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Diabetes Care

Diabetes preventive care and management of complications with hyperbaric oxygen therapy

Complications arising from diabetes are due to prolonged exposure of the capillaries (small terminal blood vessels) to high levels of sugar. This causes changes in the cellular level, creating deposits on the walls of the capillaries making them rigid and narrower. When these capillary networks, also known as microcirculation are damaged, they are no longer able to provide oxygen and nutrients to the nearby tissue, or to remove metabolic waste products.  Failed microcirculation further causes peripheral nerve damage, better known as neuropathy. This is the underlying mechanism explaining why diabetic wounds take longer to heal, how kidney and retinal damage occurs, and why the risk of stroke and heart disease is increased in diabetics.

In addition to controlling blood glucose levels and maintaining regular physical activity, preserving healthy microcirculation on which all body organs depend is the most important thing in diabetic management.

Hyperbaric oxygen therapy (HBOT) in diabetes preventive care promotes growth of blood vessels and nerve endings.  Hyperbaric oxygen therapy acts as a blood thinner and improves red blood cell compliance, enabling the blood to enter finer capillaries where the most effective transfer of oxygen takes place.  This therapy can both reduce the risk of blood clotting and thrombosis associated with diabetes and stroke as well as heighten metabolism and tissue perfusion to meet an increased demand for oxygen during activity or injury/illness.

Diabetes complications result from failed blood micro-circulation and neuropathy both of which can effectively be treated with hyperbaric oxygen therapy.

Complications of Diabetes:

In the nervous system: High levels of blood sugar can damage the nerve fibers throughout the body, most often in the nerves of the legs and feet. This is called diabetic neuropathy. Pain and numbness of the extremities are the initial symptoms. Hyperbaric oxygen therapy reduces leg pain and numbness by promoting nerve regeneration.

Wound healing: Breakdown of micro-circulation (diabetic vasculopathy) in diabetes, and consequent damage of oxygen deprived nerve endings called diabetic neuropathy can lead to occurrence of wounds and will cause their slow healing. Statistically, half of the primary lower limb amputations are related to diabetes, however, 75 to 90% can be prevented with timely initiation of hyperbaric oxygen therapy.  Furthermore, recent long-term follow-up studies showed a 23% improved 6-year survival rate in patients with chronic diabetic foot ulcers after hyperbaric oxygen therapy.

In the eye: Diabetic retinopathy affects the light-sensitive tissue at the back of the eye called the retina causing vision problems. 12% of blindness is due to diabetes alone. Timely initiation of hyperbaric oxygen therapy improves visual acuity and prevents the occurrence of blindness, glaucoma and cataracts.

In the kidneys and bladder: Some diabetics may develop kidney disease which later may lead to kidney failure. Diabetic nephropathy has become the most common single cause of end-stage renal disease. Diabetes destroys the small blood vessels responsible for filtering the waste products of the body. These impaired capillaries can be restored with hyperbaric oxygen therapy resulting in improved kidney function.

Stroke and Heart Attack: Diabetics are at high risk for stroke and myocardial infarction. Hyperbaric oxygen therapy serves as a blood thinner, creating a more effective and efficient circulation and prevents clotting and thrombosis. Re-oxygenation of the heart and brain, and extra oxygen dissolved in blood plasma can reach the areas where circulation is lost or damaged to initiate the repair.

Dental and Gum Problems: High blood sugar promotes plaque build up and bacterial growth resulting in worsening of gum and tooth problems. Hyperbaric oxygen therapy can prevent periodontitis by suppressing inflammation and reducing infection with its bacteriostatic and bactericidal properties.

Stem cell boost: Improved functions of the different organ systems in a diabetic undergoing hyperbaric oxygen therapy is the result of increased release of stem cells. A breakthrough study by Dr. Stephen Thom (2005) showed that hyperbaric oxygen facilitates the release of stem cells from bone marrow. Stem cells are essential for repair and rejuvenation of the body. Other benefits of hyperbaric oxygen therapy include improved heart pumping function, bone density, and immune system response. 

For people with diabetes oxygen therapy is the best health care option. It can be a limb and lifesaving solution.  

“40 sessions of hyperbaric oxygen therapy decreases mortality rate of patients with diabetic foot ulcers by 20%.” 

– Londahl, 2015

FACTS and STATISTICS:

There is a multitude of complications related to diabetes. Most common are diabetic foot ulcers, non-healing wounds, kidney and bladder damage, neuropathy, vision disturbances, pain and swelling of the extremities and cardiovascular disease.

According to the Canadian Diabetes Association, diabetes complications are associated with premature death. It is estimated that one of ten deaths in Canadian adults was attributable to diabetes in 2008/09. There is an estimated 48% increase in the prevalence of diabetes from 2015-2025.

