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Anti-embolism stockings vs. compression stockings -- which to choose?
7 Principles for Controlling Your Diabetes for Life
Foot Care and Diabetes
Preventing and Managing Lymphedema
Anti-embolism stockings vs. compression stockings -- which to choose?
Primary Uses
Anti-embolism stockings are primarily used by hospitals.
Patients who are immobile and confined to bed wear anti-embolism stockings to
help prevent blood coagulation.
Compression Stockings are primarily worn by people who are
ambulatory. These people often spend a great deal of time on their feet,
causing the circulation of blood to fight against the effects of gravity.
This can result in a slowing or pooling of blood.
If a person suffers from a condition resulting in the slowing or pooling of
blood, that person becomes susceptible to venous insufficiencies and/or edema.
People who have these indications will find greater relief using compression
stockings.
Compression
Anti-embolism
When a person is confined to bed, they are positioned horizontally. Because of this, the circulation of blood is not greatly
affected by the forces of gravity. Accordingly, a very light compression
is all that is needed to stimulate blood flow. Anti-embolism stockings
provide this with compression up to approximately 18 mmHg (millimeters Mercury).
Compression Stockings
Due to the increased effects of gravity and in some cases the more severe
the indication, compression stockings offer higher levels of compression.
The levels range from 20-30 mmHg to as high as 60+ mmHg.
Characteristics
Anti-embolism
Since anti-embolism stockings are primarily worn by patients confined to
hospital beds, you will find that most are not cosmetically appealing.
Openings by the toe area, along with a standard white color, do not make
anti-embolism stockings aesthetically appealing for uses outside of the
hospital.
Also, because anti-embolism stockings are designed for the non-ambulatory
patient, they do not offer a great deal of elasticity and wear resistance for
the ambulatory patient.
Compression Stockings
Juzo® compression stockings offer a higher level of compression as well as
two-way stretch elasticity. This elasticity enables a more natural freedom
of movement and increased wearing comfort during everyday use.
Using synthetic elastomers, as opposed to natural rubber, Juzo® compression
stockings are quite durable, as well as resistant to sun and ointments.
Synthetic elastomers also enable Juzo® to manufacture compression stockings
that are very inconspicuous. Combining a sheer knit and a wide variety of
colors, patients can find stockings that are fashionable as well as therapeutic.
Indication Table for Medical Compression Stockings
Class I 20-30 mmHg
Light venous insufficiency, prophylactic treatment during pregnancy, mild
varicosities without tendency toward edema, hereditary tendency toward varicose
veins
Class II 30-40 mmHg
Moderate venous insufficiency, tendencies toward edema, Post-thrombosis,
sclero-therapy follow-up, severe varicosities during pregnancy, healed venous
ulcer
Class III 40-50 mmHg
After treatment of severe ulcerations, severe tendencies toward edema,
Lymphedema, severe chronic venous insufficiency
Class IV 60 + mmHg
Severe post-thrombotic conditions, Elephantiasis, Lymphedema
Contra-indications
Unreduced edema, open ulcer, circulatory disturbance, weeping dermatosis,
acute thrombophlebitis, Phlebothrombosis
7 Principles for Controlling Your Diabetes for Life
This section will help you learn about 7
principles for good diabetes care.
These principles are the steps you can take to control your diabetes.
Every person who has diabetes has different needs. Talk to your doctor
about a treatment plan that is best for you. When you have diabetes,
controlling it can help you live a long and active life.
It Is Important to Control Diabetes
Taking good care of diabetes can lower the chances of getting:
-
Eye disease that can lead to a loss of vision or even blindness
-
Kidney failure
-
Heart disease
-
Nerve damage that may cause a loss of feeling or pain in the hands, feet, legs, or other parts of the body
-
Stroke
As you read this section, look for notes that start with a 
to help you learn how to control your diabetes.
You may find it helpful to print this section and take it with you when you go to your doctor.
Principle 1:
Find out what type of diabetes you have
If you have diabetes, you should know what type you have. If you do not know, as your doctor whether you have:
-
Type 1 diabetes. People who have this type of diabetes need to take insulin every day. This type of diabetes used to be called juvenile diabetes.
