I was inspired this week to address a relatively common issue that can have big consequences for diabetics. With this post I will try to avoid getting too scientific and keep everything basic but we have to begin with some background.

Abscesses start with a small break in the skin that allows bacteria to enter and start a local infection. Most often this is caused by a type of staphylococcus (staph.) bacteria. The primary bug found is staph. aureus. From here you can break it down to methicillin susceptible staph. aureus (MSSA) and methicillin resistant staph. aureus (MRSA). MRSA is fairly well know in the general public and requires strong antibiotics. The good news is that with early treatment, these infections can be taken care of pretty easily. The bad news is that staph. and it’s many forms exist on our skin as a part of normal life

Normal infections can be cured by antibiotic medications  but abscesses present a different challenge. At the center of an abscess is a collection of pus and bacteria and medication does not do a good job penetrating to the core. Ultimately, the best treatment for an abscess is drainage. For anyone who has had an abscess, you know the last thing you want is for someone to cut and squeeze at this painful area.

These pictures both show classic examples of abscess from the surface.

Who saw a spider?

Many patients seek advice from their medical providers after a suspected “spider bite”. 

#1 Did you see a spider?

#2 Did you witness a spider bite you?

If your answer is no to both of these, then you probably have an abscess. Cancel the Orkin appointment for tomorrow and just get some medical help….

Why is this potentially serious for a diabetic patient?

Most people do a good job keeping anything on their skin out of their bodies. Most diabetics break their own skin daily for blood glucose checks and insulin injections. Even worse, some of us wear implanted CGM’s and insulin infusion sets which provide direct communication between the outside environment and our tissue for days at a time. The skin is unable to protect us from infection when there is a compromise in its layering. On top of these possible entry points for bacteria, elevated blood glucose values can impede our natural immune response and gives bacteria extra help with its growth. Left untreated, abscesses can lead to sepsis.

The best way to prevent infection and abscess is to keep any skin compromise areas clean. For me, I always use Hibiclens prior to alcohol wipes before I inject insulin infusion sites and CGM sensors. By doing this and not keeping anything in my skin for too long I have cut skin issues down to almost zero. The other thing I have added is using Hibiclens in the shower. By using this weekly, I am able to help reduce bacteria found on my skin. Working on rotations within clinics and hospitals I am constantly surrounded by potentially dangerous bacteria. Again, sitting on top of intact skin I am safe but if any bacteria is allowed past my skin I am at risk for infection and abscess.

It’s a constant battle but one that can be easily managed if you know what to look out for. Here is a link to a site with some basic information about abscess. As with anything, if you think you may be developing an abscess, consult with your medical provider.

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