HBOT, Hyperbaric Oxygen Therapy involves a person spending 90 minutes (typically called a session) in a pure Oxygen filled chamber at a pressure nearly twice or thrice that of atmospheric pressure. This results in additional supply of oxygen to every tissue and cell in the body even to those places where the haemoglobin was not able to carry enough oxygen due to any medical reason. Also, oxygen gets directly dissolved in the plasma bypassing the need for transportation of oxygen by the red blood cells. Before getting into how HBOT helps in healing diabetic foot wounds and ulcers, one question that should be asked is ‘Why foot wounds and ulcers in diabetic patients don’t heal like normal people’?
Foot wounds and Ulcers in diabetic people
Here are the main reasons why wounds and ulcers don’t heal in diabetic people:
- High blood glucose levels – People suffering from diabetes have higher amounts of glucose in their blood due to reduced insulin production of the body. Insulin helps body to absorb the glucose in blood to perform day-to-day functions. The high glucose levels damage the system internally. Blood vessels get narrowed, arteries stiffen up, nervous system throughout the body gets damaged, especially in the limbs. These increase the risk of injury and also delays healing of the injuries.
- Diabetic Neuropathy – Damage of nervous system in the body due to higher levels of glucose happens in diabetic people. The damaged nerves don’t regenerate like that happens in healthy people. As a result, the person becomes less sensitive to pain and he/she won’t even know when they are hurt. This makes it difficult to figure out a wound or injury that occurred. Healing also becomes difficult when the nerves don’t regenerate. That is why it is important that people with diabetes cover their hands and legs with proper gloves or shoes to prevent any injury. They have to make sure that they inspect their limbs everyday for possible blistering or injury or an ulcer etc.
- Problems with blood circulation – The sugar levels in the blood don’t allow proper circulation of blood across the body. This includes the injury area. Proper supply of oxygen by the red blood cells is very important for an injury to heal. Also, the infection in the area should be fought off by the white blood cells. Due to improper circulation of blood, none of this happens as a result of which the infection / injury area doesn’t heal as it should.
- Ineffective immune system – Higher sugar levels in the blood alters the enzymes and hormones production by the body. As a result immune system gets weaker and the person will have hard time healing any injuries or ulcers. The infection keeps increasing as there is no system to arrest its spread.
- Increased inflammation – Inflammation is an important stage in wound healing. In diabetic people, the inflammation stage lasts very long making the injury chronic. When a wound becomes chronic, the balance between collagen that gets generated and de-generated is lost due to which the healing of wound doesn’t happen.
Where does HBOT come into picture in healing wounds in diabetic people?
- HBOT fills the red blood cells with more than normal amount of oxygen. Atmosphere contains nearly 20 – 21% of oxygen at normal pressure. In a HBOT chamber, a person breaths 100% oxygen at a pressure more than double that of atmospheric pressure. That is, 5 times more oxygen at higher pressure results in more oxygen dissolving in the blood (and plasma) which is carried to the site of injury. As more oxygen gets carried to the injured area, healing begins to happen.
- HBOT helps in repairing damaged blood vessels and also helps in generation of new blood vessels (Angiogenesis). This helps in carrying more blood (filled with pure oxygen) throughout the body which in turn helps the body to heal from any injury or damage.
- HBOT therapy also helps in generation of collagen. Growth of collagen helps in wound healing.
- Increase in pressure while the person is in the chamber also helps reduce swelling at the site and that too helps in better blood circulation.
What does research say about HBOT in diabetic people?
For the past 20 years, there have been many controlled and uncontrolled studies done on people suffering from diabetes with foot ulcers and wounds. Initially there was less evidence but most of it was encouraging. Later down the decade, many controlled studies were performed and here are some numbers:
- In diabetic people who were undergoing normal treatment for wound healing, there was absolutely no sign of recovery even after one month. After they underwent HBOT for a month, 66% of the subjects saw their wounds healing.
- HBOT reduced the operative interventions. When the wounds don’t heal, typically doctors suggest skin grafting, skin flap or amputation. Only 16% of the cases had to undergo operative intervention after HBOT therapy compared to 100% of the cases that didn’t go through HBOT.
- In cases of extreme amputations, the percentage was drastically reduced to 8% from 82%.
HBOT sessions may be little expensive compared to other types of conventional treatments, especially considering the short term package that you may have to opt for few sessions every week for few months. But the benefits clearly outweigh the consequences that are to be faced otherwise. Losing little money is way better than losing a limb, isn’t it? That too, without any medication and by just breathing in pure oxygen.