If you or someone you know has diabetes, it is important to be aware of gangrene which is a serious complication that can occur as a result of the disease.
Gangrene is a condition in which tissue dies due to a lack of blood supply.
If you have diabetes, gangrene will most likely develop in your toes and feet although it can develop in other parts of your body too.
In this article, we will take a closer look at what gangrene is, how it develops, its relationship to diabetes, and what treatment options are available to you.
We will also discuss ways to prevent gangrene from occurring and list other causes of it.
What is diabetes?
Diabetes, also known as diabetes mellitus, is a chronic disease that occurs when there is too much sugar (glucose) in your blood usually due to a lack of insulin or your body’s response to insulin.
Insulin is a hormone that your cells utilize to help convert glucose into energy.
There are two main types of diabetes: type 1 diabetes and type 2 diabetes.
Type 1 diabetes is when the body does not produce insulin due to your immune system attacking insulin-producing cells in your pancreas.
Type 2 diabetes is when your cells become insulin resistant and stop taking in glucose for energy.
If either form of diabetes is left untreated it can lead to serious medical complications such as heart attacks, stroke, or even gangrene.
What is gangrene?
Gangrene is a condition that occurs when tissue dies due to a bacterial infection of the skin or soft tissue, injury, or lack of blood flow.
Gangrene often affects the extremities such as the arms or legs but especially the fingers and toes; however, it can also affect your internal organs and other parts of your body too although these forms of gangrene are rare.
There are six different types of gangrene, including:
The most common type of gangrene is called dry gangrene and it usually affects the toes or fingers causing the skin to look wrinkled, dry, and turn blue, purple, brown, or black due to dead tissue.
It occurs when there is a lack of blood flow to the area, usually due to damaged blood vessels from diabetes, a vascular disease, or arterial diseases such as atherosclerosis or peripheral artery disease, and often starts as a small blister or sore that does not heal.
Less common than dry gangrene, wet gangrene is another form of gangrene but it is more serious. It occurs when you have a bacterial infection on top of a lack of blood flow to the area.
The skin has blisters, is swollen, and looks wet in appearance. It can progress quickly and if left untreated can lead to sepsis which is a life-threatening condition.
Gas gangrene is a rare but serious type of gangrene that usually occurs after an injury such as a gunshot wound or severe burn.
It is caused by bacteria, usually the bacteria Clostridium perfringens, entering the wound and releasing toxins that kill the tissue.
The affected area looks pale, feels spongy, and can emit a foul-smelling gas when pressed, which is how it got the name gas gangrene.
Internal gangrene is another rare but serious type of gangrene that can occur in any organ but most often affects the intestines.
It is caused by a lack of blood flow to the organ which can occur to your intestines if they puncture the muscles of your abdomen when you have a hernia.
When you have Fournier’s gangrene, you have gangrene of the genitals which is a very serious condition.
It is caused by a bacterial infection in the genital area or urinary tract that spreads quickly to the surrounding tissues. Men are more likely to get Fournier’s gangrene than women.
Meleney’s gangrene, also called progressive bacterial synergistic gangrene, is a form of gangrene that usually occurs after surgery and you will notice painful skin lesions a week or two after the procedure.
What are the symptoms of gangrene?
The most common symptoms of gangrene include:
- Black skin due to tissue death or discolored skin that can be red, blue, purple, or bronze
- Severe pain
- A foul-smelling discharge leaking from your wound or sore
- Hairless skin
- Shiny skin that may seem thin
- Cold skin
If gangrene is left untreated and spreads throughout your body or to your internal organs, it can lead to septic shock, a potentially life-threatening condition caused by infection, or amputation.
Symptoms of septic shock include low blood pressure, fever, increased heart rate, lightheadedness, confusion, and shortness of breath.
Please seek medical treatment immediately if you think you may have signs of infection, gangrene, or septic shock.
How does diabetes cause gangrene?
Diabetes is one of the most common causes of gangrene because it damages your blood vessels and nerves which decreases blood flow to your extremities and affects your ability to heal wounds.
When gangrene occurs due to diabetes, it is often on the toes or feet although it can occur on other parts of your body as well.
