How can you tell when your diabetic skin is breaking down and what should you do

Diabetes is only one of the causes that will lead to skin breakdown in a person.  Other causes can be anything from smoking, anemia, and a variety of vascular diseases.  Other things such as drug use and alcoholism can also do great damage to the cellular level of the skin. 

I am Diabetic so for me this is a major concern.  Skin is a real concern for us as Diabetics because we have poor circulation and our vascular systems are always compromised with this disease. What we as Diabetics need to be concerned about is what is causing it and how to recognize it then also how to treat it or what to do to prevent it.

The most common areas for skin breakdown (pressure points) in adults are the sacrum/coccyx (tailbone), heels, elbows, lateral maleollus (outside of the ankle), greater trocater (hip bone) or the bottom of the femur (outside and inside of the knee) and the ischial tuberosities (the bones we sit on).  Pressure points for children are different and based on age and development (7).  For infants and children less than three years of age, the head makes up a greater portion of the total body weight and surface areas.  When they are placed on their backs, the occipital region (back of the head) becomes the primary pressure point.  When placed on their side, the ears are also very susceptible.  For older children, the sacrum (lower spine) and calcaneous (the heel of the foot) are most at risk (9).
Source:  http://myelitis.org/newsletters/j5/journal-5-04.htm#.UhO31H_pxVI

For those with Obesity problems you should also check under the folds or flaps of skin that may overlap and create no air flow and bacterial breakdown. 

Other things that can have a big play on breakdown of skin is if clothing or blankets, pillows are folded under you creating a pressure point.  Make sure that you smooth any clothing, blankets or pillows you may be using to keep and insure a better amount of blood and oxygen flow to all parts of your body. Bedding or sheets should be as wrinkle free as possible as well.  Make sure not to wear shoes that will rub on toes or feet.  Some jewelry also can cause issues of circulation. 

Make sure that you keep skin dry and clean it will help you to insure the best possible way to keep your skin from breaking down.  At the same time you don't want your skin to not have moisture but make sure it is the right type of moisture.  Lotion your skin properly after showers or bathing because you do not want to get cracks in your skin. 

Maintain a healthy diet and get proper nutrition.  Help your body to stay vascular healthy by eating certain foods such as:   

• Omega 3 fatty acids(salmon, mackerel, flaxseed)

• Vitamin C(citrus fruits, strawberries, broccoli)

• Vitamin A(Vegetables that are dark green or dark orange in color)

• Zinc(seafood, meat and eggs)

• Protein(meat, eggs, cheese, and soy products)

Make sure that you switch positions from sitting to standing to walking and if you are laying on your side in bed switch positions about every 2 to 4 hours.  This will help you from keeping pressure off of any one point for too long.


Keep muscle spasms under control 
Some muscle spasms can be beneficial as they help you change position, if you can’t move yourself.  Too much muscle spasticity can cause rubbing and friction, especially when you are in bed at night.  Talk with your care provider about how to best manage spasticity.  Exercise and range of motion are two good ways to reduce spasticity.  Make sure orthotics (braces) are fitting properly, that they are worn correctly, and that the straps are fastened properly to prevent friction or pressure.  Be sure that your bladder and bowel programs are working well as increased spasticity can be caused by a urinary tract infection or constipation.  Spasticity can also increase when you have a burn or skin breakdown.  
Source:   http://myelitis.org/newsletters/j5/journal-5-04.htm#.UhO31H_pxVI

What does minor skin breakdown look like? 
Skin breakdown starts out as a red or purple spot on fair skin or a shiny, purple, blue or darker spot on dark skin, which does not fade or go away within 20 minutes. When you press on the spot with your finger, it does not become lighter (blanch).  It may feel warmer or cooler than the skin around it.  The spot may feel hard or squishy under your fingers and may look swollen.  If you have sensation, it may be itchy or painful.  At first, it may not look like much, especially if the skin is not broken or open, but it can get a lot worse.  If your skin becomes blistered, scabbed or has a small open area on the surface, this is more serious, as it indicates that the tissue underneath has begun to die.  At this stage, the progression of skin break down is reversible: the skin will return to normal as soon as the cause of the irritation is found and eliminated and the skin is properly cared for.  If these steps are not taken, the damage can rapidly progress to a dangerous level where infection can attack the underlying tissue and bone, posing a serious risk to your health.
 Source:  http://myelitis.org/newsletters/j5/journal-5-04.htm#.UhO31H_pxVI


What does serious skin breakdown look like?
Serious skin breakdown occurs when the cause of the problem is not eliminated and tissue has been deprived of oxygen and nutrients for so long that the tissue has died and there is now a large hole or crater.  Damage extends at least into the subcutaneous tissue.  In the most serious wounds, tissue death includes muscle and extends as deep as the bone.  Drainage is almost always present.  If you have fever, see green or yellow drainage, and have a warm temperature around the wound, you may have developed an infection.  Wounds such as this, with or without infection, must be evaluated by a health care professional.  This care may be obtained through your spinal cord injury provider or you may be referred to a wound center to be evaluated and treated by a professional that specializes in the treatment of serious wounds.  When an infection forms in a wound, the surrounding tissue and bone can become infected.  If this continues, infection can enter the blood stream causing sepsis; and if untreated, can be fatal. 
Source:  http://myelitis.org/newsletters/j5/journal-5-04.htm#.UhO31H_pxVI

Consult your physician with either of these two Serious Skin breakdowns and Minor Skin Breakdowns.  Your doctor will be able to give you the proper advice on what you should do for your Skin Breakdown. 