“A 70-90% success rate in patients who had been refractory to other modes of therapy, with success defined as avoidance of amputation and, in many cases, complete wound healing.” 

- Stone, 1997 

COST and BENEFIT ANALYSIS:

Fifty-seven percent of Canadians with diabetes reported they cannot adhere to prescribed treatment due to the high cost of needed medications, devices and supplies. The average cost for these supports is 3% of income or $1,500. People with diabetes are over 20 times more likely to be hospitalized for a non-traumatic lower limb amputation compared to the general population (Canadian Diabetes Association, 2011).


It has been shown that with hyperbaric oxygen therapy, a staggering 70 to 90 percent of primary amputations associated with diabetes can be prevented. Hyperbaric oxygen therapy can help prevent diabetic complications and therefore lessen hospital admissions and reduce amputation rate. Hyperbaric oxygen therapy is a cost-effective therapy compared to the traditional management of diabetes and its complications.

Benefits of hyperbaric oxygen (HBO) in diabetic complications
  • Revitalizes by improving blood flow and oxygen delivery to all organs
  • Regenerates small blood vessels (capillaries), nerves and bones
  • Rejuvenates by releasing stem cells from bone marrow for tissue repair
  • Reduces pain, swelling, tingling, cramps, numbness
  • Shortens recovery time after injury, surgery or in chronic illness
  • Reduces and prevents infection
  • Suppresses inflammation

In the nervous system:
  • Hyperbaric oxygen reduces neuropathy (numbness in hands, arms, legs and feet) by promoting peripheral nerve regeneration and microcirculation
  • Hyperbaric oxygen is an effective treatment for Bell’s Palsy
  • Hyperbaric oxygen is helpful for heart, digestive and other autonomic nervous system functions

In problems with the legs and feet:
  • Hyperbaric oxygen relieves pain in legs by improving circulation
  • Hyperbaric oxygen reduces swelling
  • Hyperbaric oxygen improves sensitivity and decreases paresthesias (pins and needles sensation)
  • Hyperbaric oxygen increases muscle strength, reduces weakness and fatigability (getting tired)

When wounds/ulcers occur:
  • Hyperbaric oxygen facilitates ulcer healing by promoting blood circulation
  • Hyperbaric oxygen reduces/prevents infection
  • Hyperbaric oxygen speeds up bone growth
  • Hyperbaric oxygen enhances peripheral nerve regeneration
  • Hyperbaric oxygen prevents thrombosis by increasing blood flow and decreasing its viscosity

In eye problems:
  • Hyperbaric oxygen improves retinal blood flow for better visual sharpness
  • Hyperbaric oxygen reduces the incidence of blindness caused by lack of oxygen
  • Hyperbaric oxygen suppresses infections

