Treatment of trophic ulcers on the legs with diabetes mellitus

The more extensive and deeper the ulcer with diabetes, the more difficult it is to cure. Therefore, treatment can consist of one or more stages:

1. General conservative treatment, stabilization of blood sugar level.
2. Cleansing the skin around the ulcer, eliminating the inflammatory process.
3. Stabilization of blood flow and lymph flow, getting rid of excessive accumulation of fluid in tissues.
4. Elimination of purulent-necrotic process inside the ulcer.
5. Elimination of infection in the wound.
6. Stimulation of tissue repair.
7. Strengthening of general and local immunity.
8. Surgical manipulation (removal of dead tissue, autodermoplasty, amputations of varying degrees).

The general treatment of trophic ulcers in diabetes is the use of medications that improve the rheological properties of blood, as well as antispasmodics. Qualitatively improves microcirculation drug Alprostadil - especially when applied against a background of lipoic acid, Midokalma.

Midokalm is widely recommended for the treatment of patients with ulcers in diabetes. This medicine optimizes lymph flow and circulation in the ischemic zone, without adversely affecting blood pressure and coronary blood flow.

When the infection is attached, antibiotics are prescribed, depending on the sensitivity of the bacteria (the most popular drugs are aminoglycosides). Antibiotic therapy is usually done systemically, not locally.

Be sure to monitor the course of accompanying pathologies: normalize blood pressure, treat varicose veins, thrombophlebitis. If necessary, prescribe analgesics, sedatives, antidepressants.

Necessarily use drugs that optimize the state of nerve fibers:

• preparations of α-lipoic acid (Lipamid, Tiogamma);
• preparations of magnesium;
• inhibitors of aldore reductase (Izodibut, Alredaza).

To improve the rheological properties of blood prescribe Curantil, Asperer, a means based on heparin.

For violations of fat metabolism, it is appropriate to take medications from a number of statins (for example, Rosuvastatin).

Ulcers in Diabetes: Medications

Name of the drug	Dosage and administration	Side effects	special instructions
Detraleks	Take 2 tablets per day - one morning and evening, with food.	Diarrhea, indigestion, colitis.	Capillary-stabilizing drug, venotonic and angioprotector, improving microcirculation.
İruksol	Ointment is applied to the moistened wound 1-2 times a day.	Temporary skin irritation, allergic dermatitis.	Antimicrobial ointment, helps to cleanse the ulcer from dead tissue, accelerates granulation.
Sculptor	Enter intramuscularly for 1-2 ml of 0.5% solution per day.	Heart palpitations, headaches, dyspepsia, transient hearing impairment.	Antithrombotic, increases the resistance of tissues to hypoxia.
Lipamid	Take on 0,025-0,05 g three times a day.	Rarely - digestive disorders.	A drug that improves metabolic processes, reducing the level of cholesterol in the blood.
Izodibut	Take 500 mg three times a day before meals. It is recommended to conduct courses for 2 months twice a year.	Rarely, allergic reactions.	The inhibitor of aldose reductase inhibits swelling and damage to tissues, nerve fibers. Accelerates the healing of ulcers with diabetes.

How correctly to treat ulcers with diabetes?

Treatment of the wound is performed before applying the ointment or before another dressing. Treatment is carried out once a day, or once every 2-3 days - it depends on the condition of the ulcer and the type of treatment used.

For bandaging apply special dressings that do not stick to the wound (gauze used undesirable). Preference should be given to alginates, hydrophilic fibers, atraumatic nets, bandages made of polyurethane, hydrogels, hydrocolloids, etc.

Flushing of the ulcer is carried out with antibacterial solutions that do not possess the properties of destroying growing tissue. Well suited for this purpose Miramistin, Chlorhexidine, etc. Alcohol solutions, iodine, diluted "manganese" are not suitable for the treatment of ulcers, because they inhibit the healing process.

Approximately once every 3-14 days, the dead tissue should be removed from the ulcerous surface. It is better, if such a procedure will be carried out by a doctor, or a manipulative nurse, under sterile conditions.

Ointments for ulcers in diabetes mellitus

Ulcers with diabetes are rarely dry - most often wound wetting, or even purulent, as they are infected with pathogenic microbes. In this case, the larger the size of the ulcer, the greater the probability of infection.

Suppuration of the ulcerative focus initially affects only the skin, and then - and deeper layers, up to the muscular and bone tissue. If you previously carry out an analysis of the sensitivity of bacteria to antibiotics, then in the future you can use ointments directed strictly at getting rid of the wound surface from a certain pathogenic flora.

Before applying the ointment, the ulcer needs to be treated, cleaned of secretions and dead tissue. If this is not done, then the ointment instead of good will only cause harm.

