Honey Wound Dressing Did Not Boost Blood Sugar Level

Use of Honey on a Neuropathic Ulcer
Journal of Community Nursing, February 2009, Volume 23, Issue 02

…Case Study: Mr B is a 49 year old morbidly obese man with unstable insulin controlled diabetes. The ball of his right unstable Charcot foot developed a neuropathic ulcer following the application of a plaster of Paris for stabilisation. Healing was not taking place and his blood sugars were uncontrolled. The diabetic consultant and vascular surgeons were recommending amputation as the patient was fighting recurrent infections and cellulitis. With an HBA1C of 10.5 per cent and weighing 190kg, Mr B was very immobile for his age as both his legs were very wet, oedematous and MRSA positive…

Wearing compression stockings meant daily easy access to the neuropathic ulcer, and it was at this stage that the nurse decided to start using a honey based antibacterial gel. Medihoney Antibacterial Wound Gel was chosen as it was available on the nurses’ formulary (Wicks 2007), and was one of the first honey products licenced for medical use in Europe (Simon et al 2007). The patient’s wife was taught how to apply the gel daily to the wound and cover it with an alginate and an adhesive foam dressing. The wound required daily dressings at this stage as it was quite a sizeable cavity and exudate was still heavy (honey works by osmosis and draws fluid from the wound, therefore, increasing wetness). Copious amounts of Sudocrem were therefore used to protect the peri-wound skin from deteriorating and the district nursing team was checking the wound twice weekly for progress.

Mr B was seen in the diabetic foot clinic in the early stages of the honey treatment. The podiatrist and diabetic consultant both advised the nurses to discontinue the use of the honey based treatment as it may lead to hyperglycaemia and abscesses. The district nurses at this stage involved the local tissue viability specialist nurses asking for their advice and they recommended treatment to continue as it was obviously working, and since the honey was applied topically it should therefore not affect the patient’s blood sugar levels. Cadogan (2006) argues that despite the reluctance to use honey on diabetics (due to its high sugar content), it is quite safe to do so with close observations of the patient’s blood glucose levels. White (2006) also recommends the use of honey on diabetic foot ulcers as long as it is used by experienced practitioners. The ulcer was by then 2.5cm deep (Figure 2).

Within three months of using honey on the wound, its depth was reduced to 1cm (Figure 3). Doppler assessments were performed six months after original admission to caseload and were again healthy. Mr B had to be re-measured again for smaller made to measure stockings, as the first pairs were too loose due to weight loss and reduction of oedema. His weight is currently steady at 135kg and his HBA1C is 7.1 per cent. The exudate to the wound is now non existent, the ulcer has a depth of 1mm and is continuing to heal (Figure 4). Dressings are still performed twice weekly using honey and an adhesive foam dressing, and Mr B continues to wear Class II compression stockings. He is now mobilising well and his health has much improved in a year. Orthotics have provided him with a new boot as his leg has reduced further in size and his foot shape has improved.

Conclusion: In view of the increasing prevalence of drug resistant bacteria, health professionals now need to look further afield for help in wound care. Honeys with evidence of antibacterial effectiveness are one of the wound dressings worth considering especially when drug resistant organisms are present (Blair, 2000). This new found fame, however, remains somewhat controversial in the field of diabetic wound care, probably because of the honey’s high sugar content. In the case of Mr B the use of honey on his wound has not proved detrimental to his HBA1C readings (Figure 5)…