I encourage you to read more from this article on Skin Health:  Prevention and Treatment of Skin Breakdown Janet Dean, MS, RN, CRRN, CRNP  Link:  http://myelitis.org/newsletters/j5/journal-5-04.htm#.UhO31H_pxVI

Remember we are a team a community and your information that you share is important like my information that I share can help keep us healthier and live better and stronger lives.  If you have something to share, a blog idea, or would like to share information via the blog then connect with me at diabetic.day2013@gmail.com.  Together we can support each other.

Being Comfortable in the Skin Your in with Diabetic Skin and its Care

I began wondering why is my nose always have flakey dry skin and my body would peel in places just like if I had been burned by the sun.  I just didnt know what was happening and this was a very long period into my Diabetes. 

One day while at my doctors office I asked my doctor why my skin was peeling and why was I having such an issue with my dry skin.  She told me that with Diabetes it is part of the disease and that moisture is not there like it used to be.  I still have never understood that so I went on a fact finding mission.  I am going to share what I have learned with you all.

As a Diabetic we are more prone to have different types of skin issues. Here is what happens:   The body loses fluid when blood glucose gets high, making skin drier and thus itchier and sore. If the skin becomes dry enough to crack, germs are liable to enter and cause infection. High glucose levels also inhibit sweating, which keeps skin moist. Because high glucose levels provide breeding grounds for bacteria and fungi, the body's ability to heal itself is compromised.  Source:  http://www.ehow.com/facts_5729502_skin-diabetes_.html

Some of the types of the skin issues include:

1.  Diabetic Dermopathy
2.  Necrobiosis Lipoidica
3.  Diabeticorum Lipoidica
4.  Diabetic Blisters
5.  Eruptive Xanthomatosis
6.  Acanthosis nigrica

This is a breakdown of the skin issues and a definition of what they are:

1.  Diabetic Dermopathy (also known as "shin spots") is a type of skin lesion usually seen in people with diabetes mellitus. It is characterized by dull-red papules that progress to well-circumscribed, small, round, atrophic hyperpigmented skin lesions usually on the shins. It is the most common^{[1]:540[2]:681} of several diabetic skin conditions being found in up to 30% of diabetics. Similar lesions can occasionally be found in non-diabetics usually following trauma or injury to the area, however >4 lesions strongly suggests diabetes.
Source:  http://en.wikipedia.org/wiki/Diabetic_dermopathy

2.  Necrobiosis lipoidica is a necrotising skin condition that usually occurs in patients with diabetes but can also be associated with Rheumatoid Arthritis.^[1] In the former case it may be called necrobiosis lipoidica diabeticorum (NLD). NLD occurs in approximately 0.3% of the diabetic population, with the majority of sufferers being women (approximately 3:1 females to males affected). 
Source: http://en.wikipedia.org/wiki/Necrobiosis_lipoidica. 

 

3.  Necrobiosis  Lipoidica Diabeticorum A skin condition called necrobiosis lipoidica diabeticorum (NLD) occurs when collagen breaks down, deposits of fat build up and the blood vessel walls thicken.
Source:  http://www.diabetescare.net/content_detail.asp?id=815

4.  Diabetic Blisters are also called bullosis diabeticorum or diabetic bullae. They can sometimes develop in people with diabetes, although the condition is relatively rare. Only about one-half of one percent of those with diabetes is ever diagnosed with diabetic blisters. 
Source:  http://www.diabetescare.net/content_detail.asp?id=813

5.  Eruptive Xanthomatosis is due to high concentrations of plasma triglycerides, as occurs with uncontrolled diabetes. The xanthomas usually disappear when the underlying condition is treated, as when the diabetes comes under control.  Source:  http://www.medterms.com/script/main/art.asp?articlekey=31584

6.  Acanthosis Nigricans (affects mostly Native Americans, Latinos and African Americans)  (ak-an-THOE-sis NIE-grih-kuns) is a skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened and may smell bad. Most often, acanthosis nigricans affects your armpits, groin and neck.
Source:  http://www.mayoclinic.com/health/acanthosis-nigricans/DS00653

The Skin is one of the largest Organs on a humans body.  Being a Diabetic your organs get affected by the disease.  It is of utmost importance that we have the best skin care possible so to avoid major issues with it.  Take proper care of your skin making sure to keep it clean, moisturized and in cases that there is a skin issue seek medical attention and make sure to follow the insturctions of your doctor. 

We have to take care of ourselves in able to support other Diabetics with complications.  Together we make a community that is over 26,000,000 Americans alone.  We are large and growing.  It is important to offer each other a variety of good solid information so we can care for ourselves and others better. 

If you have a story a question or would like to write an article for this blog please contact me at diabetic.day2013@gmail.com