-
Type 2 diabetes. This type of diabetes can often be controlled by the food you eat and regular physical activity. Some people may also need to take diabetes pills or insulin. This type of diabetes used to be called adult onset diabetes.
Terms that are no longer used include:
-
"a touch of diabetes"
-
"borderline diabetes"
-
"sugar's a little high"
Many people who have diabetes do not know it
Finding and treating diabetes early can prevent health problems later
on. Some people are at higher risk for diabetes than others. Risk
factors include:
-
Being older than 45
-
Being overweight
-
Having a close family member, like a parent, brother, or sister who has, or had, diabetes
-
Having had diabetes when you were pregnant
-
Being African American, Hispanic/Latino, Asian American and Pacific Islander, or Native American
Find out from your doctor what type of diabetes you have.
If your doctor describes your diabetes with a term that is no longer used, ask
your doctor whether you have type 1 or type 2 diabetes.
If you know someone who has any of the risk factors for diabetes, tell them to
ask their doctor about getting tested for diabetes.
Principle 2:
Get regular care for your diabetes
Take a look at the following statements, and decide which of them you think
are true.
People with diabetes should:
-
Always receive high-quality care.
-
Work with health care providers to make changes to their treatment plan when needed
-
See a doctor, diabetes educator, or a nutritionist on a regular basis.
-
Be able to get their health care needs taken care of regardless of their race, age, disability, or ability to pay.
-
Get support from family, friends, and co-workers.
-
Be able to get insurance and a license.
-
Be treated fairly at work.
-
Be able to get Medicare to help pay for diabetes supplies if they are on Medicare.
All of the above statements are true.
You have the right to get the best health care to help you control your diabetes.
Ask your doctor or nurse how often you need to see them for a check-up.
Write down the date and time for your next visit.
Ask your doctor or clinic staff to help you find resources if you have problems
paying for food, medicines, and medical supplies.
Make a list of things you want to talk about at your next visit to the doctor or
clinic.
Principle 3:
Learn how to control your diabetes
You and your family have the right to get correct information from your doctor and other health care providers to help you learn how to control your diabetes.
How active are you in controlling your diabetes?
Look at the list below. Think about which of the following describe
you.
- I ask my doctor for accurate information about my diabetes.
- I have talked with my doctor about other people, like a nutritionist and diabetes educator, who can help me learn to control my diabetes.
- I ask the diabetes educator and nutritionist about diet and other ways to control my diabetes.
- I talk to my doctor regularly about my special needs and controlling my diabetes.
If you do everything on the list above, you are taking an active role in learning how to control your diabetes. If you did not check everything on the list, ask your doctor about the things that you should do to learn more about how to control your diabetes. Learning how to control your diabetes can help you stay healthy.
Ask your
doctor where to go to learn more about diabetes and how to control it.
Principle 4:
Treat high blood sugar
The number one goal of diabetes treatment is to control high blood sugar levels. There are many ways that this can be done. These include:
- Eating a healthy diet
- Getting regular physical activity
- Taking medicine for your diabetes if your doctor tells you to
- Testing your blood sugar
Talk to
your doctor about the best ways to control your high blood sugar.
Get
involved in making a treatment plan and other decisions about your diabetes
care.
Principle 5:
Monitor your blood sugar level
Testing your own blood sugar
You may need to test your own blood sugar on a regular basis to help you
control your diabetes.
Talk with
your health care provider about:
- What type of test to use
- How to do the test the right way
- How often to test
- How often to report the test results
- Getting the supplies you need to do the tests. If you have Medicare, it can help you pay for your diabetes supplies.
Hemoglobin A1c Testing
A hemoglobin A1c test is done by your doctor. It measures how well
your blood sugar has been controlled over the last 2 to 3 months. This
test is very important because it tells you how well you are taking care of your
diabetes.
To learn more about this and other blood sugar tests, you can call 1-800-438-5383. Ask for the brochure called "Know Your Blood Sugar Numbers: The ABCs of Testing for Blood Sugar Control."
