1. Diabetic Glucose Control

Stable blood sugar levels are critical for wound healing. High glucose causes arteriole narrowing, restricting oxygen and antibiotic delivery to tissues. This leads to poor circulation, weakened immune response, and stalled healing. Proper glucose control prevents these complications and promotes faster recovery.

2. Wound Microcirculation & Vascular Health

Healthy blood flow is essential for healing. Many diabetic patients suffer from Peripheral Arterial Disease (PAD), restricting circulation. Dr. Reed uses advanced capillary refill testing and nitroglycerin patches to enhance microcirculation and reverse diabetic complications such as neuropathy.

3. Wound Tissue Growth Stimulation

Regular debridement (removal of dead tissue) and proper wound care stimulate new cell growth. Weekly treatments by Dr. Reed ensure:

✔ Removal of non-viable tissue

✔ Elimination of bacterial biofilm

✔ Stimulation of platelet-derived growth factors to support healing

4. Infection Control & Antibiotic Management

Targeted antibiotic therapy is key to fighting infection. Dr. Reed:

✔ Uses tissue and bone cultures (not surface swabs) for accurate diagnosis

✔ Prescribes customized antibiotic treatments to combat resistant bacterial strains

✔ Ensures proper white blood cell migration to fight infection effectively

5. Pressure Off-Loading & Wound Protection

Pressure relief is vital for wound healing. Continuous pressure restricts blood flow, oxygen delivery, and immune response. Dr. Reed provides customized solutions such as:

✔ Diabetic shoes, braces, and insoles

✔ Knee scooters or wheelchairs for non-weight bearing

✔ Surgical corrections for foot stability when necessary

6. Nutrition & Metabolic Supplementation

Diabetic patients often suffer from nutritional deficiencies, which hinder healing. Key concerns include:

✔ Low albumin levels (affecting circulation, enzyme function, and tissue repair)

✔ Vitamin B1 (Thiamin) & B12 (Cobalamin) deficiencies, leading to nerve damage and poor oxygenation

✔ Personalized dietary plans to stabilize glucose and optimize healing

✔ Intermittent Fasting to Improve Diabetic Control

A key benchmark for every patient is achieving 50% wound reduction within 30 days of starting treatment. If this milestone isn’t met, a comprehensive re-evaluation is performed to identify and address any underlying factors delaying healing.

Diabetes mellitus leads to widespread tissue damage primarily through protein glycation, a process where excess glucose disrupts cellular function and oxygen supply.

Key Mechanisms of Damage:

🔸 Osmotic Cellular Swelling – Increased intracellular glucose draws in water, causing arteriole constriction and reduced oxygen flow.

🔸 Capillary Damage – Excess glucose converts to sorbitol, weakening capillaries, reducing oxygen release, and causing albumin leakage.

🔸 Nerve Dysfunction – Glycation damages Schwann cells, leading to diabetic peripheral neuropathy.

🔸 Kidney Failure – Glomerular damage leads to proteinuria and elevated creatinine, eventually causing diabetic nephropathy.

🔸 Retinal & Cardiac Complications – Oxygen deprivation contributes to diabetic retinopathy, heart disease, and stroke.

Why the Feet Are at High Risk?

The plantar skin of the feet requires significant oxygen supply, making it highly vulnerable to diabetic foot ulcers due to diabetic angiopathy (vascular damage).

Understanding these mechanisms is critical for prevention and treatment of diabetes-related complications. Early intervention can help preserve vascular health, nerve function, and organ integrity.

1. Restricted Microvascular Flow:

• Glycation of Arterioles: Hyperglycemia causes glycation of arterioles, leading to constriction.
• Limited Blood Flow: This restricts blood flow to the wound, preventing the release of platelet-derived growth factors crucial for the initial stages of wound healing.
• Stagnant Wound: Consequently, the wound becomes stagnant, increasing the risk of infection.

   2.  Leukocyte Dysmotility:

• Enlarged Leukocytes: Excessive glucose causes leukocytes (white blood cells) to enlarge, impairing their ability to migrate out of the arteriole walls.
• Impaired Bacterial Killing: These dysmotic leukocytes fail to reach the site of tissue damage or infection, hindering their ability to kill bacteria and clean up necrotic tissue.
• Increased Infection Risk: This contributes to the wound becoming infected and possibly progressing to limb-threatening infections like osteomyelitis.