The reason it most often happens in your extremities is due to diabetic neuropathy which is a type of peripheral neuropathy when your nerves outside of your brain or spinal cord are damaged due to high glucose levels which can cause numbness.
When this happens, if you cut yourself on your foot (or wherever you have neuropathy) and are unable to feel it due to diabetic neuropathy, the wound can take too long to heal and become a diabetic foot ulcer.
The ulcer can then cause a diabetic foot infection, which can also be due to poor circulation and can cause gangrene to set in.
What are the treatment options for gangrene?
Treatments for gangrene can range from a surgical intervention to medications and how you are treated will depend on the type of gangrene you have and the severity of it.
The most common treatments for gangrene include:
When you have a surgical procedure to remove all dead or infected soft tissue then this is called debridement or surgical debridement.
The procedure is often done in stages to make sure all the necrotic tissue is removed from a deep abscess or wound and to help ensure that the infection does not spread.
Vascular surgery is often used to treat gangrene because it can improve blood flow to the affected area.
The goal of the surgery is to remove blockages in your arteries and other blood vessels that are preventing blood from flowing properly.
Your doctor may ask you to see a vascular surgeon first to see if this treatment is right for your symptoms.
If gangrene has spread too far and debridement and vascular surgery are not options due to severe infection or tissue death, then surgical amputation is an aggressive treatment that is often the only way to save your life.
Amputation is the removal of an extremity such as a toe, foot, leg, arm, or hand to stop the spread of gangrene and is often the last resort for successful treatment of it and other complications such as diabetic foot disease.
Diabetes is the leading cause of lower-limb amputations.
Skin grafting is reconstructive surgery that is often done after gangrene has been treated and the infection is under control.
The goal of skin grafting is to replace dead or damaged skin with healthy skin from another part of your body.
Depending on the type of gangrene you have, your doctor may prescribe an antibiotic treatment to help clear the infection or pain relievers if you experience any discomfort.
Hyperbaric oxygen therapy
Hyperbaric oxygen therapy is a treatment that uses 100% oxygen in a pressurized special chamber for the improvement in the healing of gangrene wounds.
The oxygen is delivered to your body at a higher than normal pressure and can help promote the growth of new blood vessels, which can improve blood flow and promote rapid healing.
What are the risk factors for gangrene?
Besides diabetes, there are several other risk factors that can increase your chances of developing gangrene, and these include:
- Diseases that affect your blood vessels such as atherosclerosis or blood clots
- Injections from needles
- Complications from COVID-19, specifically blood clots although more research is necessary to come to any firm conclusions
- Injury to your skin or soft tissue
- Anything that causes immunosuppression such as chemotherapy, some infections, certain diseases, and HIV to name a few
If you have any of these risk factors, it is important to talk to your doctor so they can help you monitor your gangrene risk and take steps to prevent it.
Are there ways to prevent gangrene?
There are several things you can do to lower your risk of developing gangrene and these include:
- Managing your blood sugar levels with blood glucose monitoring if you have diabetes
- Eating a healthy diet
- Exercising regularly
- Quitting smoking
- Maintaining a healthy weight
- Protecting your skin from injury
- Wearing appropriate footwear and socks to avoid blisters or foot ulcers for preventive foot care
- Checking your feet daily for any cuts, sores, changes in color, or signs of frostbite when in cold temperatures
- Wash your hands regularly to help reduce the spread of infection
- Wash your feet regularly to help with proper foot care
- Take care of any wounds by washing them with water and a mild soap
If you are at high risk for gangrene your doctor may also recommend that you take steps to improve circulation such as wearing compression stockings or taking blood thinners. Please talk to your doctor or health care provider if you have any questions about ways to prevent gangrene.
Gangrene is a serious condition caused by a lack of blood flow to an area of the body and can often be linked to diabetes.
The symptoms of gangrene include dead or dying tissue, pain, swelling, and changes in skin color. If gangrene is left untreated it can lead to amputation or even death.
There are several treatment options for gangrene including debridement, amputation, skin grafting, medication, and hyperbaric oxygen therapy although which treatment is best for you will be determined by your doctor.
There are also several ways to lower your risk of developing gangrene which we have also listed above.
If you have any more questions regarding gangrene, please talk to your doctor or health care provider.
References and sources:
Johns Hopkins Medicine
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