Treatment of trophic leg ulcers in diabetes mellitus

The more extensive and deep the ulcer in diabetes, the more difficult it is to cure. Therefore, treatment may consist of one or more stages:

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

General treatment of trophic ulcers in diabetes involves the use of medications that improve the rheological properties of blood, as well as antispasmodics. Alprostadil qualitatively improves microcirculation - especially when used against the background of lipoic acid, Mydocalm.

Mydocalm is widely recommended for the treatment of patients with ulcers in diabetes. This drug optimizes lymph flow and blood circulation in the ischemic zone without negatively affecting blood pressure and coronary blood flow.

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

The course of concomitant pathologies is necessarily monitored: blood pressure is normalized, varicose veins and thrombophlebitis are treated. If necessary, analgesics, sedatives, and antidepressants are prescribed.

It is essential to use medications that optimize the condition of nerve fibers:

• α-lipoic acid preparations (Lipamid, Thiogamma);
• magnesium preparations;
• aldose reductase inhibitors (Isodibut, Olredase).

To improve the rheological properties of blood, Curantil, Aspeter, and heparin-based products are prescribed.

In case of lipid metabolism disorders, it is appropriate to take medications from the statin series (for example, Rosuvastatin).

Ulcers in diabetes: medications

Name of the drug	Method of administration, dosage	Side effects	Special instructions
Detralex	Take 2 tablets per day – one in the morning and one in the evening, with food.	Diarrhea, dyspepsia, colitis.	A capillary-stabilizing drug, venotonic and angioprotector that improves microcirculation.
Iruksol	The ointment is applied to the moistened wound 1-2 times a day.	Temporary skin irritation, allergic dermatitis.	Antimicrobial ointment, helps cleanse ulcers from dead tissue, accelerates granulation.
Dipyridamole	Administer intramuscularly 1-2 ml of 0.5% solution per day.	Sensation of palpitations, headache, dyspepsia, transient hearing loss.	Antithrombotic agent, increases tissue resistance to hypoxia.
Lipamid	Take 0.025-0.05 g three times a day.	Rarely – digestive disorders.	A drug that improves metabolic processes and reduces cholesterol levels in the blood.
Isodibut	Take 500 mg three times a day before meals. It is recommended to take 2-month courses twice a year.	Rarely – allergic reactions.	Aldose reductase inhibitor, prevents swelling and damage to tissues and nerve fibers. Accelerates the healing of ulcers in diabetes.

How to properly treat ulcers in diabetes?

The wound is treated before applying the ointment or before the next dressing. Treatment is carried out once a day or once every 2-3 days - this depends on the condition of the ulcer and the type of treatment used.

For dressing, special dressing materials are used that do not stick to the wound (it is not advisable to use gauze). Preference should be given to alginates, hydrophilic fiber, atraumatic meshes, polyurethane dressings, hydrogels, hydrocolloids, etc.

The ulcer is washed with antibacterial solutions that do not have the ability to destroy growing tissue. Miramistin, Chlorhexidine, etc. are well suited for this purpose. Alcohol solutions, iodine, diluted potassium permanganate are not suitable for treating the ulcer, as they slow down the healing process.

Approximately once every 3-14 days, dead tissue should be removed from the ulcer surface. It is better if this procedure is carried out by a doctor or a manipulation nurse, in sterile conditions.

Ointments for ulcers in diabetes

Ulcers in diabetes are rarely dry - most often the wounds are wet or even purulent, as they become infected with pathogenic microbes. Moreover, the larger the ulcer, the greater the likelihood of its infection.

The suppuration of the ulcerous focus initially affects only the skin, and then - and deeper layers, right down to muscle and bone tissue. If you first conduct an analysis of the sensitivity of bacteria to antibiotics, then in the future you can use ointments aimed strictly at ridding the wound surface of a certain pathogenic flora.

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

Levomekol is often used as an ointment healing agent - this ointment cleans the wound, drawing out infection and decay products from deep tissues. This drug contains methyluracil, which promotes tissue healing and regeneration. If the ulcer turns pink and lightens after a while, this is a sure sign that Levomekol is "working".

