Diabetic Foot: Therapy

Notice: The most important measures are metabolic optimization and treatment of internal diseases and infection control.

General measures

  • Any concomitant medical conditions should be carefully monitored and treated.
  • Blood pressure should be optimally adjusted.
  • Blood lipids should be controlled and brought to a low level if necessary.
  • Nicotine restriction (refrain from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day), as alcohol can lead to hypoglycemia (low blood sugar).
  • Aim for normal weight!Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
  • Avoidance of psychosocial conflict situations:
    • Bullying
    • Mental conflicts
    • Stress
  • Avoidance of environmental stress:
    • Nitrosamines (carcinogenic substances).
  • Travel recommendations:
    • Before starting a trip participation in a travel medical consultation!
    • For the reduction of individual risk factors and preventive measures in diabetic foot see below Diabetic foot / Prevention.
    • Note in particular that you never walk barefoot and do not wear sandals, but only “broken-in” shoes; inspect the feet daily and disinfect even the smallest wounds and provide with a plaster.
    • If there is evidence of infection, immediately start systemic antibiotic therapy, e.g. azitrhomycin, cipprofloxacin.
    • In addition, note all travel recommendations under diabetes mellitus type 2 / other therapy.

Conventional non-surgical therapy methods

  • Hyperbaric oxygenation (HBO; synonyms: hyperbaric oxygen therapy, HBO therapy; English : hyperbaric oxygen therapy; HBO2, HBOT); therapy in which medically pure oxygen is applied under an elevated ambient pressure – is used for amputation-prone wounds in diabetic foot syndrome that are out of treatment. According to the Institute for Quality and Efficiency in Health Care (IQWiG), dated December 29, 2015, there is evidence that wounds close better with HBOT.A double-blind, randomized study of patients with Wagner stages 2 to 4 diabetic foot ulcers failed to demonstrate a positive effect of HBOT, either for ulcer healing or for the indication for major amputation.
  • Cold plasma therapy (ionization of ambient air by electrical discharges or electromagnetic radiation → formation of reactive oxygen and nitrogen species, mainly ozone and nitrogen oxides; effect: probably antimicrobial and infection modulating; no side effects): Diabetic foot ulcers heal faster with cold plasma treatment in addition to standard wound therapy.
  • Medical foot care – by a specialist (podiatrist) removal of calluses to prevent skin damage, inflammation and cracks; elimination of abnormal nail formation by cutting, grinding and milling (health insurance benefit).

Medical aids

Orthopedic aids are important here for pressure relief and shock absorption:.

  • Orthotic supplies:
    • In case of ulcer (ulcer): adapted footbeds with ulcer embedding.
    • In case of partial amputation: appropriate orthopedic shoe fitting.
  • Relief shoes (therapeutic shoes; orthoses with soft padding, plaster technique), if necessary also crutches or wheelchair.

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Pneumococcal vaccination

Regular checkups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Observance of the following specific nutritional recommendations:
    • Meals of diabetic patients should contain 10-20% protein (protein), <30% fats and 45-60% carbohydrates. In diabetic nephropathy, particular care should be taken to ensure that protein intake does not exceed 0.8 to 1.0 g/kg body weight per day.
    • Avoidance or reduction of monosaccharides (simple sugars) and disaccharides (double sugars) and high intake of complex carbohydrates.
    • Low cholesterol
    • Diet rich in fruits and vegetables and marine fish (due toOmega-3 fatty acids).
    • In addition, if diabetic nephropathy is present, a low-salt diet (< 6 g/day) should be followed.
    • If, in addition, advanced renal insufficiency is present, a daily drinking amount of 2-3 l is required to eliminate urinary substances and to avoid dehydration (fluid deficiency) (does not apply to edema / water retention).
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Psychotherapy

  • Psychosocial care
  • Detailed information on psychosomatic care (including stress management) is available from us.

Training

  • Every diabetic should attend special diabetic training courses that explain the diagnosis and therapy of the disease in detail, in order to be able to live as independently and as safely as possible with diabetes. Above all, those affected are shown the correct use of insulin, the importance of blood glucose self-monitoring and the adapted diet. They also learn how to avoid complications as far as possible. Furthermore, in such groups, a mutual exchange of experience can take place.