Understand The Link Between Gangrene And Diabetes

If you have diabetes, you probably know about your increased risk of infection, this includes diabetic gangrenous infections. 

You may have noticed it can take longer for wounds to heal. 

This is because of the decreased circulation that people with diabetes often experience. 

High blood sugar affects your blood vessels. 

Once your blood vessels have been compromised, this can reduce the quality of blood flow you have. 

And this can then increase your chances of developing gangrene. 

This is not something to be taken lightly since gangrene can have severe implications on your health.

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What is gangrene?

Gangrene happens when tissue death, ischemia, or necrosis occurs in your body. 

This usually occurs when the blood circulation to an area of the body is disrupted. It happens most frequently in the toes, fingers, arms, and legs. 

Gangrene can also affect muscles and organs, but this is a more rare situation.

What’s the link between gangrene and diabetes?

Gangrene is a possible diabetic complication. If you have diabetes, you are at a higher risk of developing gangrene. 

This is because along with diabetes comes high blood sugar levels. This can lead to damage to your nerves. 

This then leads to loss of feeling in the areas innervated by these nerves. This is what’s called diabetic neuropathy

If you don’t have sensation in a certain area, it’s easier to develop an injury there.

Diabetes can also affect your blood vessels and lead to blood vessel disease. Diabetic patients often have limited blood flow to their feet. 

If you aren’t getting enough blood flow to your feet, guess what else isn’t making it there? That’s right, your white blood cells. 

These are the blood cells that fight infection in the body. 

This means that any lesions you develop can take a longer time to heal correctly. You are also at higher risk of developing diabetic gangrenous infections in these lesions and wounds.

Types of gangrene

Dry gangrene

Dry gangrene happens when circulation to an area of the body gets blocked. 

How does this happen? 

Well, your blood is an essential carrier of oxygen to your body’s tissues. All your organs’ tissues require oxygen for survival. 

If a body part isn’t getting oxygen, then it can deteriorate and die, leading to dry gangrene.

Dry gangrene is usually either dark green or purple. It can even be almost black. 

The skin could be dry and wrinkled as well because of the lack of oxygen.

Wet gangrene

Wet gangrene is an appropriate name since it is wet in appearance. It has swelling and blisters. 

This can happen due to frostbite or a severe burn. 

If you have diabetes mellitus, you could develop wet gangrene after a minor injury to your toe or foot or from a foot ulcer. You might not even know it’s happening.

People with diabetes have decreased blood flow to their extremities. 

This is why tissues at the body’s extremities don’t heal as quickly, and infection can occur. 

Wet gangrene can spread fairly quickly. It’s important to seek treatment right away for wet gangrene because if it isn’t treated properly, then it can even be fatal.

Gas gangrene

If an infection develops deep inside the body, this can result in gas gangrene. 

So how does this happen? 

Harmful bacteria produced as part of the infection release gas. This gas can damage tissue, cells, and blood vessels.

Gas gangrene can show up at the site of injury or surgery. Your skin may swell and develop a bubbly appearance. 

Gas gangrene is one of the most serious types of gangrene since it can develop suddenly without symptoms at first.

Internal gangrene

If the blood circulation to an organ becomes blocked, this can lead to internal gangrene. 

Internal gangrene most commonly affects the gall bladder, intestines, and appendix. 

When gangrene affects the gall bladder, it’s called acute cholecystitis. Symptoms to look out for include fever and severe pain.

Fournier’s gangrene

Fournier’s gangrene occurs only in the genital area. 

It usually develops from an infection in the urinary tract or the genitals. 

Symptoms to look out for include pain, swelling, and tenderness in the area where your genitals are. 

You may also notice purple, green, or black discoloration and a foul odor. 

Fourniers gangrene can happen in men and women but is more common in men.

Progressive bacterial synergistic gangrene

Progressive bacterial synergistic gangrene is the type that can develop after surgery. 

Lesions may show up on the skin near the incision area one to two weeks after your surgery.

Symptoms

Gangrene symptoms usually appear in the fingers, toes, arms, or legs. 

Symptoms of gangrene typically involve the following:

  • Discolored skin
  • Feelings of numbness
  • Unusual formation of other discharge

Other causes of gangrene

Aside from diabetes, there are other potential causes of gangrene. 

Most of these are medical conditions or situations that affect circulation. 

These include the following:

  • Traumatic injury of skin or soft tissue
  • Infection of skin or soft tissue
  • Peripheral artery disease/peripheral arterial disease
  • Peripheral vascular disease
  • Atherosclerosis
  • Raynaud’s phenomenon
  • Recent surgery
  • Osteomyelitis

If someone has a minor infection but a weak immune system, this can become more serious and result in gangrene. 

Conditions that contribute to weak immune systems include the following:

  • Chemotherapy
  • HIV
  • Malnutrition
  • Kidney failure
  • Being over the age of 60

Treatment

If you develop gangrene, you must seek immediate medical attention for it. This is because urgent care is needed to remove the diseased tissue. 

This is necessary to prevent the bacterial infection from spreading through your bloodstream.

Your doctor might do a surgical debridement. This is when the gangrenous tissue is removed surgically. 

Your doctor might also perform a skin graft. This is to help repair the gangrene damage left on your skin. 

It can also help to clear up any defects from the debridement procedure. 

A skin graft is a reconstructive surgery where healthy skin is taken from elsewhere on the body. It is then placed in the area where the damaged skin was removed. 

Another option to ask your doctor about is hyperbaric oxygen therapy.

Only in extreme cases will limb amputation of the toe, finger, or foot be recommended. 

This can happen in cases of critical limb ischemia. 

Antibiotics are essential after major amputation to prevent further infection.

Complications

Gangrene could lead to necrotizing fasciitis. 

If you leave your gangrene untreated, this can lead to life-threatening infection and septic shock. 

This is why it is so crucial that you seek care immediately for gangrene, especially if you have diabetes and are more prone to infection and slow diabetic wound healing

You may take longer to heal from diabetic ulcers as well.

How to prevent gangrene with diabetes

If you have diabetes, check your fingers, toes, hands, and feet regularly. 

You are looking for any wounds, diabetic foot ulcers, or signs of diabetic foot infection or extremity infection such as swelling, redness, heat, or discharge.

Maintain a healthy weight. If you are overweight, this can cause additional stress on your blood vessels. 

When there is extra stress on your arteries, this can restrict blood flow. This then increases your risk of infection.

Be sure to dress appropriately for the weather. This is especially true of cold weather. 

Be sure to keep warm and wear lots of layers, especially on your feet and hands. If you get frostbite, this can lead to gangrene. 

If you have been exposed to the cold and notice that afterward, your skin is pale, exceptionally cold, or numb, then see your doctor right away.

And, if you smoke, quitting can reduce your chances of getting gangrene. 

This is because cigarette smoke weakens blood vessels and can increase the likelihood of getting gangrene.

Conclusion

You now know about the link between diabetes and gangrene. And knowing is the first step. 

Now that you’re aware of your heightened risk and understand the different types of gangrene to look out for, keep an eye out for symptoms of gangrene.

If you have diabetes, monitor it closely with your health care provider and diabetic foot doctor. 

If you notice any discolored skin, feelings of numbness, discharge, or pus near an area of a recent injury, you must get it looked at right away. 

Although diabetes is a significant cause of gangrene, it’s not the only one. 

It’s also important to look out for symptoms of gangrene if you have any of the other high-risk conditions such as human immunodeficiency virus or kidney failure.

It’s much easier to prevent diabetic gangrene than treating it once it has already developed. 

Watch your weight, quit smoking, and prevent frostbite. 

If you do all this and still end up developing gangrene, then seek medical care right away. Gangrene is no joke. It can lead to a life-threatening situation.

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Sources

  1. Conte, MS et al.. (2019). Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 58 (1S), S1-S109.e33. https://pubmed.ncbi.nlm.nih.gov/31182334/
  2. Novara, E; Molinaro, E; Benedetti, I; Bonometti, R; Lauritano, EC & Boverio, R. (2020). Severe acute dried gangrene in COVID-19 infection: a case report. Eur Rev Med Pharamacol Sci. 24 (10), 5769-71. https://pubmed.ncbi.nlm.nih.gov/32495913/
  3. Singh, P & Schwartz, RA. (2020). Disseminated intravascular coagulation: A devastating systemic disorder of special concern with COVID-19. Dermatol Ther. 33 (6), e14053. https://pubmed.ncbi.nlm.nih.gov/32700813/
Alternative Text

Dr. Corina Kibsey

Dr. Corina is a naturopath in the GTA, working out of various locations of Triangle Physiotherapy. Dr. Corina struggled with digestive health for most of her life, to the point where she couldn’t remember what normal digestion felt like. It wasn’t until she discovered natural treatments for digestive problems that she was able to realize how strong and healthy she could really feel. Dr. Corina is now passionate about bringing this knowledge to others, so that they don’t have to suffer like she did. She wants to help people feel like the best version of themselves.

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