Why do some people with diabetes wear compression stockings and others do not? Should anybody that has diabetes wear compression footwear and how does it relate to blood sugar levels? Does this footwear help with diabetes, or does it prevent and alleviate other conditions? Continue reading to learn the answers.
Diabetics who are experiencing symptoms of diabetic neuropathy and venous diseases (edema, thrombosis, and phlebitis) will need to wear compression stockings in order to help alleviate these symptoms (pain, swelling, infection, and fatigue) while maintaining blood pressure in the legs and feet.
Many people confuse compression stockings with compression socks. Understand that both terms are commonly used, but you may be unaware of significant differences that can have a major impact on your feet.
In this article, I will cover the complications and conditions that arise with diabetes that affect the legs and feet, and will discuss venous disease associated with diabetes. Knowing what these conditions are will help you understand why a person with diabetes needs to wear compression stockings.
I will go over the benefits, types, characteristics, side effects, and pressure levels of compression stockings and explain why some people with diabetes require them.
I will also go over the differences between medically certified compression stockings, TED (Thrombo-Embolism Deterrent) stockings, diabetic socks, and compression socks and stockings that you will find online or over the counter in your local department store.
What are Compression Stockings?
Compression stockings are specialized elastic hosiery (legwear) that are worn around the leg, compressing the limb. They help prevent and guard against progression of thrombosis (blood clots in deep veins), edema (fluid build-up or swelling), venous insufficiency (inadequate blood circulation in the veins), and phlebitis (inflammation of the walls of the vein). These are all venous (related to the vein) disorders.
Venous disease and diabetes are frequently correlated with each other, and neuropathy is a complication of diabetes that can further aggravate venous disorders. Compression stockings will definitely aid a person with diabetes who is experiencing symptoms of venous disease and diabetic neuropathy.
I personally recommend a properly fitted compression stocking for a person with diabetes, especially if they are experiencing diabetic neuropathy or any type of venous disease. People with diabetes who are on their feet for long hours during the day will benefit, as well.
Contrary to the compression socks and stockings that you can order online or purchase in a department store, medical grade compression stockings are found at a mastectomy and compression shop. These devices are often covered through your insurance, and they come in multiple compression support levels.
They are medically certified by the NIH (National Institute of Health). These specific stockings have specific pressure assigned to the stockings. Store boughten compression stockings are not required to have specific measurements of strength, as it not regulated.
How Do Compression Stockings Work?
Compression stockings work by applying pressure to your lower legs, helping them maintain proper blood flow (circulation). They do this by reducing the diameter of distended veins, increasing the velocity of venous blood flow (blood flow back to the heart).
Due to the increase in circulation the compression stockings provide to your legs, they help reduce the risk of developing DVT (Deep Vein Thrombosis) and blood clots.
Unlike other stockings, compression stockings use much stronger elastics to significantly create a large amount of pressure on the legs, ankles, and feet. They are less tight around the knees and thigh depending on the type of compression stocking, and they are the tightest at the ankles. This design promotes venous blood flow.
Class of Diabetic Compression, or Strength
Compression stockings are assigned varying levels of pressure. The pressure of the stockings is measured in millimeters of mercury (mmHg), which is a measurement of pressure, also used in blood pressure. The varying pressures of compression stockings are grouped into four classes. The higher the class, the stronger the compression.
I often refer people to who are in need of compression stockings to a local, reputable mastectomy and compression shop, where an experienced representative will help with fitting, style, and instructions for use.
Gradient Compression Levels
Mild (8-15 mmHg)
Helps relieve minor swelling of the lower extremities, minimizes achy legs, prevents fatigue for long periods of standing
Moderate (15-20 mmHg)
Prevention and relief of spider veins and varicose veins, used in post sclerotherapy (procedure to treat blood vessel malformations) for the reappearance of varicose veins, helps prevent deep vein thrombosis (DVT) also known as economy class syndrome, ideal for persons traveling long distances
Firm (20-30 mmHg)
Helps with treatment of moderate to severe edema, helps prevent and treat moderate to severe varicose veins, used post surgery, helps prevent DVT, helps manage active ulcers
Extra Firm (30-40 mmHg)
Used for severe varicose veins, used for severe edema, used post surgery, used for management of venous ulcers and DVT
Often times, first time users of compression stockings or socks are encouraged to start with a mild compression to get used to them.
