Compression consultations for the diabetic patient new orleans dinner program


Published on

New Orleans and Sav On Dinner Programs

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • This commercial program is sponsored by SIGVARIS, the global leader in graduated compression therapy which is used for the prevention and management of venous disease. SIGVARIS products are sold in over 75 countries worldwide and has manufacturing operations in France, Switzerland, Brazil and the U.S. “Our state of the art manufacturing plant for North America is in Peachtree City, Georgia. 90% of our products are made in Peachtree City, GA and can ship to you via UPS ground within 2-days. The remainder of our products are manufacturered in Switzerland or France, then shipped to Peachtree City, GA for distribution. We invite you to visit our manufacturing facilities any time you are in the Atlanta area. Contact your Territory Manager and he/she can assist you with these arrangements. As a reminder, no continuing education credits will be offered in conjunction with tonights’ program.
  • Every stocking in the SIGVARIS line has double covered yarns. Double covered yarns means the product is more durable and easier for consumers to put on (no bare elastic against the skin).
  • People come in many shapes and sizes and the SIGVARIS PFS and PFS ² allows you to fit 98.2% of the population without having to use a custom made garment. A signature feature about SIGVARIS’ precise fit sizing system which we will discuss in more detail later in the discussion is that with our sizing and our garments, we can fit an average or full sized calf in a person with a short or long leg. This is key because with a one-size fits all smalls, mediums, or larges in a person who is as short as I, being 5’2 the garment may be too long, and this same garment in a person who is 6’2 may be too tight and too short. So ideally some one will loose.
  • Before we begin our program, I want to pose the question or questions of One, do you currently carry graduated compression stockings, and Two, do you consult or recommend graduated compression stockings to your patients? If the answer to one of both of these questions is “NO”, the rhetorical question is “Why Not”?
  • Diabetic patient patronize us more than the leading disease states attributing to death. Here we see that they spend more money and fill more prescriptions. This data is one reason that so many pharmacies now offer diabetes classes and other management services. Because of the rapid expansion of available therapeutic agents to treat diabetes, the pharmacist's role in caring for diabetic patients has expanded. The pharmacist can educate the patients about the proper use of medication, screening for drug interactions, explain monitoring devices, and make recommendations for ancillary products and services. The pharmacist, although not the health care professional to diagnose diabetes, is important in helping the patient maintain control of their disease. The pharmacist can monitor the patient's blood glucose levels and keep a track of it. During their contact, the patients can ask the pharmacist any questions they did not ask the physicians and can get further information regarding diabetes. By show of hand does your pharmacy offer such services? What is included in your service offerings? Do you counsel patients about prevention who are pre-diabetic? How about newly diagnosed patient, patients returning at regular intervals, or non-compliant patients? What consultation points do you cover with a patient who is pre-diabetic, newly diagnosed, or refilling medications?
  • While statistics are good and can help us to identify a trend, for the purpose of tonight's discussion, we will only highlight a couple that are key to our topic. The CDCs 2011 Fact Sheet, included in your packet, reports that 25.8 million children and adults in the United States—8.3% of the population—have diabetes with 1.9 million new cases of diabetes diagnosed in people aged 20 and older in 2010. Ok, you may ask, well how many Americans are in the US? As a point of reference, the US Census Bureau reported that in 2010 there were 308 million people. Depending on the source, diabetes is listed as the 5 th -7 th leading cause of death in the US. Most current information listed on the CDC website based upon 2009 data, reports it as the 7 th leading cause of death after heart disease, cancer, chronic lower respiratory disease, stroke, accidents, and Alzheimer's disease. Diabetes is also listed as a major cause of heart disease and stroke? The National Health and Nutrition Examination Survey, reports diabetes as the 6 th leading cause of death. What does diabetes cost us? The CDC reports the estimated direct cost in 2007 at $174 billion. More relevant to us as pharmacist is.
  • I’m sure you have heard in school, at other dinner programs, and some other point of practice, that as pharmacist we are in the ideal position to intervene and optimize patients outcomes…WHY? Because we see patients more frequently that other healthcare professionals, we are more readily accessible, and should be in the position to spend more time consulting with patients than the physician who can spend no more than 15-minutes with the patient! To this point, we are often recognized for quasi-triaging a patient and recommending next steps, i.e., see your doctor, recommending an OTC product, or advising them on their disease state. With diabetic patients, many first become aware that they have diabetes when they develop one of its life threatening complications. So…Everyone who mentioned that there pharmacy offers a diabetes management service, clinic, or takes additional care and time to consult with your diabetic patients please raise your hand again. Now, in your consultations with patients do you mention, and as we cover the body as it relates to complications, lower your hand once we come to an area that you do not cover in your consultations. Problems of the foot are the most frequent reasons for hospitalisation amongst patients who have diabetes. Many hospital visits due to diabetes-related foot problems are preventable through simple foot care routines . Doctors estimate that almost half of all amputations are caused by neuropathy and circulatory problems that could be prevented. Amongst people who have diabetes, amputations are reported to be 15 times more common than amongst other people. 50% of all amputations occur in people who have diabetes.
  • Foot problems are a big risk in diabetics . Diabetics must constantly monitor their feet or face severe consequences, including amputation. Several key factors usually predispose ulceration and ultimately amputation. These include peripheral neuropathy, vascular disease, infection and deformity of the feet . Vascular disease is a common term that most people commonly associate only with PAD (peripheral arterial disease); however, it is any disease that affects the blood vessels of the circulatory system. This can range from diseases of the arteries, veins, lymph vessels, to blood disorders affecting normal circulation. With a diabetic foot , a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When wounds are not healing, it’s at risk for infection. In diabetic patients infections spread quickly. Diabetic patients should inspect their feet every day . Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Diabetic foot complications are more common amongst the elderly, and amputation rates do increase with age.
  • Vascular disease is a common term that most people commonly associate only with PAD (peripheral arterial disease); however, it is any disease that affects the blood vessels of the circulatory system. This can range from diseases of the arteries, veins, lymph vessels, to blood disorders affecting normal circulation. Do these numbers shock you? What does these statistics indicate to you? When I looked at these numbers, a couple of questions came to mind: For one, why do so many American’s have vein disease? Perhaps it is because…
  • As you can see from this chart, the systemic veins handle most of the blood in the body. The blood volume carried in the veins is enormous— approx. 40% of all the blood in our bodies is in the legs! What is Let’s do a quick review… (ASK THESE QUESTIONS:) Which vessels have more muscle—veins or arteries? ( Answer ): arteries Which vessels would then be more prone to dilate or stretch out under pressure? ( Answer ): veins Where is most of the blood found in the body, in the arteries or in the veins? ( Answer ): in the veins” Final point: The vessels that are most prone to damage carry the majority of the blood within our bodies.
  • So now the next question that comes to mind is whaSo let’s briefly talk about each of these factors. But first to understand them, here is a little known fact!
  • The valves function to ensure uni-directional blood flow. Venous valves are tissue paper thin structures, bicuspid structures that resemble upside down parachutes and are found every 2 to 7 cm depending on the size of the vein. The valves provide a one-way flow of venous blood, against gravity, and back to the heart . When venous valves are competent and working properly, the blood can oppose to forces of gravity and flow upwards to the heart. