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:

• Educate yourself and obtain knowledge from professionally trained medical staff on proper skin and foot care if you suffer from diabetes
• Regular medical checks up as diabetics need a multidisciplinary team to help them with all their needs (Endocrinologist, physician, GP, podiatrist, dietician, psychologist, vascular surgeon wound care specialist)
• Check blood sugar levels daily and keep levels within the normal range to ensure a healthy body. Seek medical help immediately if you feel unwell.
• Follow a healthy diet specifically formulated by a trained dietician to maintain good habits.
• Exercise daily and choose a form of exercise or sport that has a low impact on the body and is less likely to cause injury. Walking or swimming are good options.
• Quit smoking or never start smoking as it is highly addictive, and if you are newly diagnosed diabetic you want to maintain a healthy body.
• Keep well hydrated and drink water and fluids that are sugar-free.
• Test the water temperature (with your elbow if you are a diabetic) before washing. Wash feet daily in warm water with a mild soap.
• Dry feet well especially in between the toes. Moisturise feet daily, except between the toes to ensure you do not get dry feet or cracked heels that can lead to fungi and foot infections.
• Cut toenails straight to avoid ingrown toenails.
• Protect your feet by making good shoe choices. Refer to a podiatrist or orthotist for advice on a prescribed shoe if needed.
• Wear proper-fitting shoes and socks that do not cause redness and pressure.
• Clean new wounds with mild soap and water, cover with a dressing, and seek prompt medical attention as a minor injury can become infected.
• Consider medical grade-honey. Melcura Honey is an effective product for diabetic foot ulcer wound healing.

Do not..

• Listen to lay people’s advice on how to care for your feet as they are not medically trained.
• Neglect to keep regular medical appointments.
• Neglect warning signs that indicate blood sugar levels are too high or too low as this can damage blood and nerve supply to the feet.
• Overeat, under-eat, starve, or continuously eat the wrong foods or drinks. This could lead to poor or no feeling in your feet.
• Exercise if you have a blister or open wound on your foot. Wait until it heals and get advice on when to commence exercise.
• Smoke. This impairs the circulation and damages the blood vessels that supply oxygen and nutrients to keep you healthy.
• Drink alcohol as most alcoholic beverages contain sugar which raises the blood sugar level and is harmful to a diabetic.
• Test water with feet or soak feet in a bucket of water as you may not be able to feel the temperature of the water and can burn your feet.
• Apply moisturiser between toes as moisture can lead to foot fungal infections.
• Treat ingrown toenails yourself as infection can lead to wound complications.
• Walk barefoot as you may injure your feet, and this can lead to an infection that is difficult to heal. Walk on your feet if you have a wound under your foot. Offload the area by using a crutch, wheelchair, or cast prescribed by a medically trained professional treating the wound. Pop blisters yourself on your feet. This is a break in the skin and may lead to further wound complications.
• Wear poorly fitted, tight shoes that can cause redness and pressure and lead to blister formation that becomes a wound that is difficult to treat.
• Leave the wound open as this dries out the wound, delays wound healing, and may lead to spreading infection that may result in an amputation.
• Purchase or make home remedies to treat corns, calluses, and warts. Intervention from a trained podiatrist or medical professional is required.

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.