Diabetic Compression Stockings vs. Compression Socks
There are a few varieties of compression socks. The compression products differ in length, causing some people to refer to them as stockings and some refer to them as socks.
Stockings are deemed to be the versions that are longer in length, and the terms are interchangeable. However, shorter medically certified compression stockings are referred to as calf stockings.
Benefits of Compression Stockings
Compression socks and stockings provide relief to feet and legs, promoting better circulation, but additional benefits of compression accessories are listed below.
- Promotes circulation in your legs, sending the blood back to your heart
- Vein support; prevent deterioration due to venous disease
- Prevent or ease pooling of blood and fluids in lower extremities
- Alleviate swelling of legs, feet, and ankles
- Help prevent orthostatic hypotension (lightheadedness or unsteadiness upon standing)
- Help prevent venous ulcers to lower extremities
- Prevent development of DVT (Deep Vein Thrombosis) in your legs
- Reduce pain caused by varicose veins
- Aids in the reversal of venous hypertension
- Improves movement and drainage of lymphatic system (BetterHealth.vic.gov.au)
Types of Compression Stockings and Socks
Three main types of compression stockings and socks are identified and used for specific situations, and certain functions. These include:
- Graduated Compression
- Non-medical Support Hosiery
Graduated Compression Stockings
These types of compression stockings are designed for mobility, and they must meet specific strength and length medical specifications; they require a professional fitting. These stockings have the strongest compression emanating from the ankle, and the pressure gradually weakens as the hose extends towards the top, where it ends.
Stockings that end just below the knee, known as calf stockings, will help limit swelling in the lower leg (due to fluid buildup), and they will also restrict peripheral edema (mayoclinic.org).
The stockings that extend past the knee towards the thigh and waist will reduce the amount of pooling of the fluid in the legs and help in the prevention of orthostatic hypotension, or postural hypotension (mayoclinic.org).
Anti-embolism stockings, or TED (thromboembolism-deterrent) stockings are designed to specifically reduce the possibility of acquiring DVT. TED hose are used to support the venous and the lymphatic drainage of the leg. (The fluids In the lymphatic system move around the body, removing toxins and waste from bodily tissues.)
*FYI: Anti-embolism stockings are known as what is commonly called TED stockings or TED hose.
Non-medical Support Compression Socks and Stockings
Non-medical support compression socks do not require a prescription or professional fitting and they usually contain mild pressure level, although the pressure level is not regulated. As mentioned, these types of compression socks are sold over the counter at various pharmacies, department stores, and online.
They differ from the other two types of compression socks because they are uniform in their pressure level throughout the sock (this means that they provide constant pressure from the top to the bottom). They are typically sold as airplane socks, and they can be used to alleviate tired and aching legs.
Characteristics of Compression Socks and Stockings
Compression socks we now know come in various styles, types and have multiple levels of pressure. They can also have numerous characteristics that can complement any condition or situation that the individual needs. These conditions include being seamless, breathable, moisture-wicking, warm, square-toed, fitted, and padded.
Seamless compression socks
These types of socks are manufactured without a seam. Seams can cause blisters and ulcers if they rub up against your skin when worn for a prolonged period of time. Some seams are on the outside of the sock.
Moisture-wicking compression socks
Moisture-wicking compression socks help keep your feet dry. If you have an ulcer or compromised skin, moisture can lead to infection, or worsening infection. If left untreated or unnoticed due to diabetic neuropathy, the condition can worsen, putting you at greater risk for amputation.
Breathable compression socks
Breathable compression socks allow air to pass through the socks helping to keep your feet and socks dry for longer periods of time.
