Diabetic compression sleeves, how to choose
Diabetes and compression stockings "There is only one absolute exclusion criterion"
Even today the opinion is still heard that diabetics should never wear medical compression stockings.
Dr. med. Giovanna Eilers, specialist in internal medicine, does away with this prejudice. As a diabetologist DDG in the Berlin practice diabetes and cardiology as well as a certified ZRM trainer and coach for integrative stress medicine IAH, she approaches the topic from several sides.
What criteria does a diabetic have to meet in order for medical compression stockings to be used in his therapy?
Dr. Eilers: Actually, one should ask the question the other way around: What are the exclusion criteria? If a patient suffers from advanced peripheral arterial disease, this is an absolute exclusion criterion. In the case of diabetes patients with arterial problems in the early stages, on the other hand, I speak to the angiologist who is also treating these patients. I asked him if he could advocate compression therapy in each case despite the arterial disease. In fact, the vascular specialist gives me the green light in many cases. Like all high-risk patients, these patients are of course regularly called in to look at their feet and check the development of the arterial disease - and also to check whether the compression therapy can be continued.
It is also often said that diabetes patients with neuropathy are not allowed to wear compression stockings. How do you judge that?
Dr. Eilers: Neuropathy is not an absolute, but rather a relative contraindication to compression. In view of the central importance of compression in the treatment of venous disorders, I also prescribe compression stockings more frequently to patients with neuropathy, as long as these are not pronounced. Of course, it is very important that I educate the patient and explain what to look out for. He must be really good at putting on the stockings and be able to look at his legs in order to avoid constrictions and notice pressure points in good time. They also have the same problem with shoes: Neuropathic patients regularly have to look carefully at their feet and examine whether small objects have got into the shoes that could cause pressure points and wounds on the foot. The risk here is just as high as with compression, but that doesn't mean I can do without prescribing shoes. Nor can I do without prescribing medical compression stockings for ulcus cruris therapy whenever this is justifiable. First and foremost, it is about properly training the patients - or the relatives, if the patients themselves are not able to put on the stockings properly and to control the condition of their legs.
What requirements does a medical compression stocking for diabetics have to meet?
Dr. Eilers: It is important that the diabetic can put on the stocking himself. Diabetics are often multimorbid patients whose gross and fine motor skills are restricted. These patients therefore need a stocking that is easy to pull on or an excellent donning aid. Then there is the question of skin tolerance: My patients often have very sensitive skin that becomes extremely dry when wearing some stockings, which in turn paves the way for new open areas to appear. But I see the real difficulties elsewhere: We have really excellent stockings, but we fail because the patients do not wear the stockings. Often the patients are only inadequately supported in this direction, for example when schooling - even with the dressing aid - in medical supply stores.
Are diabetics more difficult than other patients to get them to wear compression stockings?
Dr. Eilers: One should always keep in mind that diabetes makes many demands on patients of all kinds: They have to wear the appropriate shoes, keep a blood sugar diary and much more. And then there are also the medical compression stockings - that too! In addition, many diabetics have neuropathy. The fact that they cannot really feel their feet and legs also causes something at the brain level. What I can't really feel doesn't really belong to me on the emotional level either. And when a part of the body is no longer properly perceived, the motivation to do something about it disappears. In some ways, diabetics are the more difficult patients. Because of all of the factors mentioned, it is not easy to get them to even try wearing compression stockings. But I have to say that the VenoTrain ulcertec, which I prescribe to wound patients very often, has made a huge breach here. When the patients find that they can really put on this stocking, a way is paved in their heads, so to speak. And if the wound heals later and I still prescribe compression for you, you are more willing to try that too. Here I only prescribe the compression class and the height of the stocking. The patient has to make the final decision in favor of a product in the medical supply store. I observe that patients, and especially patients, often choose the VenoTrain micro, which also impresses them with its appearance.
As a doctor, what can you do to achieve the highest possible level of acceptance for medical compression stockings?
Dr. Eilers: It starts with the fact that you as a doctor, as a therapist, have to be convinced of it. For example, I wear compression stockings even though I have no venous disease - simply because my legs feel good with them at the end of a long day. And I can only recommend every doctor to try compression stockings and find out how comfortable they are. On this basis one can then try to break down prejudices against the stocking in the patient and convince him to try the stocking for three weeks first. In addition, my big topic is to activate the patient's motivation. I not only work as a doctor, but also as a coach and trainer. With the Zurich Resource Model® or ZRM for short, I have found an ideal complement to my medical work. This motivational psychological self-management method is about the fact that people can learn to activate their own motivation and that patients manage to implement their health goals in the long term. This is where we will have to step up if we want to treat patients with chronic wounds and reduce the amputation rate.
Images: Bauerfeind, private
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