Taking care of our skin is always important, but in diabetes skin care requires more consideration. The skin, our body’s largest organ, is a vital physical barrier between the outside world and everything inside us. Although it seems like a pretty simple thing, there are many blood vessels, nerves and various other structures within it. These all affect the integrity of our skin, and influences how well it does its job.
It’s in Your Blood
One primary cause of medical complications in diabetes is high blood glucose levels, especially if levels are consistently high over a prolonged period of time. High levels of circulating glucose can lead to damage to the body’s blood vessels. Since all organs in the body rely on blood perfusion from these vessels, any damage to them can lead to problems for the respective organs.
People with diabetes may thus be at risk of various complications if their blood glucose levels are not adequately controlled. These may include eye problems (such as retinopathy), kidney damage (nephropathy) and, of course, skin issues. The cells of our skin need good blood flow to maintain its integrity.
Other factors, like high blood pressure and high cholesterol, may also increase the risk of blood vessel damage. For people with diabetes, it’s important for blood pressure and cholesterol to also be monitored regularly. If you have concerns about these, you should talk to your doctor about appropriate monitoring and management.
Nerves Know the Problems
Nerves in the skin detect things like heat and pain to let us know when there are problems or danger present. Over time, high blood glucose can cause damage to the body’s nervous system, affecting the body’s ability to detect when something’s amiss.
For example, in many patients with diabetes, the nerves in the feet can become damaged over time. This means that you could get a wound on your foot, and not notice. Treatment is then unnecessarily delayed until you realise that the wound is there. Consequently, this may increase the risk of further complications such as ulceration and infection.
What Can Go Wrong?
Other possible diabetes skin complications include dry skin, itchy skin and rashes. These may be due to poor blood circulation, leaving the skin dehydrated or lacking in the nutrients that it needs.
If the barrier property of the skin is compromised, this could also lead to infections of the skin and underlying tissues. A common manifestation of this is diabetic foot ulcers. Since our blood also carries immune system cells (such as macrophages and neutrophils), wounds may also be more susceptible to infection if blood flow to the area is compromised.
Furthermore, once a wound is established, it may take longer to heal in someone with diabetes compared to someone without diabetes. This is because our blood also carries cells important to tissue repair and healing.
Drug-induced Diabetes Skin Reactions
Unfortunately, some drugs that are used to treat diabetes can also cause skin problems. Usually these side effects are not common, but it’s good to be aware of this possibility. For example, all sulfonylureas may potentially cause skin rashes. Symptoms may include redness and itchiness, and, if severe, the sulfonylurea will need to be stopped.
Insulin, which is injected just under the skin, may also cause issues. These may be minor, and go away with a bit of time, or these may build up over time. Mild redness and itching may be experienced around the site of injection, but this tends to resolve on its own. If you don’t rotate your injection site, and insulin is frequently injected into the same point, lipodystrophy may occur. Insulin has various effects on lipid/fat metabolism, and frequent injection of insulin into one spot can lead to a build up of fatty tissue in that area (lipodystrophy).
Taking Care of Your Skin
Generally, the most important treatment aims for people with diabetes will be controlling blood glucose, blood pressure and cholesterol. Managing these appropriately will help minimise the risk of complications associated with diabetes. Make sure you talk to your healthcare team about lifestyle and medical interventions that are suitable for you. And remember: prevention is better than cure!
Early detection is also helpful, so diabetes skin care should include some self-monitoring. Talk to a healthcare professional about what symptoms to look out for. They will likely advise you to pay special attention to the skin on your legs and feet, especially the soles of your feet.
Other Measures You Can Take
Dry and Itchy Skin
There’s a vast array of treatments for dry and itchy skin available in shops and pharmacies. Your choice of product will depend on the area you’re treating, the degree of dryness/itchiness you’re experiencing, and various other factors. Your pharmacist or other pharmacy staff should be able to help you choose a product suitable for your condition.
Some lotions, although initially soothing and cooling, may dry out the skin as they dry off, so you should usually avoid these. Alternatively, gels may provide a cooling effect without drying out your skin. Creams that absorb into the skin can be useful for everyday moisturising. These may be available with additional ingredients to help hydrate the skin (such as urea) or soothe itchiness (such as colloidal oatmeal).
Ointments and thick creams are best for holding moisture in the skin, but the greasy feeling can limit their use. Of course, it’s possible to use a combination of products. Perhaps you could use an ointment in the evenings, while you’re at home, and then a cream during the day.
Infections and Wounds
Generally, you can manage minor wounds with over the counter products available in pharmacies. Your pharmacist or other healthcare professional can advise you of the best way to clean and dress your wound. However, if infection appears likely, or if the wound covers a significant area of skin, referral to a doctor will be necessary. Never attempt to treat an infection on your own. It’s best to have it assessed by a healthcare professional in order to determine the best treatment pathway.
Diabetes skin infections – such as foot ulcers – will need antibiotic treatment. Superficial infections may be able to be treated with topical preparations (applied onto the skin), but oral antibiotics (in the form of tablets or capsules) may also need to be prescribed.
If in doubt, always consult a qualified healthcare professional to determine what sort of care you require. Generally, if a wound is exudating (secreting pus or liquid) and/or has an unusual odour or colour, it is best to seek immediate medical attention. Similarly, if the skin is hot to the touch (for no obvious reason), or if you have a fever or other concurrent illness, you’ll need to consult your doctor.
Eat Your Way to Good Skin Health
A diet that includes a wide range of fruit and vegetables is a great way to improve your skin health. Click on these links to have a read about common fruit myths, and tips on how to include more fruit in your diet. You can also check out the Recipes page to find delicious and easy ways to eat more fruit and vegetables.
Diabetes Skin Health: The Big Picture
In the end, remember that anything that helps manage your diabetes will have flow-on effects for your skin health. Check out these Pro Tips for managing diabetes, and you’ll be well on your way to improving your overall health!