Levomekol is not the only medicine used to treat ulcers in diabetes. Methyluracil ointment, Solcoseryl, and Oflomelid are also often prescribed as ointment preparations. The listed products accelerate the restoration of the epithelium and wound scarring.

Vitamins

If the patient follows all the doctor's recommendations on nutrition, then additional intake of vitamin preparations may not be necessary. In other cases, certain vitamins and minerals can be included in the treatment regimen.

For example, to increase tissue sensitivity to insulin, it is additionally recommended to take capsules with magnesium, zinc, vitamin A, and α-lipoic acid.

Antioxidants are used to protect blood vessels from high blood sugar levels. Experts note that antioxidants can prevent complications associated with diabetes. Retinol, tocopherol, zinc, selenium, glutathione, and coenzyme Q10 are prescribed as supplements.

Today, pharmacists offer a huge number of individual vitamins and vitamin complex preparations. However, when choosing, it is necessary to take into account the individual recommendations of the doctor.

If we consider various dietary supplements, which are offered to us by pharmacies no less en masse, then, in fact, doctors classify such treatment as self-medication. Diabetes is too complex a disease, and getting rid of ulcers in diabetes is just as difficult. Therefore, you should not count on vitamins to help cure. However, vitamin preparations can support the body, strengthen the immune system and improve blood vessels - provided that other medical recommendations are followed.

Physiotherapy treatment

Physiotherapy is included in the general treatment to improve blood circulation in small vessels, to restore trophism in the ulcer formation area, to stabilize blood flow and eliminate the inflammatory process.

The inflammatory reaction can be stopped by procedures such as:

• ultraviolet irradiation (erythemal doses);
• UHF, microwave.
• To combat infection, the following is prescribed:
• electrophoresis with antibiotics, enzyme preparations;
• darsonvalization;
• local aeroionotherapy;
• local aerosol treatment.

If necessary, additional procedures are prescribed to improve blood flow in the vessels:

• ultratonotherapy;
• electrophoresis with vasodilators (Dibazole, Nicotinic acid, etc.);
• infrared radiation;
• galvanization.

At the regeneration stage, procedures are used to help speed up this process:

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

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

Folk remedies

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

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

Compresses filled with washed and crushed lilac and coltsfoot leaves are applied to the ulcer area. Lungwort and plantain are also suitable for this purpose. The compress is fixed and not removed for 5-6 hours. The total duration of treatment is 4-6 weeks.

You can lubricate the wounds with a mixture of 10 g of mumiyo, 100 g of natural honey and one egg white.

A mixture of resin with pork fat, as well as sea buckthorn, rosehip, and St. John's wort oils are also used as ointments.

Ulcers in diabetes usually heal poorly, and when treating such wounds, it is necessary to be careful, not forgetting the rules of hygiene. Do not allow the wound to become contaminated to avoid the addition of a fungal or bacterial infection.

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Herbal treatment

You can treat a diabetic ulcer not only from the outside, but also from the inside, by taking infusions and decoctions of various medicinal herbs.

Prepare a herbal infusion consisting of 1 tbsp. nettle flowers, 1 tbsp. quinoa, half a cup of alder leaves. Pour 200 ml of boiling water over the raw materials and leave to infuse until cool. Take a teaspoon before breakfast and at night.

Fresh dandelion, chicory, and burdock rhizome bars are roasted. The roasted parts are ground in a coffee grinder and used for brewing (like coffee). Drink one cup daily.

Take equal amounts of centaury herb, clover flowers, lady's mantle leaves, dandelion rhizome, rowan berries, mint leaves. Pour 2 tbsp. of raw materials into a thermos, pour 500 ml of boiling water, leave for 6-8 hours. Filter and take 1/3 cup, three times a day before meals.

Take equal amounts of birch buds, viburnum bark, nettle leaves, bay leaf, dandelion rhizome, bean pods, fennel and flax seeds. Pour 2 tbsp of raw material with 500 ml of boiling water, leave for 6-8 hours. Take 1/3 cup before meals, three times a day.

Homeopathy

Homeopathy specialists recommend using certain medications for diabetic ulcers, regardless of whether the patient is being treated with insulin or not. Homeopathic remedies are prescribed along with traditional medications prescribed by a doctor, as well as in combination with an appropriate diet. Such a complex effect is aimed at stabilizing blood sugar levels, stimulating insulin synthesis by the pancreas, and strengthening blood vessels.

