builds up resulting in blockage of the large arteries and the small vessels are damaged so that they do not transfer oxygen properly to the tissue. These vessels can become leaky. Poor blood flow can result in damage to the skin and connective tissue resulting in sores and infections. These complications are treated with medications to increase insulin or improve uptake of glucose into cells. Excess weight can worsen diabetes and weight control is an important component to the management of diabetes. Pressure sores and infections are treated with antibiotics, protective bandages and compression.

Patients with lymphedema have leakage of lymphatic fluid into the tissue causing swelling and connective tissue damage and increased risk of infection. While diabetes generally causes damage to the arteries and capillaries, lymphedema is the result of damage to the lymphatic system. Together, these diseases result in damage to both the arterial and lymphatic systems and both lead to damage to the subcutaneous tissue, connective tissue and skin. The result is increased swelling, decreased levels of oxygen i n the skin and connective tissue and susceptibility to infection.

Effective treatment of the tissue swelling requires compression that can get to the deep subcutaneous tissues without obstructing the lymphatic and venous outflow. That is why the high and low pressure exerted by the the ReidSleeve and Optiflow is so effective in treating lymphedema and other swell disorders. The technology is designed to apply effective pressure to the skin, subcutaneous tissue and the connective tissue of the deep dermis.

J Wound Care 1999 Jan;8(1):5-10
Chronic wounds and nursing care.

Lindholm C, Bergsten A, Berglund E

Department of Nursing Research, Uppsala University Hospital, Sweden.

This study has collated data on the prevalence of chronic wounds and the demography of patients with these wounds. Diagnostic methods, nursing care, the presence of diabetes and pain are analysed, as well as data on healing, amputation and mortality three months post-study. A total of 694 patients were identified: 406 with leg or foot ulcers, 117 with pressure ulcers and 171 with other wounds. Most patients were treated in the community. Leg ulcer aetiology was verified with ultrasound Doppler examination. There was a correlation between low Norton score (< 20) and severity of pressure ulcer (Stage III or IV). The use of 113 different wound dressings or combinations of products was reported. Time spent on dressing changes was the equivalent of full-time employment for 57 nurses. Wound cleansing was not predominantly performed with tap water, as recommended, but with saline. Almost all patients with venous leg ulcers (88%) were treated with compression but in 35% of these support stockings were used. Pain was present in almost half of all patients, more commonly in Stage III or IV pressure ulcers than in Stages I and II, and was most often reported in older patients. Diabetes was present in 25% of all patients with leg and pressure ulcers, and in 57% of patients with foot ulcers. At three-month follow-up, 28% of pressure ulcers, 40% of leg ulcers and 61% of other wounds had healed. Mortality was 35% in patients with pressure ulcers, 4% in those with leg ulcers and 7% in those with foot ulcers. These data h ave been presented to politicians in the county, resulting in allocation of resources for a wound healing centre.

BMJ 1999 Jun 12;318(7198):1591-4
Risk factors for erysipelas of the leg (cellulitis): case-control study.

Dupuy A, Benchikhi H, Roujeau JC, Bernard P, Vaillant L, Chosidow O, Sassolas B, Guillaume JC, Grob JJ, Bastuji-Garin S

Dermatology Department, Hopital Henri Mondor, 94010 Creteil, France.

OBJECTIVE: To assess risk factors for erysipelas of the leg (cellulitis).
DESIGN: Case-control study.
SETTING: 7 hospital centres in France.
SUBJECTS: 167 patients admitted to hospital for erysipelas of the leg and 294 controls.
RESULTS: In multivariate analysis, a disruption of the cutaneous barrier (leg ulcer, wound, fissurated toe-web intertrigo, pressure ulcer, or leg dermatosis) (odds ratio 23.8, 95% confidence interval 10.7 to 52.5), lymphoedema (71.2, 5.6 to 908), venous insufficiency (2.9, 1.0 to 8.7), leg oedema (2.5, 1.2 to 5.1) and being overweight (2.0, 1.1 to 3.7) were independently associated with erysipelas of the leg. No association was observed with diabetes, alcohol, or smoking. Population attributable ris k for toe-web intertrigo was 61%.
CONCLUSION: This first case-control study highlights the major role of local risk factors (mainly lymphoedema and site of entry) in erysipelas of the leg. From a public health perspective, detecting and treating toe-web intertrigo should be evaluated in the secondary prevention of erysipelas of the leg.

Tony Reid MD Ph.D

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