Look Ma..No Insulin Q & A
Fall 2004 Series - Diabetes: diagnosis, management and emerging treatments

Q: What is new from the field of dermatology regarding diabetic foot

ulcers Treatment?

Response from Dr. Jan Dutz
Diabetic foot ul cer s develop in 15 % of patients with diabetes and are a major source of disability. We have learned that the approach to healing these ul cer s must be MULTIDISCIPLINARY with involvement of podiatrists (foot specialists), surgeons, and infectious disease specialists. In general, the ulcer s are treated by "preparing" the ul cer bed for healing with the use of moist dressings and the removal of dead tissue. (Skin cells cannot grow on rocks or in the desert). Removal of pressure by casting or change of foot-wear is important. If there is infection, it should be treated. New approaches include the use of growth factors (becaplermin - platelet derived growth factor), tissue-engineered skin (apligraf) and suction devices (vacuum assisted closure) to promote healing. Although each of these shows promise, they are costly and studies of their efficacy and cost-effectiveness are ongoing. For a good review on this topic see:
 
Boulton AJ, Kirsner RS, Vileikyte L. Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med. 2004 Jul 1;351(1):48-55. Review

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Q: I was very interested in what Dr. Innis had to say about cannabinoid receptors and n-6 polyunsaturated fats. Are there any references for further reading? Do all the polyunsaturated fats stimulate appetite and are there any studies (animal or human) that have shown weight gain vs. controls?

Response from Dr. Sheila Innis
First, remember that arachidonyl is an n-6 polyunsaturated fatty acid because the ligands for the cannibanoid receptor is arachidonyl ethanolomine.  This is important to know when you read the literature, because they don't always say that it is an n-6 polyunsaturated fatty acid. One good overview is:
 
Cooper SJ. 2004
Endocannabinoids and food consumption: comparisons with benzodiazepine and opioid palatability-dependent appetite. In the European Journal of Pharmacology. 2004 Oct 1:500(1-3):37-49
 
You can look for more papers in PubMed by entering “anandamide and appetite” into the search field. Visit the PubMed website.