Mr. Gupta is a 56-year-old diabetic obese patient with a history of uncontrolled blood sugar levels. His HbA1c levels were consistently high at 9.5% for previous three tests, indicating poor long-term blood sugar control. For diabetic patients HbA1c should be under 7%. He was taking combination of oral hypoglycemic drugs metformin (1000mg) and glimepiride (2mg) to manage his diabetes. His compliance was very poor for the diabetic diet and hypoglycemic medicines due to his careless attitude towards the disease.

One day, Mr. Gupta noticed a small wound on his right foot that was not healing, and his foot felt numb. In the hope of self healing he ignored the wound for one month. At the end of one month he found the ulcer very painful, nonhealing and increasing in the size gradually with oozing pus. Then he consulted a diabetologist in his area.

The foot examination revealed that Mr. Gupta had developed a diabetic foot ulcer with moderate infection. His doctor explained that diabetic foot ulcer is a complication of diabetes and are caused by nerve damage and poor blood flow to the feet. The doctor advised Mr. Gupta to keep his blood sugar levels under tight control to prevent future complications.

Mr. Gupta’s doctor checked his blood sugar levels, which were found to be elevated at 240 mg/dL. The doctor prescribed him 12 units of insulin (Injection Lantus) once in night to help better control his blood sugar levels. Mr. Gupta was also advised to continue taking his oral medications.

The doctor sent the pus sample for culture and gram staining and prescribed antibiotics dicloxacillin and clindamycin as an empirical treatment for diabetic foot and advised Mr. Gupta to keep the affected foot clean and dry. Mr. Gupta was also advised to avoid walking on the affected foot and wear special shoes that would reduce pressure on the wound.

Mr. Gupta visited his doctor after three days with culture and gram staining reports.  The doctor cleaned and debrided the wound, removing any dead tissue and debris. He then applied a special dressing to the wound, which was changed regularly. His antibiotics were kept same seeing those sensitive in the reports. Mr. Gupta was diligent in taking care of his wound and following his doctor’s instructions carefully in the apprehension of further diabetic foot ulcer complication and amputation of limb.

Despite the initial slow healing, Mr. Gupta’s wound eventually started to heal. His blood sugar levels were also under better control, with HbA1c levels decreasing to 7.5%. His doctor advised him to continue his medications, including insulin injections and oral medications, and monitor his blood sugar levels regularly with strict diet control.

Diabetic foot ulcers can take a long time to heal and require diligent nursing care and atte