Ask your
doctor or nurse educator what your last hemoglobin A1c test result was, and when
your last test took place.
Ask your
doctor or nurse educator what your target hemoglobin A1c test result should be.
Principle 6:
Prevent and diagnose long-term diabetes problems
People with diabetes must control their blood sugar levels to prevent problems such as eye disease, kidney disease, nerve damage, heart disease, and stroke. Here are some tests that you should get on a regular basis:
Blood
pressure checks
Cholesterol
tests
Other blood
fat tests (ask your doctor what tests you should have)
Remember, to help control and manager your diabetes, your should also do the following:
- Eat a healthy diet
- Take medicine if your doctor tells you to
- Get regular physical activity
- Get regular foot and eye exams
- Work with your health care providers to do these things
Principle 7:
Get checked for long-term problems and treat them
To check for problems that diabetes can cause, you should see your doctor or other health care providers on a regular basis. Doing this can prevent problems or find them early, when they can be treated and managed well.
Ask your
doctor or other health care providers about how often you should have your:
- Feet checked
- Eyes tested
- Kidneys tested
Ask your
doctor or health care providers about other tests you may also need to have.
To take good care of your diabetes for life, be sure to follow these 7 principles:
- Find out what type of diabetes you have
- Get regular care for your diabetes
- Learn how to control your diabetes
- Treat high blood sugar
- Monitor your blood sugar level
- Prevent and diagnose long-term diabetes problem
- Get checked for long-term problems and treat them
People who have diabetes and keep their blood sugar levels under control can expect to live a long and active life.
To learn more about how to control your diabetes, visit the National Diabetes Education Program Website or call 1-800-438-5383.
Here are some other places that you can contact to get more information about how to control your diabetes.
- American Association of Diabetes
Educators
1-800-338-DMED - American Diabetes Association
1-800-DIABETES
1-800-232-3472 - American Dietetic Association
1-800-877-1600
1-800-366-1655 (consumer nutrition hotline in English and Spanish) - Centers for Disease Control and
Prevention
Division of Diabetes Translation
(877) 232-3422 - Juvenile Diabetes Foundation
International
1-800-JDF-CURE
1-800-223-1138 - National Institute of Diabetes and
Digestive and Kidney Diseases
National Diabetes Information Clearinghouse
(301) 654-3327
Foot Care and Diabetes (applies to anyone with neuropathy or circulation problems)
Why do I have to take special care of my feet?
Foot problems are common in people with diabetes. This is why you need
to check your feet for cuts, abrasions, and signs of irritation every day and to
protect them with proper footwear.
When you do not protect your feet properly, infections can develop from minor injuries. Here are a few reasons why this happens:
- Diabetes can damage nerves in the feet, making them less sensitive to pain. This means that you may not feel a minor cut or abrasion until a severe infection develops.
- Diabetes can cause reduced circulation. This is a problem since proper blood flow is necessary for healing injuries.
- Elevated blood glucose can interfere with the body's ability to fight infection from cuts and abrasions. It also hampers the healing process.
How should I care for my feet?
Your podiatrist (a doctor specializing in the care of the foot) will
teach you how diabetes affects your feet, and will set up a foot care program
for you. Most people with diabetes can care for their own feet, although
some need to see a podiatrist on a regular basis for evaluation and foot care.
To properly care for your feet, you should do the following each day:
Washing
- Wash your feet with mild soap and lukewarm water. Always check the water temperature with your elbow or another part of your body where the sensation is good before putting your feet in. Never put your feet into hot water.
- Never soak your feet. This dries the skin and makes it more prone to cracking and infection.
- Use a soft washcloth to clean your feet thoroughly and to get all the soap off.
- Use a soft towel to dry your feet, especially between your toes. Never dry or warm your feet by putting them on or near a radiator or heater.
Examining
- Inspect your heels and the tops and bottoms of your feet for skin irritation or breakdown. Look for sores, cuts, blisters, cracks between the toes, and blue, purple, or white spots. Be sure your feet feel warm and that there are not any red "hot" spots or swelling. Check for irritation or scaling between the toes, too. If you cannot see the bottoms of your feet, use a mirror. If you are unable to examine yourself, have someone do it for you. Notify your podiatrist or primary care clinician right away if anything looks unusual.
