Dr. G returns to the foundation of diabetic limb salvage, explaining essential ulcer terminology—erosion, partial/full-thickness ulcers, tunneling, undermining, exudate types, wound bed tissue, biofilm, and signs of infection—and how to measure and document them. Clear, accurate wound language improves diagnosis, care coordination, coding, and outcomes; this episode includes practical examples and a sample documentation template to help clinicians speak wound fluently.
Dr. Giulia Baldazzi, a vascular surgeon, fellow and phd candidate researcher, shares her journey from UCSF to Italy and explores advances in perfusion assessment, revascularization, and limb preservation for diabetic foot care. She discusses diagnostic innovations (PAT, MaxCORE, NIRS), the importance of early vascular referral and multidisciplinary teams, and practical strategies to prevent amputations and improve healing.
Dr. G explains porokeratosis — a ring-like skin disorder that can masquerade as a callus or wart and cause pain, ulceration, and even malignant change on diabetic feet. The episode covers what porokeratosis looks like, why people with diabetes are at higher risk of complications, and when to biopsy. Practical advice includes daily foot checks, avoid self‑debridement, early offloading and specialist referral, medical and procedural treatment options, and the importance of glycemic and vascular care to prevent recurrence and severe outcomes.
Dr. G (Woon Picasso) exposes the hidden crisis of diabetic foot disease in prisons: its prevalence, the resource and policy barriers that lead to missed checks and preventable amputations, and the moral and legal imperative to provide care. The episode outlines practical, low-cost prevention and treatment steps—intake screening, annual and monthly checks, proper footwear, telemedicine, wound kits, offloading, and urgent referral pathways—urging nonjudgmental, consistent care to save limbs and lives.
Dr. G explains how silver nitrate works as a quick, low-cost chemical cautery for treating hypergranulation ("proud flesh") in diabetic and other chronic wounds, outlining the mechanism, application steps, and the expected gray discoloration. He summarizes benefits—rapid control of excess granulation, antimicrobial action, and minor hemostasis—along with key cautions such as pain, staining, tissue damage, and contraindications (infected wounds, exposed bone), and offers practical tips for safe, sparing use.
Dr. Gabrielle Hutchison Donaldson dives into the 2025 Nobel Prize in Physiology or Medicine for discoveries about regulatory T cells (T‑regs), explaining why these immune brakes matter and how they control self‑tolerance. The episode links T‑reg biology to diabetes and diabetic foot ulcers, covering mechanisms, early T‑reg therapies, and how boosting regulatory pathways could reduce chronic inflammation and improve wound healing. Practical takeaways include maintaining tight glycemic control, following standard wound care, considering clinical trials, and watching for future localized or engineered T‑reg strategies that might speed healing and prevent amputations.
Dr. G explains erysipelas — the classic shiny, well-demarcated red leg — covering its causes (mainly streptococcal), distinguishing it from cellulitis and other mimics, initial investigations, and outpatient vs inpatient treatment strategies. Special considerations for people with diabetes (imaging, admission thresholds, and limb salvage), prevention of recurrence, and clear red flags for urgent surgical review are highlighted.
Dr. G explains the key differences between Kling (conforming) and Kerlex (bulky padding), when to use each, and how wrapping technique and tension can affect perfusion and healing in diabetic feet. Includes practical application steps, pressure checks to avoid ischemia, tips for moisture and allergy management, and clinical pearls for better wound outcomes and patient education.
This episode explains the piezoelectric effect—how mechanical stress creates tiny electrical signals—and how those signals guide cell migration, angiogenesis, collagen deposition, and epithelialization in wound healing. It describes how diabetes weakens natural bioelectrical cues through neuropathy, poor circulation, and collagen changes, and reviews clinical approaches that restore or mimic these signals: electrical stimulation, low‑intensity ultrasound, and emerging piezoelectric dressings and wearables. The episode also covers practical limitations (cost, compliance, lack of standard protocols) and highlights future directions like nanotech dressings, piezoelectric insoles, and AI‑guided devices that could make step‑powered healing a valuable adjunct in limb salvage.
Dr. G explains when to use IV versus oral antibiotics for diabetic foot infections, covering severity-based choices, common empirical regimens, and why wound cultures matter. The episode reviews pharmacokinetics, expected timelines for improvement (48–72 hours), typical durations for soft-tissue infection and osteomyelitis, and criteria to step down from IV to oral therapy. It also highlights monitoring, common side effects and drug interactions, red flags for treatment failure, and the importance of a multidisciplinary approach to optimize outcomes.
Dr. G explains drop foot — the inability to lift the front of the foot — and why people with diabetes are at special risk due to neuropathy, compression, and poor circulation. This episode covers how to recognize drop foot, key diagnostic steps (EMG, imaging, vascular testing), urgent red flags, and a step-by-step treatment plan including AFOs, FES, physical therapy, surgical options, wound care, and vascular referral for ulcers.
