Patient with venous stasis ulcer. Started Apidra with Lantus. Had some swelling in lower leg on Lantus. Started Apidra, now has edema with serous drainage from the wound.
Is he wearing the stockings? I find that a lot of people wont wear them at home especially as the weather gets warmer. I really like using Dynaflex dressings to treat stasis ulcers. These are a four stage wrapping that is left in place for a week. The patient cant take them on and off. If there is bacterial load in the wound you can use Silvadene or better yet, a dressing like aquacel silver alginate hydrofiber wound care lonic colloidal silver bandage as it absorbs the moisture pouring from the wound and kills bacteria. It can be used as curing highly exudated infected wound and wounds tending to be infected. It can be used for difficult healing chronic wounds.(such as diabetic foot wound,Venous leg ulcer and so on. It can be filled into deep wound to keep it from being infected. Great stuff! It is a bit pricey though. You can use the Aquacel Silver under the Dynaflex dressing though and the Dynaflex offers good compression when put on properly. He will continue to have problems, however, until he gets his blood sugar under control. The edema (swelling) has nothing to do with insulin. It is due to his uncontrolled diabetes which is sabotaging his circulation and the poor circulation is causing the edema. It is also more than likely killing his nerves and causing neuropathy which can cause pain, burning and tingling in the legs and feet. It also affects the kidneys. I dont know why people are so terrified of getting on insulin as insulin is much superior for controlling blood sugar. Your body naturally controls blood sugar with insulin but when the pancreas stops working due to advancing diabetes, injected insulin becomes the only way to manage. I think people can ignore that they have diabetes but adding insulin makes it "too real" or something! I dont get it. They dont understand why pills are no longer an option when the pancreas no longer functions. You can only give them the information and tell them what will happen if they dont manage their diabetes. From there it is their decision to either do what they need to or not.
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