Completely new to this site. Looking for advice on my diabetic leg ulcers still not healing after 4 months. Nurses just dressing them once a week then I have to clean and dress them another 3 times. Wondering if this is normal?
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Hi Newbie here Mark137
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Leadinglights
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Welcome to the forum. I hope somebody will have some advise but if blood glucose levels are high then healing can take much longer so it is important to try to get your blood glucose managed as well as you can.
Are you monitoring what your levels are and if they are running high then some dietary changes may be required to address the issue.
Are you on any medication as that may need to be adjusted to get your level better managed.
Are you having any special dressings I believe silver or Manuka honey impregnated dressings are effective in reducing infection or are you being prescribed antibiotics?
What is your nurse saying about the slow healing?
Sorry for so many questions.
I am on a massive cocktail of drugs I have RA, osteoporosis, Sjögren’s syndrome, type two diabetes, Cushings disease and a few other problems. I have had type two for about 8 years and my RA for over 30 years. My diabetes is caused mainly by steroids. I have gained a lot of weight due to lack of mobility. I am wheelchair bound if out and about. I have lost most of the feeling in my feet and have started to lose feeling in my fingers. My glucose levels are on average between 12- 20 on my glucose monitor. 52 on the doctors scale which I do not understand. My GP has said my glucose levels are high due to the severity of my leg ulcers. Which are cleaned With octenilin then when dry flaminal is applied followed by adaptic touch webbing then a melolin dressing then wrapped in bandage. I take two 500 mg metformin a day. Plus 50+ other tablets a day for all my other problems. Also a once a fortnight biologic drug which aids my RA but it also crashes my immune system. As you can see my case is far from straight forward
Leadinglights
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OMG that is a complex mix of conditions but it does sound as if you are having proactive aggressive treatment for the leg ulcers.
As you say your glucose levels are high and that cannot be helping. The 52 you mention would be 52 mmol/mol which would be the result from an HbA1C test which is the average over the previous 3 months but in the context of a diabetes diagnosis is not all that high, many have levels in triple figures and the threshold is 48mmol/mol to give a diagnosis, with the level you are seeing on your monitor, I would expect it might have been higher.
Have they considered any additional medication to help with blood glucose level as you are not on the max dose of metformin and there are other meds that could be added.
As you say your glucose levels are high and that cannot be helping. The 52 you mention would be 52 mmol/mol which would be the result from an HbA1C test which is the average over the previous 3 months but in the context of a diabetes diagnosis is not all that high, many have levels in triple figures and the threshold is 48mmol/mol to give a diagnosis, with the level you are seeing on your monitor, I would expect it might have been higher.
Have they considered any additional medication to help with blood glucose level as you are not on the max dose of metformin and there are other meds that could be added.
rebrascora
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Hi and welcome.
The levels you are getting on your meter and the result of 52 which will be an HbA1c result at the doctor's do not tally. When was that result of 52? If not recently (within the last 6 months) then you need to push for an up to date test with finger prick readings that high and ulcers which are not healing..... which they won't with levels that high. Unfortunately you will need to be politely pushy to get more support to get your levels down to a reasonable level. It may be that you need to modify your diet or it may be that you need a combination of dietary changes and stronger diabetes medication. Do you do any exercises with your feet to stimulate blood flow. I appreciate that your mobility is limited but that makes it all the more important to move your feet and toes regularly. The ulcers will not heal when your blood is thick and syrupy and stagnant, so improving your BG levels and encouraging blood flow will be key to the healing process. Maybe one of those pedaling machines that you can use whilst you are sitting watching TV or whatever. I appreciate that the steroids will be making your BG levels worse so extra medication may also be necessary.
It also occurs to me that RA and Sjogren' are autoimmune conditions, so it is possible that you may actually be a slow onset Type 1 (also autoimmune) rather than steroid induced, in which case you would need insulin to manage your diabetes and in the current situation insulin might be helpful anyway to get those BG levels down to help your ulcers heal.
Have you been prescribed the BG meter and test strips and if so, are you also on other diabetes medication like Gliclazide as well as the Metformin? It is uncommon for test strips to be prescribed when you are just on Metformin so wondering if you didn't realize that Gliclazide is a diabetes medication when you are on so many tablets or if perhaps the test strips are prescribed because of the steroids..... or you self fund the test strips for testing as in fact many Type 2s find it helpful to do.
Sorry if my post is a bit confusing..... just having lots of thoughts about your potential situation and not knowing enough about your circumstances to draw any conclusions, so not a terribly structured reply.
