Diabetics With Sepsis A Cause of Worry

Mr. Muthu has been living with diabetes for the past 20 years. He is supposed to take his insulin injection twice times a day but on and off he misses it.

He suffered a small puncture wound on his sole after accidentally stepping on a sharp stone barefooted in the backyard. His family doctor treated him with a course of antibiotics and did the wound dressing.

After three weeks, Muthu’s general condition deteriorated, and the wound became the size of a tennis ball with pus discharge. The orthopedic doctor scheduled him for an operation to remove the unhealthy tissues on his foot. Why did Muthu’s wound not heal and what caused it to fester?

Diabetes results in the blood sugar level in our body to be abnormally high and is damaging to our blood vessels. Over time, the damaged blood vessels supplying the organs of our body becomes blocked and can lead to stroke, heart attack, kidney failure, blindness and poor healing wounds.

Another consequence of diabetes that is less addressed is its potential to increase the risk of infection and, later, sepsis. Diabetic patients are proven to be more prone to infections especially in the lungs, skin and urinary tract.

Sepsis, as was previously highlighted in this column, is a life-threatening body response because of infection which is not being adequately addressed by our body’s defence system. Sepsis is the leading cause of death around the world.

So, let us explore how diabetes increases the risk of sepsis. Every day we are exposed to a potpourri of harmful bacteria or viruses called pathogens. Biomolecules called cytokines and white blood cells act as our bodies’ natural defense against infections.

Wound monitoring is important

Studies have shown that diabetes will dull the production and response of these cytokines and white blood cells. On top of that, a diabetic patient with poorly controlled blood sugar provides an excellent environment for bacteria to grow. The result is harmful, the pathogens can easily gain entry into a diabetic person, rapidly multiply and overwhelm his body leading to sepsis.

Diabetic patients also recover slower from infection as the body’s repair framework is less robust. Clearance of harmful toxins and pathogens along with the delivery of essential nutrients for repair and recovery after an infection are impaired due to the damaged blood vessels.

The delayed wound repair causes the body to be constantly exposed to harmful elements and results in recurrent infection. This will drive the body’s defence to a state of exhaustion. Once the body’s defence is crippled, sepsis develops.

So, what can a diabetic patient do to decrease his risk of sepsis? Good blood sugar control will delay or halt diabetes-related organ damage and render him less prone to infection.

Close and frequent wound monitoring by a health professional is important as a wound, even a simple scratch, should not be taken lightly as it can rapidly fester. A diabetic patient with an infection tends to be admitted as he may need a stronger selection of antibiotics to assist the
body’s defence in killing harmful pathogens.

Malaysians’ love and pride for our food are undisputable. This has allowed us to clinch the top spot for a nation with the highest rate of being overweight and also of diabetic patients in Asia.

If no proper prevention program is implemented, we will be seeing more diabetic patients presenting with sepsis and that is certainly a cause of worry. — The Health

Assoc Prof Dr Tan Toh Leong is Consultant Emergency Physician, Faculty of Medicine, Universiti Kebangsaan Malaysia and Founder and President of Malaysian Sepsis Alliance (MySepsis) while Dr Liew Yew Kong is Emergency Physician, Hospital Shah Alam and Committee member of MySepsis