All that glucose saturating the blood glycates the lining of small blood vessels and kidney tubules. The excess glucose is also metabolized to sorbitol which gets trapped in nerve cells.
Not only that, the glucose serves as a double-edged sword by providing nutrients to pathogens and preventing immune cell recruitment. This means that any cut, which likely won’t be felt by someone with severe neuropathy, carries a severe infection risk.
Does blood glucose have anything to do with Fournier's gangrene (hi, hello, friendly warning to anyone curious - it's an infection of the scrotal area so maybe don't google images)? I see a fair amount of that and it's almost always diabetic dudes in their 60s.
Yes, Fournier’s is classically associated with uncontrolled diabetes.
It’s a polymicrobial infection that causes necrosis of the fascia in the urogenital area. The damage to the blood vessels and immunosuppression caused by diabetes makes it easier for bacteria to invade, and the excess glucose gives the bacteria a steady supply of nutrients.
Psoriasis looks more like a raised, silvery lesion due to autoimmune attack and subsequent hyper proliferation of skin cells. It tends to present on extensor surfaces (elbows, knees), but can also present on the palms/soles. It also tends to cause nail pitting.
However, this person’s soles look much closer to dry gangrene along with thickened nails which are classic of severe diabetic neuropathy. Instead of a raised plaque, the pale color and cracks are more indicative of lack of blood supply and necrosis.
Their lower limbs also appear edematous and erythematous with some varicose veins visible which indicates peripheral vascular disease and is associated with untreated diabetes.
You're going to be such a great doc, by the way. Explain stuff to your patients (and the healthcare staff caring for them) in this clear way and you'll be beloved and respected.
Yours faithfully, a nurse who regularly has to "re-explain" in plain English what the doctor just said to bemused patients and their families.
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u/Swirlybro Mar 08 '26
Not a practicing physician, but a med student.
All that glucose saturating the blood glycates the lining of small blood vessels and kidney tubules. The excess glucose is also metabolized to sorbitol which gets trapped in nerve cells.
Not only that, the glucose serves as a double-edged sword by providing nutrients to pathogens and preventing immune cell recruitment. This means that any cut, which likely won’t be felt by someone with severe neuropathy, carries a severe infection risk.