Nutrition, Diabetes, and Wound Care

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Wound healing in patients with diabetes is challenging and problematic due to circulation and nerve damage that goes hand in hand with the disease. Diabetes educators routinely educate their patients about day-to-day foot care. However, what measures are dietitians making in the prevention and treatment of wounds for individuals with diabetes?

Optimum diabetes management is correlated with minimizing complications including retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and peripheral arterial disease. 60% to 70% of individuals diagnosed with diabetes have some form of nervous system damage, often compromising sensation in the extremities which is why routine foot care is so important. Diabetic foot wounds are one of the most common wounds seen.

Diabetes influences wound healing by impacting all the stages of healing. There is no specified blood glucose level or hemoglobin A1c level that encourages wound healing. However according to the 2009 Standards of Medical Care in Diabetes, decreasing A1c to less than or around 7% can reduce vascular and neuropathic complications.

The four domains dietitians can use in medical nutrition therapy for patients with diabetes include caloric, protein, fluid, and micronutrient intake through a balanced diet. Calorie needs are 30 to 35 kcals per kilogram to meet the energy demanding needs for optimal wound healing. Increased protein requirements of 1.25 to 1.5 grams per kilogram is needed to manage a positive nitrogen balance. Wounds, especially draining wounds, can increase risk of dehydration; Fluid needs are 30 ml per kilogram. Supplemental nutrition can be utilized to meet elevated nutrition needs.

Patients with wounds may benefit from multivitamin use and added zinc and vitamin C, however, there are no established guidelines. Linda Ro, a dietitian in home healthcare, frequently treats patients with diabetes who have foot ulcers. She recommends increasing protein from food sources first (meats, cheese, milk, and peanut butter). She also recommends a multivitamin and additional zinc and vitamin C, with physician approval, or supplement use. Overall, nutrition professionals who are treating patients with diabetic wounds should focus on maintaining good blood glucose control, consume a healthy diet with adequate calories, protein, fluid, and vitamins and minerals. Dietitians should frequently reassess the patient and make changes to the nutrition care plan as needed to optimize healing. Hopefully in the future there is evidence based research to standardize zinc and vitamin c supplementation and maintaining A1c levels at or below 7% for wound care in patients with diabetes.

Grieger, L. (2009, August). Nutrition and wound care. Today’s Dietitian, (11)8, 12.

-SK

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