Melcura Diabetic wounds info piece for Diabetic month

Taking Care of Diabetic Wounds

Did you know that diabetes is a leading cause of death in South Africa? The International Diabetes Federation (IDF) recently reported that worldwide there are 463 million people with diabetes and more than 19 million of those are on the African continent.

It is estimated that by 2045 there will be around 47 million diabetic patients in Africa: the highest increase in diabetes globally. Closer to home, 1.8 million South Africans have diabetes, and the IDF estimates an additional population of 69% of the total number of diabetics are still undiagnosed.
A big stumbling block, especially in South Africa, is the lack of awareness of the disease and access to diabetic-appropriate healthcare.

The basics of Diabetes
Diabetes is a category of metabolic disease associated with the development of high blood sugar or glucose. The two primary types of diabetes are Type 1 and Type 2.
Type 1 diabetes is an autoimmune disease that causes the immune system to create antibodies that target the insulin-producing cells of the pancreas. Insulin is a hormone that allows your body to use glucose for energy. Over time, the body is unable to produce insulin, and the patient must find other means to take in insulin each day.
Unlike Type 1 diabetes, Type 2 diabetes occurs when the pancreas continues to produce insulin, but the body doesn’t use it properly, causing a person to become insulin resistant.

The result is that the pancreas will start to go into overdrive to correct the deficit, becoming worse over time. Eventually, the pancreas will stop making insulin altogether and the patient will require insulin injections.
Type 2 occurs much more frequently in adults than in children, but Type 1 and Type 2 diabetes both share similar symptoms. These symptoms include excessive thirst, frequent and increased urination, and weight loss. Additional symptoms include blurred vision, fatigue, and longer than usual healing times for even the most minor cuts and bruises.

Children with diabetes
As a mom with a Type1 diabetic child, Delia Greeff wants other parents and diabetic patients to know that a correct diagnosis is crucial. “Diabetes is serious, but with the correct treatment, it is manageable. Treatments are constantly being improved, so once you have a diabetes diagnosis and know how severe it is, you can then take the correct steps to manage it”, she says.
According to Delia, one of the biggest challenges of having a diabetic child is wound care. “My little boy is happy and busy”, says Delia, “so it is my job to make sure I am always checking him for any scrapes or bruises, no matter how small. And as any parent knows, these are almost a daily occurrence.”

She says to address diabetic wounds as quickly as possible. Thoroughly clean the wound with clean water and mild soap. It is recommended that diabetic wounds are treated with a product such as medical-grade honey and dressed with a plaster or bandage. Even the most superficial grazes need to be monitored for infection and must be cleaned and redressed frequently to support the healing process.
“Honey-based wound care like the Melcura HoneyGel and HoneyBalm are winners in our home as it’s so easy to apply, it accelerates the healing process and fights off infection. We take it wherever we go”, says Delia.
Some of Delia’s top advice for other moms with diabetic children is to carefully manage their feet. She says “Toenails need to be cut correctly and monitored for ingrown toenails and infections, as the diabetic can often not feel/sense a problem and this can easily escalate into a serious wound that will require medical attention. In severe cases, diabetics are recommended not to walk barefoot to avoid cuts, puncture wounds, or thorns. We can’t, however, keep our children from playing and we just need to be extra vigilant with diabetic children. Educating yourself on the topic and connecting with parents of other diabetic
children is a big help.”

“My son makes use of an insulin pump and continuous glucose monitoring device to assist in managing his blood glucose levels. Both these devices require entry points into the body. These too can become infected and inflamed. Again, Melcura HoneyGel and HoneyBalm are my go-to for post-device removal treatment to the open area. The honey-based formulation has saved us from diabetic ulcers and the like, over and over”, says Delia.

Why diabetic wounds need extra care
• Neuropathy
According to the World Health Organization (WHO), a leading symptom of diabetes is neuropathy (nerve damage). The lack of sensation due to the nerve damage, particularly over pressure points, on the foot means that any small cuts and wounds or extended microtrauma are undetected. This can lead to an extensive breakdown of overlying and surrounding tissue, and eventual ulceration. Diabetic foot ulcers pose a complex clinical challenge because of their potential to develop persistent
and recurrent infections that may result in delayed healing.
• Poor circulation
Diabetics are more likely to develop peripheral vascular disease, a condition of poor circulation. Peripheral vascular disease causes your blood vessels to narrow, which renders them unable to deliver enough blood to neighbouring cells and limbs. The
condition affects red blood cells’ ability to pass through the vessels easily which prevents nutrients and oxygen from reaching the cells.
• Dysfunctional immune response
Many people who have diabetes may have problems with immune system activation. With less blood flow, the body is less able to mobilize normal immune defences and nutrients that promote the body’s ability to fight infection and promote healing.
• Infection
Neuropathy in the feet increases the chance of foot ulcers which may struggle to heal. Wounds come into contact with bacteria and being open for longer makes them more susceptible to becoming infected. Reduced blood flow and a dysfunctional immune system can impact on the body defence mechanism to fight off the bacteria that can cause an infection. Additionally, bacteria thrive on the extra sugar that’s available in the bloodstream. If the infection is untreated and left to spread, it can lead to complications such as sepsis or worst scenario bone infection or gangrene requiring amputation.
• Diabetic wounds are unlike typical wounds in that they take longer to heal. Molecular investigations of the microbial flora within chronic Diabetic foot ulcers highlighted the presence of biofilms. Biofilms are clusters of microorganisms that stick to each other and surfaces and encapsulate themselves in a protective matrix.
The microbial species within a biofilm are protected and markedly less susceptible to antibiotics. This makes them more difficult to eradicate.

Expert Advice
Janine Bérichon, a registered nurse and advanced wound care representative for Melcura, has been active in the medical field for over 20 years. Below are her key points for treating diabetic wounds:

Use tried and tested products
Melcura honey has some unique natural features that make it effective on diabetic wounds even more so than some normal wounds and it has been advocated for healing diabetic ulcers that contain biofilms. Due to its osmotic effect, Melcura honey draws moisture from within the wound bed into the product, softening slough and dead tissue, allowing this and any microbes to be rapidly cleaned away. This prepares the wound bed for new granulation tissue and promotes quicker healing.

Melcura honey has an acidic pH which creates an unfavourable environment for bacterial growth. Melcura honey creates a moisture-laden layer on the wound bed, which is an advantage in the removal and change of wound dressings by reducing or eliminating the pain associated with this process (may not concern diabetic patients with neuropathy) and avoiding damage to the newly grown tissue.
Absorption, and therefore reduction, of oedema from around the ulcer margins, reducing the associated pain and improving microcirculation with more oxygen and nutrients, promotes rapid tissue repair. The moist wound healing with Melcura honey products improves the healing time. In addition, safety has been established with the use of Melcura honey in the treatment of
wounds in neonatal and paediatric patients. Melcura honey is not cytotoxic and won’t harm healthy cells.

Sweet, sugary honey for diabetic wounds?! It does sound contradictory, but comparisons between pre- and post-honey dressing treatment of Diabetic foot ulcers showed no statistically significant differences in blood glucose levels in people with diabetes.
Melcura products have been chemically analysed and are manufactured under defined conditions that are subject to quality assurance procedures.

Support local
Treating these types of wounds is usually a time-consuming and expensive process, in which the prevention of further degradation of the wound, is a primary concern.

Melcura honey products are easy and quick to apply. They are also locally manufactured making them affordable in our tough local socioeconomic environment, thus ensuring even the most rural of areas have access to easy-to-use advanced wound care.