Dr. G interviews Emmy winning journalist Kym  Nicholas, CEO and co‑founder of the Global PAD Association, about peripheral arterial disease (PAD), its strong link to diabetes, common misdiagnoses, and why early vascular evaluation can prevent unnecessary amputations. They discuss patient stories, systemic gaps in care, lifestyle interventions like supervised walking programs, global best practices, and resources to get help at padhelp.org.
In this episode of Diabetic Foot Files, Dr. G explores how existing medications — from metformin and insulin to statins, fentanyl, sildenafil, doxycycline and nitric oxide donors — are being repurposed to help heal stubborn diabetic foot ulcers. We review the biology behind each drug, early clinical evidence, and why topical formulations may offer targeted benefits with minimal systemic exposure. Listeners will learn which agents show the strongest signals (topical insulin, topical metformin, topical statins), which remain promising but mixed (topical phenytoin), and how repurposed therapies fit as adjuncts to standard wound care rather than replacements. Practical takeaways include safety considerations, off-label use discussions, and the need for larger trials.
This episode explores new randomized evidence that semaglutide, a GLP-1 receptor agonist used for diabetes and weight loss, can improve walking distance and quality of life for people with type 2 diabetes and symptomatic peripheral arterial disease (PAD). The landmark STRID trial showed median gains of about 26 meters (mean ~40 m) in walking distance over a year, along with better pain scores and daily function. Large real-world studies also suggest fewer PAD-related hospitalizations and amputations. Benefits likely come from multiple effects: weight loss and improved glucose control, anti-inflammatory actions, better endothelial function and muscle metabolism, all combining to improve perfusion and exercise capacity. Semaglutide is an adjunct to standard PAD care (exercise, smoking cessation, statins, antiplatelets, revascularization when needed). Common side effects include GI symptoms; monitor eye health, pancreatitis risk, and avoid use in patients with MEN2 or medullary thyroid cancer history.
In this episode of Diabetic Food Files we explain how peripheral arterial disease (PAD) and chronic kidney disease (CKD) interact in people with diabetes to worsen circulation, slow wound healing, and raise the risk of infection and limb loss. We outline the key symptoms to watch for, recommended screening tests (ABI/toe–brachial index, urine albumin-to-creatinine ratio, eGFR), and why every person with diabetes should be evaluated for both conditions. Management strategies discussed include antiplatelet and lipid therapy, ACEi/ARBs, SGLT2/GLP-1 agents, supervised exercise, diligent foot care, revascularization when needed, and close coordination among nephrology, vascular, podiatry, and endocrinology. Early detection, aggressive risk control, and a multidisciplinary care team can greatly reduce the chance of amputation and preserve kidney function—know the signs and get screened.
This episode of Diabetic Foot Files explores peripheral arterial disease (PAD) in people with diabetes — its history, how diabetes accelerates arterial damage, the biology behind impaired wound healing, and clinical clues to distinguish ischemic from neuropathic ulcers. We cover bedside tests (ABI, TBI, TcPO2), modern revascularization options, medical and lifestyle management, and emerging therapies, emphasizing early recognition and multidisciplinary care to improve limb salvage and outcomes.
Dr. G explains how nicotine — from cigarettes, vapes, pouches, and nicotine replacement products — reduces blood flow, disrupts immune and cellular repair, and slows or worsens healing in diabetic foot wounds. He summarizes the science, lists nicotine-containing products, and gives practical, evidence-based guidance for clinicians and patients on screening, cessation options, and wound-care strategies to improve outcomes while working toward nicotine abstinence.
A focused look at fifth metatarsal ulcers in diabetic patients — why they form, how the peroneus brevis and lateral biomechanics drive injury, and the clinical strategies to heal and prevent recurrence.
This episode explains Monckeberg ("Mockingbird") sclerosis—a medial arterial calcification common in diabetes and chronic kidney disease—how it stiffens arteries without narrowing the lumen, and why it can make ABI results falsely reassuring. Learn how to spot the classic railroad-track calcifications on x-ray, which vascular tests to use instead (toe-brachial index, duplex ultrasound, TcPO2), and why multidisciplinary care and optimized medical management are essential. The episode covers practical steps for diagnosis, monitoring, and treatment planning to prevent delayed care and improve limb salvage outcomes in diabetic foot patients.
This episode explores how the current culture around diabetic foot ulcers drives unnecessary amputations and presents a practical, evidence-based roadmap to change it. Dr. G outlines the data supporting multidisciplinary care, step-by-step clinical checklists for rapid triage and management, system-level referral pathways, and patient engagement strategies to make major amputation rare.