Skin care
- Apply a water-soluble moisturizing cream such as Eucerin® or Nivea® to keep skin soft. This is especially important for dry and callused skin. Never use cream between your toes or on open sores. Do not use petroleum jelly, Vaseline®, mineral oil, or perfumed lotions that contain alcohol.
Corns and calluses
- Gently and gradually rub down corns, calluses, and other hard skin with a dry washcloth, pumice stone, or emery board. This is most effective after a bath or shower. See your podiatrist if you cannot see your feet adequately, if you have reduced sensation, or if you have poor circulation. Have your podiatrist cut corns and calluses if they are a problem; never do it yourself.
- Do not cut corns or calluses. Also avoid over-the-counter corn and callus removers or remedies. These contain acid and will burn the skin.
Toenails
- Cut your toenails after a bath when they are the softest.
- To avoid cutting skin around the toe, trim toenails straight across using nail clippers, an emery board, or file. Do not use scissors.
- Carefully file sharp toenail edges to prevent them from cutting into adjacent skin.
- If it is difficult to trim your toenails, or if you have reduced sensation or poor circulation, schedule an appointment with your podiatrist.
What should I wear on my feet?
Shoes
- Always wear protective footwear (shoes or boots), even on the beach and in the house. Slippers are appropriate only if they cover the entire foot; however, do not wear them all day. When outdoors, avoid footwear that does not cover your entire foot, like sandals, clogs, or flip-flops.
- Don't ware the same pair of shoos every day. Switch back and forth so you don't give any one pair of shoes a chance to create a problem.
- Always wear properly fitting, comfortable shoes. When standing, your shoes should extend 1/2" beyond your longest toe and be wide enough so that there is no unnecessary pressure on any part of your foot. These suggestions will help avoid skin breakdown as a result of rubbing. Avoid shoes with pointed toes or heels greater than 1" in height. If you have a hammer toe, bunion, or other abnormality, your clinician may refer you to a podiatrist or orthopedist for evaluation and treatment suggestions.
- Avoid shoes made from material that prevents your feet from breathing (such as plastic), since fungus grows in warm, moist settings.
- Shake your shoes out before putting them on. Anyone with decreased feeling in the feet may not notice if they are walking on a pebble or other sharp object. This could lead to foot sores.
Stockings and socks
- Wear clean socks or stockings each day.
- Wear cotton or wool socks that absorb moisture. In the winter, wear one pair each of heavy and light socks for better insulation.
- If you have circulatory problems, avoid stretch socks, socks with elastic around the top, knee-high pantyhose, garters, and girdles. These items can reduce circulation to your feet.
- Always wash colored or dyed socks before wearing. This prevents dyes from irritating blisters or cuts.
- Be sure socks are the right size and that they fit smoothly in your shoes without any wrinkles, folds, or holes. Do not wear socks with seams and darns.
What should I do if I have an infection?
An infection may be present if you see any combination of these symptoms:
- redness
- swelling
- open sores
- pus
- red streaks
- warmth
You may not feel any pain in this area due to a loss of sensation. The first thing you should do is call your podiatrist or primary care clinician. If it is after office ours, call Urgent Care.
For a minor infection, your clinician will clean the infection and may give you antibiotics to keep the infection from spreading and to help heal it. Be sure to take the antibiotics for the entire length of the treatment, since it will not work if you skip doses. You will need to dress your wound at least once a day. Sometimes, a health care worker comes into the home to do this for you. Your clinician may give you crutches or a special surgical shoe to wear. You also will need to reduce your activity. Your clinician will want to see you for follow-up visits to be sure the infection is healing properly.
Your clinician may decide to hospitalize you to treat the problem. Still, prompt detection of an infection in its earliest stages will help to avoid a hospital stay.
What should I do if I see a cut or abrasion on my foot?
- Clean the area with warm water and soap, then see if any foreign material is present. Apply Bacitracin® or a mild antiseptic and over with sterile gauze or a prepared dressing. If you are unsure of the severity of the injury, see your clinician as soon as possible.