Often, Levemekol is used as an ointment remedy, this ointment cleans the wound, drawing out infection and decay products from the deep tissues. In the composition of this drug is methyluracil, which promotes tissue healing and regeneration. If the sore becomes pink and brightens after a while, then this is a sure sign that Levomekol "works".

For the treatment of ulcers with diabetes, not only Levomekol is used. Of the ointment preparations are often appointed also Methyluracil ointment, Solcoseryl, Oflomelid. These funds accelerate the recovery of the epithelium and scarring of the wound.

Vitamins

If the patient complies with all the medical recommendations on nutrition, then additional intake of vitamin preparations may not be needed. In other cases it is possible to include certain vitamins and minerals in the therapy regimen.

For example, to increase the sensitivity of tissues to insulin, it is additionally advised to take capsules with magnesium, zinc, vitamin A, α-lipoic acid.

Antioxidants are used to protect blood vessels from high blood sugar levels. Specialists note that antioxidants are able to prevent the appearance of complications against the background of diabetes. In addition, prescribe retinol, tocopherol, zinc, selenium, glutathione, coenzyme Q10.

To date, pharmacists offer a huge number of individual vitamins and vitamin complex preparations. And still, when choosing, it is necessary to take into account the individual doctor's recommendations.

If we consider various dietary supplements, which are no less massively offered to us by pharmacies, then, in fact, doctors consider this treatment to be a self-medication. Diabetes is too complicated a disease, and getting rid of ulcers with diabetes is just as difficult. Therefore, count on the fact that vitamins can heal, it's not worth it. However, vitamin preparations can support the body, strengthen immunity and improve blood vessels - provided that other medical recommendations are observed.

Physiotherapeutic treatment

Physiotherapy is connected to general treatment to improve blood circulation in small vessels, to restore trophism in the zone of ulcer formation, to stabilize blood flow and eliminate inflammation.

Inflammatory reaction can be stopped by such procedures as:

• ultraviolet irradiation (erythema dose);
• UHF, VHF.
• To combat infection, appoint:
• electrophoresis with antibiotics, enzyme preparations;
• darsonvalization;
• local aeroionotherapy;
• local aerosol treatment.

If necessary, additionally prescribed procedures for improving blood flow in the vessels:

• ultratonotherapy;
• electrophoresis with vasodilators (dibasol, nicotinic acid, etc.);
• infrared radiation;
• galvanization.

At the stage of regeneration, procedures are used to help accelerate this process:

• laser therapy;
• electrophoresis with vitamins, microelements;
• magnetic therapy;
• oxygen;
• ultraphonophoresis (iodine, Lidase);
• paraffin therapy;
• manual therapy.

For general strengthening of the body and increasing the immune response, heliotherapy, aerotherapy, ozone baths are recommended.

Alternative treatment

In addition to drug treatment, there are many proven recipes from alternative healers. Such recipes are deservedly successful, and often help to quickly get rid of an ulcer in diabetes - especially if the treatment is carried out at an early stage of the disease.

It is recommended to clean the wounds with fresh juice from plants such as fern and yarrow.

Compresses filled with washed and crushed leaves of lilac, mother-and-stepmother are applied to the area of sores. Suitable for this purpose is also a lungwort and plantain. The compress is fixed and not removed for 5-6 hours. The total duration of treatment is 4-6 weeks.

You can lubricate the wound with a mixture of 10 grams of mummy, 100 grams of natural honey and one egg white.

As the ointment is also used a mixture of a sour with pork internal fat, and also oil of sea-buckthorn, dogrose, St. John's wort.

Ulcers in diabetes usually heal badly, and when handling such wounds, care must be taken not forgetting the rules of hygiene. Do not allow contamination of the wound to avoid attachment of a fungal or bacterial infection.

[1], [2], [3], [4], [5], [6],

Herbal Treatment

Influence on the ulcer with diabetes can be not only outside, but also from the inside, taking infusions and decoctions of various medicinal herbs.

Prepare an herbal diet consisting of 1 tbsp. L. Color of nettle, 1 tbsp. L. Quinoa, half a cup of alder leaves. Raw materials are poured into 200 ml of boiling water, insist until it cools. Take a teaspoon until breakfast and at night.

Roast fresh squashes rhizome dandelion, chicory, burdock. Fried pieces grind in a coffee grinder and use for brewing (like coffee). Drink daily, one cup.

Take equal amounts of grass of a thousand-centner, clover flowers, cuff leaves, dandelion roots, mountain ash berries, mint leaves. Pour 2 tbsp. L. Raw materials in a thermos, pour 500 ml of boiling water, insist 6-8 hours. Filter and take 1/3 cup, three times a day before meals.

Take equal amounts of birch buds, bilberry bark, nettle leaves, bay leaves, dandelion roots, bean leaves, fennel seeds and flax. Pour 2 tbsp. L. Raw 500 ml of boiling water, insist 6-8 hours. Take 1/3 cup before meals, three times a day.

