Optimizing Wound Healing for Diabetic Patients
by Sara Mattillion, MS, RD, LDN
Managing life with diabetes in and of itself can be challenging, but what happens when wounds are thrown into the mix?
Wound healing is a dynamic process and fantastic example of how our body’s systems work together to replace and repair damaged tissue. Our bodies are hardwired to initiate an automatic response, or series of events often referred to as the “cascade of healing,” when the skin becomes damaged. This series of events is comprised of four phases (i.e. the phases of healing).
Phases of Healing
During phase one (hemostasis phase), the body’s objective is to stop the bleeding. During this process blood platelets and collagen mix to form a stable blood clot. Phase two (inflammatory phase) is easily identifiable. This is when edema (fluid retention), erythema (reddening of skin), heat and pain occur. The body is working hard at destroying bacteria and removing debris; preparing for new tissue growth. Phases three (proliferative phase) and four (maturation phase) take the longest to occur. During the proliferative phase the body produces new connective tissue to fill the wound and new blood vessels are formed. In the later stages of phase three a new layer of epithelial skin cells migrates across the wound. The maturation phase (phase four) is when the new tissues gain strength, flexibility and durability. This phase varies greatly in length depending on the severity of wounds, but on average lasts 21 days to two years.
For diabetics, wound healing is simply not the same…
For those who are unfamiliar with wound healing’s link to diabetes, allow me to explain. Many people with diabetes develop wounds that are slow to heal, do not heal properly or never heal. Diabetes impairs the body’s sensitivity and/or production of insulin. Insulin is an essential hormone that regulates our cells ability to absorb and utilize glucose for energy. When this system of blood sugar regulation is disrupted, damage occurs. Poor circulation, weakened white blood cell function and neuropathy are common results of significantly elevated blood glucose levels. White blood cell damage puts someone at a higher risk of infection while poor circulation makes it difficult for the body to deliver important nutrients to wounds. As a result, wounds heal more slowly, if at all. Even if you are someone who has diabetes and chronic wounds, all hope is not lost! Emphasis on proper nutrition and optimized blood glucose control will significantly help to improve the cascade of healing.
Nutrition and Glycemic Control
Optimized glycemic control begins with a basic understanding of carbohydrates and metabolism. Carbohydrates are the body’s preferred source of energy. The body metabolizes carbohydrates into glucose (sugar) which is then transported to cells and used as energy. The normal range for blood glucose is 70-100 mg/dL. In diabetes, glucose readings between 70 and 140 mg/dL are desirable. It is within this range that our bodies function optimally.
As previously mentioned, carbohydrate intake has a direct effect on a person’s blood sugar level
s. It is important to remember carbohydrates are more than just bread and pasta! Sources of carbohydrates include grain products, starchy vegetables, fruit and even some dairy, not to mention sweets and candy! Being mindful of what carbohydrates are eaten and in what quantity are the cornerstones of a carb-controlled diet. Whenever possible, chose whole grains over refined grains, whole fruit over fruit juice and make an effort to include more non-starchy vegetables into your daily routine.
A small snack or balanced meal every three to four hours is ideal. Eating in this way helps promote a regular appetite (making it easier to get enough overall calories and protein) and makes it easier for the body to regulate the level of glucose in the blood.
For every snack aim for one to two carbohydrate choices and one protein source. At mealtimes make it a priority to include two sources of protein and three to five carbohydrate choices.
Some examples of balanced snacks include whole wheat crackers with low-fat cheese, a slice of whole wheat toast or some fruit with peanut butter, fresh vegetables and hummus, Greek yogurt with fresh berries.
Meal ideas can be as simple as a garden salad topped with a protein (chicken, lean steak, salmon), roasted chicken with your favorite vegetables and brown rice, turkey sandwich on wheat with hummus and fresh vegetables, grilled salmon with half a baked potato and side salad.
Vitamins and Minerals do make a difference
Often overlooked for their importance, micronutrients (i.e. vitamins and minerals) are just as essential to the wound healing process as overall calories and protein are! Ascorbic acid (vitamin C), vitamin A, vitamin D, zinc and magnesium are the key players.
Ascorbic acid, or vitamin C as it is commonly known, can improve wound healing drastically. Vitamin C plays an important role in in all stages of wound healing, particularly collagen synthesis, or the creation of the protein used to make new tissue. Some studies have shown vitamin C supplementation can help speed up the healing process. It is also a great antioxidant, protecting new and existing cells from damage. Excellent sources of vitamin C include citrus fruits, broccoli, cauliflower, bell peppers, leafy greens, potatoes, tomatoes, berries.
Vitamin A (the general term for retinoids) is commonly associated with skin. Does the term retinol cream ring a bell? Vitamin A is essential in all phases of wound healing as some of its main functions are to stimulate new skin cell growth. Too much vitamin A can be toxic, so additional supplementation is not recommended unless your doctor tells you otherwise. Dietary sources of vitamin A include animal liver, dairy foods, eggs, fortified cereals, orange and yellow fruits and vegetables and leafy greens.
Several studies have been done on vitamin D and its effects on blood glucose levels and wound healing. The results of the studies have been promising, concluding vitamin D supplementation has a positive effect on stabilizing glucose and cholesterol levels. As we learned earlier good glycemic control is essential to wound healing. Vitamin D also promotes the creation of cathelicidin, an antimicrobial unit the immune system uses to fight off wound infections. These anti-inflammatory and antioxidant effects make vitamin D an essential player in the cascade of healing. Foods high in vitamin D include cod liver oil, fatty fish such as salmon and tuna, fortified beverages like milk, cheese, egg yolks.
Magnesium plays an essential role in carbohydrate and lipid metabolism, acts as an anti-inflammatory agent and is necessary in producing protein and new tissue during the wound healing process. Magnesium rich food sources include pumpkin seeds, nuts, avocado, dark leafy greens, beans, whole grains, dark chocolate, legumes (lentils, chickpeas, soybeans).
Zinc deficiency has been associated with slow wound healing, reduced wound strength and reduced skin cell production. Zinc, like the other vitamins and minerals previously discussed also plays a pivotal role in collagen synthesis, new tissue growth and healing. Foods high in zinc include lean red meat, shellfish, legumes, seeds, nuts, dairy products, eggs, whole grains, and dark chocolate.
Now, before you go on a shopping spree at your local health food store take a good look at your diet!
Before you go out and purchase any dietary supplements, take an honest look at your diet. Are you including foods from all food groups? Are you getting enough protein? What about fruits and vegetables, are you eating the rainbow? Are most of your meals balanced?
If you answered no to one or more of these questions, reach out to a Registered Dietitian! He or she will analyze your diet and let you know which nutrients you are meeting and which you are not. Then your doctor can make suggestions based on this information and tailor nutrition supplements to meet your individual needs.