Warm compression socks
Socks in their most basic application are also designed to keep our feet warm, and compression socks are no different. Warm feet lend to better circulation.
Square toe compression socks
These compression socks are designed with a box-type shape, which allows your toes to have space. When toes are squeezed together, they can cause a buildup of moisture.
Bombas brand socks are an example of a square toed compression sock.
Fitted compression socks
Compressions socks that are fitted will conform to the patient’s legs, not having any loose fabric, which could cause irritation on the skin due to rubbing and prolonged usage.
Padded compression socks
Padded compression socks will be designed and manufactured with internal padding, which will allow the feet to rest comfortably and securely. This protects the skin, alleviates pain, and cushions the feet.
Tips for Putting on Compression Stockings
Compression socks and stockings can be challenging to put on. Some people prefer an instruction manual.
Use these tips to assist you in donning your socks:
- Do not roll up; instead, turn them inside out.
- Open-toed stocking may need to be held in place.at the bottom while pulling up.
- Make sure the garment is straight, with the heel in place.
- Place foot in garment and gently pull over the heel. (It will be snug.)
- Smooth out wrinkles and place the top band just underrated the knee.
- Smooth wrinkles from the bottom up.
- Don’t pull them up too high.
- Put your stockings on before you start your day, as this is when you will have the least amount of swelling.
- If you are already up, sit with your legs elevated for a bit
- Talcum powder sometimes helps if you’re skin is too moist or too dry.
- Rubber gloves sometimes help.
- Practice. It will take some time to get used to.
If your stockings seem too tight, or they are causing you pain, numbness, or tingling, contact your provider. You might need to be refitted for your stockings.
How Long Should a Diabetic Wear Compression Stockings?
When compression stockings are recommended after surgery, they are usually worn both day and night, as much as possible. Your surgeon or healthcare professional will advise you as to how long you should wear your stockings after your operation, and show you how to use them correctly. They should be worn until you are able to move around freely. They are recommended to prevent blood clots, or DVT.
If you have a prescription for compression stockings due to circulation issues, you may need to wear them for several years. In some cases, diabetics may wear them for the rest of their lives.
Depending on the condition of the diabetes and any persisting complications, a person with diabetes may be advised to wear compression stockings for differing durations, which are individualized. It is always best to consult with your physician to decide what is best concerning your health.
If your healthcare provider is monitoring your progress, you will likely need to have your legs measured again and your stockings replaced every 3 to 6 months.
Precautions for Diabetic Compression Stockings
Compression stockings are an ideal tool for maintaining good circulation, and other issues relating to venous disease and diabetic neuropathy. However, a person with diabetes should always be aware that any form of medical aid in terms of medication and/or devices can come with risks if not monitored and used correctly, including compression stockings.
Take Precautions, Such As:
- Getting compression socks or stockings that fit you properly
- Making sure you are putting your compression socks on and taking them off correctly
- Checking to see if the socks are causing more of an Infection
- Checking to see if you are allergic to the material
- Do not fold the top of the stocking down
- Make sure to not snag toenails, jewelry, or fingernails on the stockings
- If you have a run in the stockings, they will likely need to be replaced
Side Effects of Compression Stockings
Suppose you do not take preventative and precautious measures. In that case, side effects could include breaking and irritation of the skin, peripheral nerve damage, and worsen ischemia and cause inadequate oxygenated blood circulation.
How do Diabetic Socks Differ from Compression Socks?
Many of my patients interchange “diabetic socks” with “compression socks,” but they are not the same thing.
Diabetic socks are loose fitting. They are designed to protect your feet from moisture, and to reduce pressure to prevent injuries including blisters, sores, and other wounds.
Some of them are padded for extra protection. They are seamless, or the seam is on the outside of the sock to prevent skin irritation. Diabetic socks are non-elastic or non-binding to promote circulation and to prevent fluid from collecting in the feet and ankles.
Compression socks and stockings are snug-fitting. They are designed to lessen fluid buildup and prevent blood from pooling in the lower extremities, especially for people who have circulation problems.
