Updated on October 16, 2020.
Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
Circulatory issues are a problem for everyone in our increasingly sedentary society. Have you ever calculated how much time you spend sitting? If you work in an office, you clock about eight hours per day at a desk. Maybe ten. If you drive to work or take public transit and commute, you can add another 1-2 hours per day of sedentary positioning. After dinner, and tired from the day, most of us head to the couch to watch TV for an average of 2-3 hours before bed.
That adds up to as much as 13-15 hours per day of low to no physical activity. The average American sleeps about 6-7 hours per night. That means we are only potentially active on average, for about 2-3 hours per day. And our bodies aren’t biologically designed for that kind of lifestyle.
The loss of circulation to extremities is a severe health problem for individuals with Type I or Type 2 Diabetes. And more common with people diagnosed with Diabetes for a variety of reasons. First, the bloodstream’s high glucose levels (sugar) lead to a thickening of the blood. That deposits more plaque that narrows the pathways of major arteries and veins. It restricts the blood flow (particularly to extremities like the legs and feet).
The loss of efficient circulation also impacts organ function for patients with diabetes. With a lower blood supply, the kidneys and liver can become compromised. Major organ functioning is also impaired by glucose (sugar), impacting the pancreas and preventing cardiovascular issues like an increased risk of heart attack and stroke.
What Causes Leg and Foot Ulcers for Patients With Diabetes?
Whenever your body is fighting off a virus or bacterial infection, it relies on the bloodstream to carry white blood cells. Leukocytes are the scientific name for white blood cells, and they are the chief defenders or security guards of the human body. Whenever there is an infection, the brain triggers an immune system response that sends more leukocytes to the area of disease. That’s how the body fights off infection.
One of the problems that occur when blood circulation is compromised is an impact on immune system functioning. You’ve probably heard that people who have diabetes are more prone to infections. This stems in part from issues with healthy blood circulation.
When circulation is a problem due to restricted blood flow, the body can’t deliver as many leukocytes to infection areas. All it takes is one small cut to the leg or foot to become infected. In a person who is not immune-compromised, the infection can clear up with wound care and antibiotics. But oral antibiotics also rely on the bloodstream for delivery throughout the body, and they can be less effective for people with diabetes.
Peripheral neuropathy can cause muscle weakness and loss of reflexes. This changes how a person walks and leads to deformed feet and conditions like hammertoes and Charcot’s foot. Diabetic ulcers develop when there is uneven pressure or friction on feet or ankles. Numbness from circulation loss makes it hard to detect pain in the area as well.
Infections Are Hard to Resolve for Individuals Who Have Diabetes
When the body cannot heal a wound and delivering white blood cells to the infection site is compromised by circulatory issues, the wound does not get better. In fact, the tissues in the area of the wound site can become necrotic. Gangrene can set in. When a severe infection happens to a person with diabetes, ulcers like look like open wounds can appear. And they are extremely difficult to heal because the immune system is compromised.
When a severe infection cannot be resolved and gangrene has been diagnosed, the next step is removing the necrotic tissue. This can include amputation of toes, excising tissue in the infected area, or possible leg amputation. Amputations are performed only in the most challenging situations when an infection will not resolve. And when the patient is at risk of systemic spread of the disease throughout the body and bloodstream, which can lead to sepsis, heart attack, or stroke.
Intractable Ulcers Can Be Life-Threatening When They Do not Heal.
An intractable ulcer for a patient with diabetes refers to a wound that will not heal. Patients can receive oral and IV antibiotics in varying degrees of strength to try to address the infection. But as diabetics can be severely immune-compromised, it doesn’t always work.
Amputation is a last resort for patients with diabetes because it presents other health risks. Just as the patient cannot heal from the original foot or leg ulcers, major surgery can exacerbate symptoms. And contribute to a more severe infection. Often patients are required to be on home IV infusions of strong antibiotics for weeks after surgery.
Finding a better way to treat diabetic leg ulcers is a high priority in the medical community. Did you know that 34.2 million Americans are living with diabetes? And approximately 1 in 3 Americans have pre-diabetes (high risk to develop chronic disease). Just under 80,000 people worldwide die from complications from diabetes annually.
Is Topical CBD a New Approach to Healing Diabetic Foot and Leg Ulcers?
A new medical study from Toronto, Canada, has created hope and the potential to treat diabetic ulcers with CBD topical creams successfully. In Canada, both medical and adult-use cannabis is legalized at the federal level. This allows medical research into chronic diseases and cannabis therapeutics applications to progress unhindered, unlike the United States. Both fundings for cannabis research and access to cannabis for clinical studies is restricted.
The research conducted by the Canadian scientists was recently published in the International Wound Journal. The clinical trial involved two patients who had persistent leg ulcers. The clinical trial results are very encouraging and offer new hope for patients diagnosed with diabetic neuropathy and ulcers.
The clinical trial involved the application of a blend of cannabinoids, terpenes, and flavonoids. The patients were seniors with low immune system functioning and circulatory issues. The ulcers that inflicted both patients were treatment-resistant. Physicians had exhausted all other approaches to curing the ulcers for the patients who were facing systemic infections.
One patient saw a complete wound closure within 74 days of treatment with the proprietary blend of terpenes, cannabinoids, and flavonoids. The second patient saw complete wound healing after 77 days. Both patients reported relief of pain in the ulcerated wound areas and surrounding tissue.
What Does the New Research Mean for Patients with Diabetic Foot Ulcers?
In the not so distant future, hospitals, long-term care facilities, and home healthcare teams may be able to prescribe and administer the breakthrough treatment. One of the most beneficial aspects of a topical solution is that it presents no secondary infection risk to the patient.
Instead of unsuccessfully fighting diabetic ulcers to the extent that the tissue becomes necrotic (dead or gangrene), requiring removal, this presents a new treatment possibility. One that could save lives and prevent invasive surgical procedures like amputations in the future for patients with diabetic neuropathy and treatment-resistant ulcers.