Many doctors 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 sugar levels.

• Homeopathic remedy No. 1 includes the following components:

1. Acidum phosphoricum 3;
2. Sicygnum 3;
3. Arsenic 3;
4. Iris 3;
5. Uranium 3;
6. Creosote 3.

Equal proportions of the drug are taken 30 drops 3 times a day.

• Homeopathic remedy #2 for ulcers in diabetes includes:

1. Salidago 3;
2. Drosera 3;
3. Vixum album 3;
4. Cannabis 3;
5. Hypericum 3;
6. Equisetum 3.

The remedy is taken in equal proportions, dissolving 40 drops in 200 ml of water, two teaspoons once an hour.

• Homeopathic remedy No. 3 is represented by the drugs Cardiocenes and Neurocenes (30). They are alternated for three days, in the evenings. Dosage - 15 drops twice with an interval of a quarter of an hour.
• Homeopathic remedy No. 4 is the drug Myrtilus, which is taken before meals, 20 drops (twice a day).

Surgical treatment

Surgical treatment of diabetic ulcers is used when it is necessary to excise dead tissue. This is necessary if the effect of disinfectant solutions and enzyme preparations does not lead to the spontaneous rejection of such tissues. In such a situation, excision is carried out extremely carefully so as not to damage the integrity of viable areas.

If there is a large ulcer in diabetes, then its chances of self-healing are low. Therefore, they resort to surgical covering 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. Transplantation is not performed if there is an infection in the wound. In addition, the operation should be preceded by cleaning the ulcer from dead tissue and preliminary treatment with drugs to strengthen the vessels.

In case of irreversible blood flow disorders in the extremities, in case of damage to a large vascular network, it is possible to perform vascular reconstruction – these are bypass operations or balloon angioplasty.

If complications develop in the form of gangrene, amputation of part of the limb (fingers, feet) or complete amputation of the limb is performed.

Diet for ulcers and diabetes

Diet for diabetics is the basis of treatment. The goal of dietary changes is to restore impaired metabolic processes and establish control over body weight. The diet is prescribed taking into account the patient's lifestyle, blood sugar level, body weight, and food tolerance.

First of all, the patient should refuse food rich in easily digestible carbohydrates. Meals should be taken up to six times a day to avoid overeating and to prevent the feeling of hunger.

The meals prepared for the patient must contain sufficient amounts of vitamins. But the fat content, as well as the daily caloric content of food, must be limited.

The following are prohibited: any sweets, chocolate, baked goods, jam, alcohol. The use of spices and smoked foods is limited.

Recommended products and dishes:

• protein diabetic bread, bran, baked goods made from rye flour;
• vegetable soups;
• soup with meat or fish about 2 times a week;
• low-fat meat, fish;
• fresh, stewed or boiled vegetables;
• vermicelli - not often;
• green;
• dairy products;
• eggs - chicken, quail;
• weak tea, coffee;
• compotes, jelly with fructose or stevia;
• fruits allowed for diabetes.

When ulcers appear, it is especially important to constantly monitor blood sugar. Diet is considered the best way to normalize this indicator.

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Diet for stomach ulcers and diabetes

Diabetic ulcers can form not only on the body, but also in the digestive organs. In such cases, diet often plays a decisive role.

In case of gastric ulcer against the background of diabetes, it is allowed to eat such food that would not have an irritating effect on mucous tissues. All dishes can be either boiled or steamed.

The meal regimen should be fractional - up to six times a day, in small portions.

Nutritionists advise paying attention to the following foods:

• dairy products, including milk-based porridge;
• stewed chopped vegetables, soups with vegetables and vegetable oil;
• low-fat meat – chicken, turkey, beef (pureed);
• boiled low-fat fish;
• porridge, vermicelli;
• steamed omelettes, boiled eggs;
• fruits from the list of fruits allowed for diabetes, baked or boiled;
• green;
• tea with milk, vegetable juice, rosehip infusion.

In no case should you starve or, on the contrary, overeat. It is better to eat measuredly, little by little, so as not to burden the stomach and pancreas.

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