The levels you are getting on your meter and the result of 52 which will be an HbA1c result at the doctor's do not tally. When was that result of 52? If not recently (within the last 6 months) then you need to push for an up to date test with finger prick readings that high and ulcers which are not healing..... which they won't with levels that high. Unfortunately you will need to be politely pushy to get more support to get your levels down to a reasonable level. It may be that you need to modify your diet or it may be that you need a combination of dietary changes and stronger diabetes medication. Do you do any exercises with your feet to stimulate blood flow. I appreciate that your mobility is limited but that makes it all the more important to move your feet and toes regularly. The ulcers will not heal when your blood is thick and syrupy and stagnant, so improving your BG levels and encouraging blood flow will be key to the healing process. Maybe one of those pedaling machines that you can use whilst you are sitting watching TV or whatever. I appreciate that the steroids will be making your BG levels worse so extra medication may also be necessary.
It also occurs to me that RA and Sjogren' are autoimmune conditions, so it is possible that you may actually be a slow onset Type 1 (also autoimmune) rather than steroid induced, in which case you would need insulin to manage your diabetes and in the current situation insulin might be helpful anyway to get those BG levels down to help your ulcers heal.
Have you been prescribed the BG meter and test strips and if so, are you also on other diabetes medication like Gliclazide as well as the Metformin? It is uncommon for test strips to be prescribed when you are just on Metformin so wondering if you didn't realize that Gliclazide is a diabetes medication when you are on so many tablets or if perhaps the test strips are prescribed because of the steroids..... or you self fund the test strips for testing as in fact many Type 2s find it helpful to do.
Sorry if my post is a bit confusing..... just having lots of thoughts about your potential situation and not knowing enough about your circumstances to draw any conclusions, so not a terribly structured reply.
rebrascora
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Can you give us an indication of the sort of things you currently eat and drink for an average breakfast, lunch and evening meal, so that we can perhaps suggest some simple swaps which would help your BG levels. Carbohydrates are the key cause of high BG levels as they all break down into glucose in your digestive system and get absorbed into the blood stream where, as diabetics, we have difficulty processing them. Many people naively think diabetes is all about sugar, but it is all carbohydrates, so the starchy ones as well as the sweet suagry ones and the sugar and starch from so called healthy foods like fruit and wholemeal and jacket potatoes and oats etc break down into glucose just like the white bread and sugar, so reducing portion size of these things as well as cutting down the sweet stuff all helps bring BG levels down. That may seem to be very restrictive but actually you can still have large filling meals it is just that you need to choose lower carb options. It takes a bit of getting your head around it at first but we can make suggestions and hopefully you will find things you enjoy amongst them.
The simplest thing you can do which will usually have the biggest impact is to change your breakfast, if you currently have toast or breakfast cereal. Most people are more insulin resistant in the morning, so having a low carb breakfast instead of these traditional high carb options can have a significant impact on your levels for the rest of the day and because most of us have a similar breakfast everyday, it is just a question of changing your breakfast habit.
The simplest thing you can do which will usually have the biggest impact is to change your breakfast, if you currently have toast or breakfast cereal. Most people are more insulin resistant in the morning, so having a low carb breakfast instead of these traditional high carb options can have a significant impact on your levels for the rest of the day and because most of us have a similar breakfast everyday, it is just a question of changing your breakfast habit.
Flower
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Hi and welcome @Mark137
I'm sorry you are having a tough time with a lot of conflicting conditions.
This information is on steroid induced diabetes
https://www.diabetes.org.uk/diabetes-the-basics/other-types-of-diabetes/steroid-induced-diabetes
Having had leg and foot ulcers the only way they healed was after sustained in range blood sugars after IV antibiotics dealt with the infection.
As @rebrascora has said your long term control HbA1c test result of 52 mmol/mol - the approximate average of 3 months blood glucose levels - doesn't seem to match with your finger prick levels of between 12-20 mmol/L. An average of the lower 12 mmol/L finger prick would give an HbA1c of about 76 mmol/mol. I would request a new HbA1c test when you’re able to see what is going on. Your blood sugar might be dropping into normal range at other times and the HbA1c of 52 mmol/mol may be correct.
Here's some information on HbA1c test
www.diabetes.org.uk
If high glucose is circulating in your body- and you have a lot of conditions/steroids that are limiting what you can do about this - the environment will not be right for you to fight infection and for good new skin to start to heal the ulcers. It's a vicious circle that can go on and on.