In kidney and bladder problems:
  • Hyperbaric oxygen improves bladder control reducing urinary urgency and frequency
  • Hyperbaric oxygen improves kidney function
  • Hyperbaric oxygen reduces/prevent infection of the kidney and bladder
Further reading:
  1. Canadian Diabetes Association. 2011. The burden of out-of-the-pocket costs for Canadians with diabetes. Toronto, Ont. Canadian Diabetes Association. [PDF]
  2. Londahl M. 2015. Improved 6-year survival in patients with chronic diabetic ulcers after hyperbaric oxygen therapy: outcome from a randomized double-blind study. Lund University, Sweden. European Association for the Study of Diabetes 2015 Meeting. 
  3. Cronje, FJ; Smart,H; Hyperbaric oxygen therapy in South Africa; Wound Healing, SA; 2008 [PDF]
  4. Thakham J;McElwain D; Long R;The use of hyperbaric oxygen therapy to treat chronic wounds: A Review; Wound Rep Reg, Wound Healing Society, 2008 [PDF]
  5. Rollins, MD; Gibson,JJ; Hopf, HW; Wound Oxygen Levels during hyperbaric oxygen treatment in healing wounds; Undersea and Hyperbaric Medical Society; 2006 [PDF]
  6. “Canadian Diabetes Association Technical Review: The Diabetic Foot and Hyperbaric Oxygen Therapy”, Canadian Journal of Diabetes, 2006, 30(4):411-421
  7. “Adjunctive Hyperbaric Oxygen Therapy for Diabetic Foot Ulcer: An Economic Analysis”, Canadian Agency for Drugs and Technologies in health, March 2007 [PDF]
  8. Tandara,Andrea; Mustoe, Thomas; Oxygen in Wound Healing- More than a Nutrient; World J. Surg.28, 294-300, 2004 [PDF]
  9. Bakker DJ: Hyperbaric oxygen therapy and the diabetic foot. Diabetes Metab Res Rev; 16 Suppl 1: S55-8. Review, Sep-Oct; 2000
  10. Cianci P, Consensus Development Conference on diabetic foot wound care: a randomized controlled trial does exist supporting use of adjunctive hyperbaric oxygen therapy. Diabetes Care, 2000 June. [PDF]
  11. Milington JT, Norris TW. Effective treatment strategies for diabetic foot wounds. J Fam Pract 2000 Nov;49(11 Suppl):S40-8.
  12. Wunderlich,R; Peters,E; Lavery,L. Systemic Hyperbaric Oxygen Therapy Lower extremity wound healing and the diabetic foot; Diabetic Care; 2000 [PDF]
  13. Farrell H.: Hyperbaric oxygen in the management of foot lesions in diabetic patients. Fourth Consensus Conference of the European Committee on Hyperbaric Medicine. London, December 4-5, 1998. Diabetes Nutr Metab; 12 (1): 47-8. Review, Feb 1999 [PDF]
  14. Cianci P, Hunt TK: Long-term results of aggressive management of diabetic foot ulcers suggest significant cost effectiveness. Wound Repair and Regeneration; 5 (2): 141-146,1997.
  15. Stone,J. 1997. The Adjunctive Role of Hyperbaric Oxygen Therapy in the Treatment of Lower Extremity Wound in Patients with Diabetes. Diabetes Spectrum. Vol.10 No.2, 1997, p 118-123. Retrieved from: http://journal.diabetes.org/diabetesspectrum/97v10n2/pg118.htm
  16. Brakora MJ, Sheffield PJ: Hyperbaric oxygen therapy for diabetic wounds. Clin Podiatr Med Surg; 12 (1): 105-17. Review, Jan 1995 [PDF]
  17. Boykin JV: Wound healing management: enhancing patient outcomes and reducing costs. J Healthc Resour Manag; 15: 4:22, 24-6, May 1997
  18. Hehenberger K, Brismar K, Lind F, et al.: Dose Dependent Hyperbaric Oxygen Stimulation of Human Fibroblast Proliferation. Wound Repair and Regeneration; 5:147-150,1997
  19. Hirn M, Niinikoski J, Lehtonen OP: Effect of hyperbaric oxygen and surgery on experimental multimicrobial gas gangrene. Eur Surg Res;25:265-269,1993
  20. Hirn M: Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis. European Journal of Surgery; Supplement (570):1-36, 1993
  21. Cianci P: Adjunctive Hyperbaric oxygen therapy in the treatment of the diabetic foot. J Am Podiatr Med Assoc; 84(9): 448-55. Review, Sep 1994
  22. Faglia E, Favales F, Aldeghi A, Calia P, Quarantiello A, Oriani G, Michael M, Campagnoli P, Morabito A: Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. Diabetes Care; 19(12): 1338-1343,1996.
  23. Hammarlund C, Sundberg T: Hyperbaric oxygen reduced size of chronic leg ulcers: a randomized double blind. Plastic Reconstructive Surgery; 93:829-834,1994.
  24. Hart GB, Lamb RC, Strauss MB: Gas gangrene I. A collective review. II. A 15-year experience hyperbaric oxygen. J Trauma; 23:991-1000, 1983
  25. Hart GB, Strauss MB: Gas gangrene–clostridial myonecrosis: a review. Journal of Hyperbaric Medicine;5(2):125-144,1990 [PDF]
  26. Jain KK: Hyperbaric Oxygen Therapy in Infections. Textbook of hyperbaric medicine: Ch 13, Hogrefe & Huber Publishers, Inc., 3rd Ed.13: 189 –211, 1999.
  27. Jain KK: Hyperbaric Oxygen Therapy in Wound Healing. Textbook of hyperbaric medicine: Ch 14, Plastic Surgery, and Dermatology, Hogrefe & Huber Publishers, Inc., 3rd Ed.14: 213–241, 1999
  28. Jain KK, “Hyperbaric Oxygen as an Adjuvant in Rehabilitation and Sport Medicine” Hyperbaric Medicine 1999; 31: 440-445
  29. Jain KK, “Hyperbaric Oxygenation in Traumatology and Orthopedics” Hyperbaric Medicine 1999; 26: 390 –403