- Avoid sticky adhesive tapes like Band Aids®; use paper tape instead. Telfa® dressing is also useful because it will not stick to wounds.
- If the area becomes infected, inflamed, or does not heal in a few days, call your primary care clinician or podiatrist immediately.
- You may need a tetanus shot if you puncture the skin (if you have not had one in 10 years). Consult your primary care clinician.
What should I do if I get athlete's foot?
Athlete's foot is caused by a fungus that grows in warm, moist conditions. Its symptoms include scaling between the toes or on the bottoms of the feet, itching, and small blisters. If you have these symptoms, see your podiatrist or primary care clinician. You should also:
- Make sure you are drying your feet carefully, especially between the toes.
- Change your socks and shoes at least once a day.
- Use Tinactin®, Halotex®, or Lotrimin® on the affected areas. Only use medications your clinician has approved.
How can I help my circulation?
A common warning sign of poor circulation is a cramping pain in the calf or thigh. This pain usually appears while walking and disappears after rest. Here are a few things you can do to help your circulation, regardless of whether you have problems or not:
- Exercise. Simple exercises, such as walking, improve
circulation. Other good exercises include:
> Rotating the feet and legs in, out, up and down in a circular fashion (to move the hip, knee, and ankle)
> Flexing, extending, and spreading the toes - Quit smoking. Smoking is especially harmful to people with diabetes because it reduces circulation. Therefore, it is very important that you do not smoke. Ask your primary care clinician for information on how to quit smoking. Also ask about smoking cessation classes.
****
Care of the diabetic foot:
- Be sure to inform your physician that you are a diabetic.
- See your physician regularly and be sure that your feet are examined at each visit.
- Notify your physician at once should you develop a blister or sore on your foot.
- Do not smoke.
- Inspect the feet daily for blisters, cuts, and scratches. The use of a mirror can aid in seeing the bottoms of the feet. Always check between the toes.
- Wash feet daily. Dry carefully, especially between the toes.
- Do not soak feet.
- Avoid extremes of temperatures. Test water with a hand or elbow before bathing.
- If feet feel cold at night, wear socks. Do not apply hot water bottoms or heating pads. Do not soak feet in hot water.
- Do not walk on hot surfaces such as sandy beaches or on the cement around swimming pools.
- Do not walk barefooted.
- Do not use chemical agents for the removal of corns and calluses. Do not use corn plasters. Do not use strong antiseptic solutions on your feet.
- Do not cut corns or calluses: follow special instructions from your physician.
- Do not use adhesive tape on the feet.
- If your vision is impaired, have a family member inspect feet daily for signs of blisters, redness, or calluses. Have your nails trimmed by a trained individual.
- Cut nails straight across.
- Avoid crossing your legs -- this can cause pressure on the nerves and blood vessels.
- For dry feet, use a very thin coat of lubricating oil such as baby oil. Apply this after bathing and drying the feet. Do not put the oil or cream between the toes. Consult your physician for detailed instructions.
- In the wintertime take special precautions. Wear wool socks and protective foot gear, such as fleece-lined boots.
- Wear properly fitting stockings. Do not wear mended stockings. Avoid stockings with seam. Change stockings daily.
- Do not wear garters.
- Do not wear sandals with thongs between the toes.
- Do not wear shoes without stockings.
- Inspect the inside of shoes daily for foreign objects, nail points, torn linings, and rough areas.
- Shoes should be fitted by qualified personnel and be comfortable at time of purchase. Do not depend on shoes to stretch out. Shoes should be made of leather.
Preventing Lymphedema
A breast cancer diagnosis provokes tremendous fear and anxiety. Couple that with treatment -- chemotherapy, radiation, or mastectomy -- and women experience even more stress an anxiety.
Afterward, most survivors feel so happy to be alive that they don't think twice about the side effects of treatment, such as lymphedema. But about 20 percent of breast cancer survivors -- nearly 400,000 American women -- develop the condition.
