Gangrene is the death of body tissue due to infection and a loss of blood supply. The condition is typically caused by an injury and commonly affects the extremities - fingers, feet and toes. People with diabetes are at an increased risk of developing gangrene because uncontrolled blood sugar levels can damage nerves and the immune system, interrupting the flow of blood and making it more difficult to fight off infection.
The common signs of gangrene include:
There are several types of gangrene that can affect people with diabetes in different ways.
Wet gangrene (also known as moist gangrene) is the most dangerous form of gangrene because it spreads quickly and can be fatal if left untreated. Gangrene is referred to as wet when there is a bacterial infection. People with diabetes may unknowingly develop it following a minor foot or toe injury due to neuropathies. Infection can impede blood circulation due to tissue swelling and the production of gas and bacterial toxins. This type of gangrene often produces pus or an oozing fluid hence the term "wet."
Dry gangrene can occur due to a lack of blood flow to a given part of the body. It is common in the extremities because, by the time the blood has circulated this far, it has lost much of its oxygen. Unlike wet gangrene, there is no wound or bacterial infection that causes the condition.
Dry gangrene develops slowly, worsens over time and is characterized by dry or shriveled skin that appears brown to purplish-blue or black.
Gas gangrene is due to internal infection usually caused by Clostridium perfringens bacteria. This rare and potentially deadly form of gangrene can develop after injuries or surgeries and spreads quickly. As the bacteria grow and spread, they produce toxins and gas that damage the skin, blood vessels and tissues. At first, the skin appears normal but then starts to turn reddish, purple or gray. It may even appear bubbly or make a cracking sound when pressed. Some injuries are at a higher risk of developing gas gangrene, such as deep wounds, muscle injuries and severely damaged tissues.
Internal gangrene can develop when blood flow is blocked to one or more internal organs such as the appendix, gallbladder and intestines. The initial symptoms are less evident than wet and dry gangrene and vary depending on the organ or organs affected. Occasionally the skin overlying an organ may be discolored, and the localized area swollen and painful.
Fournier's gangrene or genital gangrene is a rare condition that affects the genitals and the area around them. While more common in men between the ages of 50 and 60, women and children can also get it. The cause is typically an infection in or near the genitals. Bacteria enter through a cut or break in the skin, where they quickly spread, depriving areas of oxygen, leading to necrosis (tissue death).
The skin and blood vessels around the genital region are usually destroyed. Typical symptoms include intense pain in the genital area, fatigue, fever, low blood pressure, blisters and a foul odor coming from the infection site.
Some cases of Fournier's have been tied to diabetes medications. In 2018, the FDA warned that people taking some kinds of type 2 diabetes drugs (SGLT2 inhibitors) are at an increased risk of developing this type of gangrene.
To prevent the formation and development of gangrene, people with diabetes need to control their blood sugar levels. Therefore, regular self-monitoring with a glucometer is a good idea.
Also, take extra care of your feet. Check them daily for skin breaks, discoloration, numbness, pain or swelling. Report problems to your doctor immediately. Wear shoes that fit correctly to prevent injuries that can lead to infections and gangrene.
Other preventative measures include:
If you have diabetes and want to know more about improving your health and wellbeing or would like treatment for complications such as diabetic sores, please visit us at the Midwest Institute for Non-Surgical Therapy. Dr. Akinwande and the team can see you at one of four convenient locations throughout the St Louis area. Call MINT today to book a consultation on 314 255 2204.