  30. Jones H.P. The role of oxygen and its derivatives in bacterial killing and inflammation. In Gottlieb S.F., Longmuir I.S., and Totter J.R. (eds): Oxygen: An In-Depth Study of its Pathophysiology. Bethesda, Maryland: Undersea Medical Society, pp. 493-516, 1984
  31. Kindwall EP: Effects of Hyperbaric Oxygen Therapy in Infections Disease: Basic Mechanisms, Hyperbaric Medicine Practice: Ch 10, Best Publishing Company, 2nd Ed.10: 205-244,1999
  32. Kindwall EP: Wound Management: Best Chronic Wound Care Practices for The Hyperbaric Practitioners, Hyperbaric Medicine Practice: Ch 17, Best Publishing Company, 2nd Ed: Ch 17:395-429,1999
  33. Kindwall EP: Enhancement of Healing in Selected Problem Wounds, Hyperbaric Medicine Practice: Ch 33, Best Publishing Company, 2nd Ed: Ch 33:813-850,1999
  34. Williams RL: Hyperbaric oxygen therapy and the diabetic foot. J Am Podiatr Med Assoc; 87(6): 279-92. Review, Jun 1997;
  35. Zamboni WA, Wong HP, Stephenson LL, Pfeifer MA: Evaluation of hyperbaric oxygen for diabetic wounds: prospective study. Undersea Hyper Med;24(3): 175-179, 1997
  36. “Medical Progress: Hyperbaric-Oxygen Therapy”, Review Articles, The New England Journal of Medicine, 334(25):1642-1648, June 1996
  37. Kivisaari,J; Vihersaari,T; Renval,S; Ninikoski,J; Energy Metabolism of Experimental Wounds at Various Oxygen Environments; Annals of Surgery, 1975 [PDF]
  38. Knighton DR, Silver IA, Hunt TK: Regulation of wound healing angiogenesis- Effect of oxygen gradients and inspired oxygen concentration. Surgery; 90(2): 262-270, Aug 1981
  39. Mader JT, Adams KR, Wallace WR, Calhoun JH, Hyperbaric oxygen as adjunctive therapy for osteomyelitis. Infect Dis Clin North Am. 1990 Sep;4(3):433-40.
  40. Baroni G, Porro T, Fuglia E et al.: Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care 10:81-86, 1987
  41. Niinkoski J, Hunt TK, Dunphy JE: Oxygen supply in healing tissue. Am J Surg; 123: 247-252, March 1972
  42. Oriani G: Chronic Hyperbaric Oxygen Therapy Indications. Handbook on Hyperbaric Medicine, Springer; 110-124,1996
  43. Oriani G, Meazza D, Favales F, et al: Hyperbaric oxygen therapy in diabetic gangrene. Journal of Hyperbaric Medicine; 5(3): 171-175, 1990
  44. Reiber GE, Pecoraro RE, Koepsell TD: Risk factors for amputation in patients with diabetes mellitus. Annals of Internal Medicine; 117: 97-105, 1992.
  45. Sipinen SA.[Hyperbaric oxygen therapy in sports injuries]. Duodecim. 1995;111(13):1187-8. Review. Finnish.
  46. Staples J, Clement D.Hyperbaric oxygen chambers and the treatment of sports injuries. Sports Med. 1996 Oct;22(4):219-27. Review.
  47. Stephens MB: Gas gangrene: potential for hyperbaric oxygen therapy. Postgrad Med; 99(4): 217-20, 224. Apr 1996
  48. Stone JA, Cianci P: The adjunctive role of hyperbaric oxygen therapy in the treatment of lower extremity wounds in patients with diabetes. Diabetes;10(2): 118-123, 1997
  49. Hunt TK, Conolly WB, Aronson SB, Goldstein P: Anaerobic metabolism and wound healing: A hypothesis of the initiation and cessation collagen synthesis in wounds. The American Journal of Surgery; 135: 328-332, Mar 1978
  50. Vihersaari,T;Kivisaari,J;Ninikoski,J; Effect of Changes in Inspired Oxygen Tension on Wound Metabolism; Annals of Surgery; 1974 [PDF]
  51. Weisz G, Ramon Y, Waisman D, Melamed Y: Treatment of necrobiosis lipoidica diabeticorum by hyperbaric oxygen. Acta Derm Venereol; 73(6): 447-8, Dec1993
  52. Niinikoski J. Effect of oxygen supply on wound healing and formation of experimental granulation tissue. Acta Physiol Scand; 334:1-72, 1969.

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MEDICAL DIRECTORY  / 
Diabetes care
JL C, Surrey, BC

“Hyperbaric oxygen therapy proved to be the very best non intrusive therapy with the most positive end results. I have tried many natural remedies to help with the negative long term effects that my very brittle diabetes has caused. I would definitely recommend this therapy to everyone that needs some help. 

Thank you so very much.”  

Diabetes Neuropathy
P K - Vancouver

“I love to dance but had to stop because of numbness in my feet that caused me to slip and rip my Achilles tendon. After intense oxygen therapy the feeling is back in my feet and I’m back dancing again.”

Diabetes amputations
Sherry H - Trail, BC

"I wonder how many limbs that were saved from being amputated at your clinic would have been lost waiting for an opening at VGH.  "

(#0567-1008)

Proudly serving Metro Vancouver and British Columbians with hyperbaric oxygen services and wound care since 1999

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 Information contained on this site is intended for general consumer understanding and education. It should not be used as a substitute for any medical professional opinion, advice or prescribed medication nor should it serve as diagnosis or treatment of health problems.