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Q&A with Australian Health Practitioners
What causes chronic leg ulcers in diabetes patients?
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Carolien Koreneff
Counsellor, Credentialled Diabetes Educator (CDE), Diabetes Educator, Psychotherapist, Registered Nurse
Carolien Koreneff is a Somatic (body-oriented) psychotherapist, Health Coach, Counsellor as well as a Credentialed Diabetes Educator with over 20 years experience. She currently sees … View Profile
Leg ulcers can be caused by poor circulation, oedema (fluid build up in the legs) and trauma (skin damage due to cuts or other injuries). People with diabetes can be at higher risk of developing leg ulcers as they are at higher risk of developing infections, including cellulitis, due to high blood glucose levels. When leg ulcers are present one would need to keep BGLs low (preferably between 4 and 8 mmol/L), keep the fluid in the legs down to a minimum by keeping the limbs elevated and possibly by taking some diuretics (fluid reducing medication) and make sure the ulcers are dressed with the right kind of dressing. Your community or practice nurse can help you recommend an appropriate style of dressing. If heart disease is present then this too will need to be adequately treated as heart problems can contribute to the oedema and hence can slow down the healing process.
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Fumi Somehara
Dietitian, Nutritionist
Fumi is a dietitian (APD) specialising in Dancer's Health and Eating Disorders Treatment. Her work is grounded in Health At Every Size (R) and Non-Diet … View Profile
Great answer and guidance from Caroline above!
I'd also be interested whether your blood suglar levels have been controlled well, as good control will be the key in managing other risk factors and issues. It will be of your benefit to visit a dietitian for a review.
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Angela McGinnis
Diabetes Educator, Registered Nurse
I am a Nurse Practitioner with special interests and experience in diabetes, cardiovascular, heart failure, wounds and vascular. I can prescribe and order diagnostics. I … View Profile
The majority of leg ulcers are caused by varicose veins. Diabetics are prone to this as much as the general population, but they are more prone to infection. Accurate diagnosis is vital. A vascular specialist can be very helpful and compression bandaging is the gold standard.
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Dr Shannon Thomas
Vascular Surgeon
Dr Thomas is a Vascular Surgeon with over 10 years clinical experience in the field. He is a member of the Royal Australian College of … View Profile
There are some great answers on this thread, and indicative of the number of specialist doctors, nurses and allied health professionals involved in the care of patients living with diabetes.
Generally speaking, an ulcer on the leg (ie from the ankle to the knee) is likely due to problems with the venous circulation. The venous problems may co-exist with infection, arterial problems as well as other rarer conditions.
An ulcer on the foot in a patient living with diabetes is unfortunately common and worrying. There may be several causes including problems with the small nerves in the foot (leading to a lack of protective sensation), arterial blockages, foot architectural and mechanical disturbances, poor foot care etc. Arterial blockages are pose the highest risk to loss of the limb in that a patient and should be corrected aggressively to give the leg a maximal chance at healing.
Review with a vascular surgeon for help with diagnosis and management is critical in this condition
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