Diabetes and Venous Disease Overview
In order to understand why a person with diabetes might require compression socks, it is important to understand what conditions and diseases there are that can affect a person with diabetes, requiring them to wear compression stockings. Diabetes can lead to diabetic neuropathy (mayoclinic.org/diseases-conditions/) and then can aggravate and has been associated with venous disease (specifically venous insufficiency). Let’s llook at these conditions and determine what precautions and remedies are available.
Diabetes has been associated with venous disease, and these conditions aggravate the symptoms of chronic venous insufficiencies as well as varicose veins. Although these two diseases are not directly the cause of one another, they do share some serious risk factors that can be significantly dangerous when viewed in parallel with each other.
How Does Diabetic Venous Disease Affect Circulation?
Numbness or tingling occurs in a limb when too much glucose builds up in the blood, and as diabetes progresses, blood flow in the legs and feet begins to deteriorate, which results in further damage to nerves.
Venous disease will impact circulation in the legs and feet, and the result is significant swelling, itching, and burning. If diabetes is poorly controlled, it will worsen the condition of venous symptoms by placing a significantly enormous amount of stress on the veins. When these two diseases are working in tandem, the risk of complications is raised drastically, leading to more swelling and infectious risk.
Venous insufficiency is a type of venous disease that is most commonly found in the legs, but is also found in the arms. It is where blood vessels are impaired in the heart, arm, and legs. Veins stay filled with blood causing valves to become damaged and walls of the vein to weaken. This can lead to poor circulation and blood clots, and damage or weakening to valves or walls of the vein.
Symptoms of Venous Insufficiency May Include:
- Leg cramps
- Tingling sensations
- Heaviness in extremities
- Redness or discoloration around ankles
- Varicose veins
- Weakness in the legs
- Ulcers on the ankles and legs
- Slow healing of wounds
Diabetic neuropathy is a severe and common complication of diabetes, both for people with type 1 and type 2 diabetes. This condition is caused by long-term high blood sugar levels, causes nerve damage, usually in the feet.
Diabetic neuropathy is a severe condition, and if you have diabetes and are experiencing tingling, pain, weakness, numbness in your hands or feet, you should consult a physician immediately.
When neuropathy is prolonged, a person with diabetes can be susceptible to infections and injuries, including wounds that don’t heal properly. This can lead to more severe infections and, in very severe cases, amputation.
Symptoms of Diabetic Neuropathy may include:
- sensitivity to touch
- loss of sense of touch
- difficulty with coordination when walking
- numbness or pain in your hands or feet
- burning sensation in feet, especially at night
- muscle weakness or wasting
- bloating or fullness
- nausea, indigestion, or vomiting
- diarrhea or constipation
- dizziness when you stand up
- excessive or decreased sweating
- bladder problems, such as incomplete bladder emptying
- vaginal dryness
- erectile dysfunction
- inability to sense low blood glucose
- vision trouble, such as double vision
- increased heart rate
Four main types of diabetic neuropathy:
- Peripheral neuropathy
- Autonomic neuropathy
- Proximal neuropathy
- Focal neuropathy
Going into detail on these various types of neuropathies is beyond this article’s scope; however, the main concern regarding neuropathy is that it is a complication associated with diabetes.
if you Have diabetes and have been diagnosed with venous disease, or you are experiencing any symptoms of diabetic neuropathy, it is very important for you to see your healthcare provider to have your legs and feet evaluated.
Compression stockings help maintain adequate blood circulation by creating pressure on the legs and feet. This helps reduce pain, swelling, aching, and fatigue of the lower extremities.
Certain Insurance companies will cover medically certified compression stockings. The stockings may be tailored to each individual. Anyone is able to purchase them from a mastectomy and compression shot, but they are rather expensive.
Various compression stockings and socks are available for purchase at local department stores or online. The strength of the stockings may be approximate, and the fit will not be individualized to you, but they will be less expensive.
So should diabetics wear compression stockings? They help countless people with diabetes. Make an appointment with your physician and find out.