Supporting Studies:

• Spampinato SF, et al. (2020): Discusses the treatment of impaired wound healing in diabetes, emphasizing the role of old drugs. (Pharmaceuticals (Basel). 2020 Apr 1; 13(4):60)
• Pezhman L, Tahrani A, Chimen M. (2021): Explores dysregulation of leukocyte trafficking in Type 2 diabetes and potential therapeutic avenues. (Front Cell Dev Biol. 2021 Feb 22; 9:714-528-3668)

DIABETIC NEUROPATHY (DNP) CHALLENGES AND NITROGLYCERIN

Neuropathy pain and numbness remain major complications of diabetes, often resistant to traditional treatments like Lyrica or Gabapentin, which only mask pain and can cause sleep disturbances.

For over 33 years, Dr. Mark Reed has used nitroglycerin patches to increase microcirculation in the lower extremities, reversing oxygen ischemia—similar to its effect in treating angina. Applied for 12 hours daily, these patches have been highly effective in reducing or eliminating radiating burning pain in the feet.

Additionally, for wound healing, Dr. Reed places an extra patch near the ulcer to increase oxygenation, improve white blood cell migration, and accelerate tissue repair. Research supports the significant pain reduction achieved with transdermal nitroglycerin. (Taheri A, Farbood et al., J Diabetes Metab Disord, 2015).

In 50% of diabetic patients, large vessel disease (atherosclerosis) occurs alongside microvascular damage caused by hyperglycemia. This condition results from atherosclerotic plaque—a buildup of fibrous material, lipids, and cholesterol—often affecting arteries in the thigh and below the knee, increasing the risk of limb loss.

Atherosclerosis worsens oxygen deprivation in the feet by restricting blood flow to the microcirculation (arterioles and capillaries), compounding the effects of diabetes-induced ischemia. Every diabetic patient with weak pulses or neuropathy should be screened for peripheral vascular disease (PVD). If arterial Doppler studies and ankle-brachial index (ABI) tests indicate reduced circulation, revascularization may be required.

A simple analogy: Large arteries are like the main water pipe supplying a house, while arterioles are the smaller pipes leading to faucets. Diabetes constricts these smaller vessels, preventing oxygen delivery. Nitroglycerin patches help by dilating arterioles, restoring oxygen flow to tissues, reducing complications, and improving healing.

UNDERSTANDING GLYCATED HEMOGLOBIN (HBA1C) MONITORING

Glycated hemoglobin (HbA1c) is a key marker for assessing osmotic microcirculation ischemic cell damage from high blood sugar (glycation). Since red blood cells have a 120-day lifespan, HbA1c provides a reliable measure of medium-term blood sugar control in diabetes.

The goal for diabetic patients is to maintain HbA1c below 6, achieving diabetic remission—a state where microcirculation damage is minimized. This helps prevent serious complications, including:

✅ Diabetic foot ulcers

✅ Neuropathy (nerve damage)

✅ Retinopathy (vision loss)

✅ Nephropathy (kidney disease)

✅ Cardiopathy (heart disease)

Monitoring and controlling HbA1c levels is essential for long-term health and complication prevention in diabetes.

The types of ulcers treated include the following:

• Diabetic wounds
• Pressure Ulcers
• Venous status ulcers
• Skin lacerations
• Traumatic injuries
• Ischemic Ulcers with or without gangrene
• Post-surgical incision wounds
• Infected wounds
• Post-cancer radiation wounds
• Lymph edema ulcerations
• Burn wounds

Gangrene occurs when there is a loss of blood supply to an area of skin, often due to poor circulation or bacterial infection. It is most common in diabetic patients with circulatory issues in the feet and toes. A sudden onset of foot pain, cold skin, and color changes may indicate a critical blockage of blood flow, requiring immediate medical attention.

Diabetic neuropathy further increases the risk by reducing pain sensation, meaning injuries like ingrown toenails or minor cuts can go unnoticed, leading to infection, gangrene, and potential amputation.

Types of Gangrene & Treatment

1. Dry Gangrene (Non-Infected)

• Assessment: A Wound Care Specialist evaluates the condition with X-ray or MRI to rule out gas gangrene.

• Treatment: Often managed with povidone-iodine desiccants to keep tissue infection-free until it naturally sloughs off.

2. Wet Gangrene (Infected) & Gas Gangrene

• Signs: Severe redness, swelling, pus, fever, weakness, and a rapidly spreading infection. Gas gangrene can develop, caused by flesh-eating bacteria like Hemolytic Streptococcus, which has a 94% mortality rate if untreated.

• Treatment: Requires immediate surgery to remove infected tissue, IV antibiotics, hyperbaric oxygen therapy, and, in severe cases, bypass surgery to restore circulation.

Urgency of Treatment

Wet or gas gangrene is a life-threatening emergency. Without immediate medical intervention, it can lead to amputation or death. Early detection, proper wound care, and circulation assessments are crucial to prevent severe complications.

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