How Lymphedema Begins
Removing lymph nodes is an important part of breast cancer treatment. That way doctors can determine whether cancer has spread from its primary site. Without these nodes, women are at increased risk for lymphedemas -- the build-up of lymphatic fluid in the tissue.
Signs and symptoms include a full sensation in the limb(s); tight skin; decreased hand, wrist or ankle flexibility; and difficulty fitting into clothing. If left untreated, lymphedema can lead to serious infections. Three stages -- ranging from mild to severe -- characterize the condition:
- Stage One (mild lymphedema). During this phase, tissue is still in the pitting stage. When you press an area with your finger, it indents and holds the indentation briefly. Usually when you wake up in the morning, the area looks normal. As the day progresses, however, slight swelling can occur.
- Stage Two (moderate lymphedema). The tissue now has a spongy consistency and is non-pitting. When pressed, the tissue bounces back without any indentation. Fibrosis (formation of fibrous tissue) begins at this stage, marking the beginning of limb hardening and notable swelling.
- Stage Three (severe lymphedema). At this stage, swelling is irreversible, and the affected area grows large. The tissue feels hard (fibrotic) and unresponsive.
Treatment Options
To treat lymphedema, therapists move accumulated fluid out of the affected areas. This process is called complex decongestive therapy (CDT). It's based on compression bandaging, exercise and manual lymph drainage -- a form of massage that consists of rhythmic strokes that stimulate lymphatic vessels to contract and encourage lymph flow. Skin care is also an important part of CDT.
If skin isn't maintained, lesions can develop that allow bacteria to enter an already immune-compromised system. This produces addition lymph system destruction. CDT treatment, however, helps maintain skin. Swelling usually decreases in four to 14 treatments over two to four weeks.
To further reduce swelling in the arms, patients usually wear medical-grade compression garments. With proper care, lymphedema can be prevented:
Infection
- Keep your arms clean. Wash often if you perspire, but always dry your skin well so moisture doesn't remain in skin folds or between fingers.
- Protect your fingers, hands and arms from punctures. Use your unaffected arm if you have blood drawn, your blood pressure taken, or need injections.
- Trim your fingernails carefully. Don't cut or tear the cuticles.
- Wear gloves when you're working outside to avoid punctures from thorns and tools.
- Use an electric shaver under your arms. The skin is less likely to become injured.
Muscle Strain
- Use your affected arm as normally as possible, but avoid heavy lifting and vigorous pushing, pulling or scrubbing.
- Ask your doctor, nurse or physical therapist about the best exercise program.
Burns
- Always wear protective clothing and sunscreen with an SPF 15 or higher. If possible, stay out of the sun from 10 a.m. to 3 p.m.
- Avoid hot baths, saunas and dishwater.
- Wear oven mitts when cooking or baking.
Constriction
- Avoid anything that constrains your hands or arms, such as tight sleeves or cuffs, watchbands or jewelry.
- Make sure your bra fits properly so the straps don't dig into your shoulders.
With proper education and care, you can recognize lymphedema's symptoms and seek treatment early. Talk to your therapist and learn more about how to avoid the condition.
Guidelines for avoiding lymphedema- Don't ignore any slight increase of swelling in your arm, hand, fingers or chest wall.
- Never allow an injection or blood drawing in your affected arm(s).
- Have your blood pressure checked regularly.
- Keep the edemic or at-risk arm(s) spotlessly clean. Use lotion after bathing, and when drying, be gentle and thorough.
- Avoid vigorous, repetitive movements, such as scrubbing, pushing and pulling.
- Avoid heavy lifting. Never carry heavy handbags or bags with over-the-shoulder straps on your affected side.
- Don't wear tight jewelry or elastic bands around affected fingers or arm(s).
- Avoid extreme temperature changes when bathing or washing dishes. Protect your arm from the sun at all times as well.
- Avoid trauma, such as bruises, cuts, or sunburns.
- When air traveling, wear a well-fitting compression sleeve.
- Maintain your ideal weight through a low-sodium, high-fiber diet, and avoid smoking and alcohol.
With proper education, you can recognize lymphedema's signs and seek treatment early to avoid the condition's irreversible effects.