There are other drugs that can be used for Type 2 diabetes to help maintain stable, lower blood sugars. I know how frustrated and unwell I felt with ulcers and dressings that just wouldn't heal and how much better I started to feel when my body started to heal. I would start with getting a new HbA1c blood test and having a discussion on whether a different drug could help you manage your blood sugars and hopefully start to heal your ulcers.
I'm sorry you are having a tough time with a lot of conflicting conditions.
This information is on steroid induced diabetes
https://www.diabetes.org.uk/diabetes-the-basics/other-types-of-diabetes/steroid-induced-diabetes
Having had leg and foot ulcers the only way they healed was after sustained in range blood sugars after IV antibiotics dealt with the infection.
As @rebrascora has said your long term control HbA1c test result of 52 mmol/mol - the approximate average of 3 months blood glucose levels - doesn't seem to match with your finger prick levels of between 12-20 mmol/L. An average of the lower 12 mmol/L finger prick would give an HbA1c of about 76 mmol/mol. I would request a new HbA1c test when you’re able to see what is going on. Your blood sugar might be dropping into normal range at other times and the HbA1c of 52 mmol/mol may be correct.
Here's some information on HbA1c test
What is HbA1c?
HbA1c is your average blood glucose (sugar) levels for the last two to three months. If you have diabetes, an ideal HbA1c level is 48mmol/mol (6.5%) or below. If you're at risk of developing type 2 diabetes, your target HbA1c level should be below 42mmol/mol (6%).
If high glucose is circulating in your body- and you have a lot of conditions/steroids that are limiting what you can do about this - the environment will not be right for you to fight infection and for good new skin to start to heal the ulcers. It's a vicious circle that can go on and on.
There are other drugs that can be used for Type 2 diabetes to help maintain stable, lower blood sugars. I know how frustrated and unwell I felt with ulcers and dressings that just wouldn't heal and how much better I started to feel when my body started to heal. I would start with getting a new HbA1c blood test and having a discussion on whether a different drug could help you manage your blood sugars and hopefully start to heal your ulcers.
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I have just been to have the wound dressed it turns out I have another infection in the wound. This probably explains the excruciating burning pain. I have been prescribed more oral antibiotics I was told my last reading was 56 I thought I had been told 52. I am in tomorrow for full blood tests and more swabs. The last swab was on Friday showing the infection was pseudomonas based bacteria. Hopefully the latest round of antibiotics will work and will see improvements. My wife informed me it’s not 4 months but six months that I have had these for
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rebrascora
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An HbA1c of 56 still doesn't match up with BG readings of 12-20 so it may be that your diabetes has deteriorated since that HbA1c test was done and needs a review and more medical support. It is therefore good that you have arrangements made to have bloods done and fingers crossed the new antibiotic help clear them up because they look really nasty.
In the mean time modifying your diet to reduce the amount of carbs you are eating should help to lower your BG levels a bit. Did you check to see if you are also taking other diabetes medication like Gliclazide?
In the mean time modifying your diet to reduce the amount of carbs you are eating should help to lower your BG levels a bit. Did you check to see if you are also taking other diabetes medication like Gliclazide?
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Sorry to hear what a tough time you are having @Mark137
Hope the round of blood checks can shed some light on things for you.
Those ulcers look nasty! Hope the ABs can sort the infection swiftly. Infection and illness can elevate BG levels, which in turn can slow healing - it’s perhaps a little surprising that more isn’t being done to try to reduce your day-to-day BG levels, especially if you are needing steroids which also bump up your BGs. This may be because your HbA1c isn’t reflecting the sorts of levels you are seeing, so maybe the Drs haven't clocked your 12-20s? But from a completely unqualified perspective, it feels like your body could do with a bit more of a hand managing your glucose levels.
Hope you can get some answers soon, and ways can be found to balance the needs of your multiple conditions.
Hope the round of blood checks can shed some light on things for you.
Those ulcers look nasty! Hope the ABs can sort the infection swiftly. Infection and illness can elevate BG levels, which in turn can slow healing - it’s perhaps a little surprising that more isn’t being done to try to reduce your day-to-day BG levels, especially if you are needing steroids which also bump up your BGs. This may be because your HbA1c isn’t reflecting the sorts of levels you are seeing, so maybe the Drs haven't clocked your 12-20s? But from a completely unqualified perspective, it feels like your body could do with a bit more of a hand managing your glucose levels.
Hope you can get some answers soon, and ways can be found to balance the needs of your multiple conditions.
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