Homeopathy

Specialists in the field of homeopathy are advised to use certain drugs for diabetic ulcers, regardless of whether the patient is being treated with insulin, or not. Homeopathic remedies are prescribed against the background of traditional medicines prescribed by a doctor, and also in combination with compliance with the appropriate diet. Such a complex effect is directed as much as possible to stabilize the blood sugar level, stimulate the synthesis of insulin by the pancreas, strengthen the vessels.

Many physicians consider homeopathy to be one of the safest methods for treating ulcers in diabetes: such drugs have virtually no side effects and do not lead to a sharp change in the level of sugar.

• Homeopathic remedy №1 includes components:

1. Acidum phosphoric acid 3;
2. Sicignum 3;
3. Arsenic 3;
4. Iris 3;
5. Uranium 3;
6. Creosote 3.

Equal proportions of the drug take 30 caps. 3 times a day.

• Homeopathic remedy №2 from ulcers with diabetes includes:

1. Salida 3;
2. Drosera 3;
3. Wysum Album 3;
4. Cannabis 3;
5. Hyperix 3;
6. The Equisetum 3.

In equal proportions, the agent is taken by dissolving 40 drops. In 200 ml of water, two teaspoons once an hour.

• Homeopathic remedy №3 is represented by drugs Kardiotzeniz and Neurocenosis (30). They alternate for three days, in the evenings. Dosage - 15 caps. For two times with an interval of a quarter of an hour.
• Homeopathic remedy № 4 - preparation Mirtilus, which is taken before meals for 20 cap. (twice a day).

Surgery

Surgical treatment for a diabetic ulcer is connected when it is necessary to excise dead tissue. This need arises if the effect of disinfectant solutions and enzyme preparations does not lead to independent rejection of such tissues. In such a situation excision is carried out extremely carefully so as not to disrupt the integrity of viable areas.

In case there is a large ulcer in diabetes, its chances of independent tightening are low. Therefore, they resort to an operative cover of the wound surface with a skin graft. Such an operation is also not always effective, which, first of all, depends on the degree of blood circulation in the affected areas. Do not transplant if there is an infection in the wound. In addition, surgery should be preceded by cleaning the ulcer from the necrotic tissue and preliminary treatment with preparations for strengthening the vessels.

With irreversible blood flow disorders in the limbs, with the defeat of a large vascular network, it is possible to perform vascular reconstruction - these are bypass surgery, or balloon angioplasty.

With the development of complications in the form of gangrene amputation of a part of the limb (fingers, feet), or complete amputation of the limb.

Diet for ulcers and diabetes

A diet for diabetics is the basis of treatment. The purpose of changes in nutrition is the restoration of disturbed metabolic processes, the establishment of control over body weight. The diet is prescribed taking into account the patient's lifestyle, blood sugar level, body weight, food tolerance.

First of all, the patient should give up food saturated with easily assimilated carbohydrates. Eating should be done up to six times a day to avoid overeating and prevent the appearance of a feeling of hunger.

Dishes that are prepared for the patient must contain enough vitamins. But the content of fats, as well as the daily calorie content of food, should be limited.

Under the ban fall: any sweets, chocolate, muffin, jam, alcohol. Restrict the use of spices, smoked products.

Recommended foods and dishes:

• protein diabetic bread, bran, baking from rye flour;
• vegetable soups;
• soup with meat or fish about 2 times a week;
• low-fat meat, fish;
• fresh, steamed or boiled vegetables;
• vermicelli - infrequently;
• greenery;
• milk products;
• eggs - chicken, quail;
• not strong tea, coffee;
• compotes, jelly on fructose or stevia;
• fruits, allowed for diabetes.

When ulcers appear, it is especially important to constantly monitor blood sugar. The best way to normalize this indicator is diet.

[7], [8]

Diet with stomach ulcer and diabetes

Ulcers in diabetes can form not only on the body, but also in the digestive organs. In such cases, dieting often plays a decisive role.

With a stomach ulcer against a background of diabetes it is allowed to eat such food that does not have an irritating effect on the mucous tissues. All dishes can be boiled or steamed.

The mode of food intake should be fractional - up to six times a day, in small portions.

Nutritionists advise to pay attention to such food:

• dairy products, including cereals in milk;
• stewed chopped vegetables, soups with vegetables and vegetable oil;
• low-fat meat - chicken, turkey, beef (in the garbled form);
• boiled fish of low-fat varieties;
• porridge, vermicelli;
• omelettes for steaming, boiled eggs;
• fruits from the list of allowed for diabetes, in a baked, boiled form;
• greenery;
• tea with milk, vegetable juice, rose hip infusion.

In no case can not you starve or, conversely, overeat. It is better to eat in a measured, little way, so as not to strain the stomach and pancreas.

[9], [10], [11], [12]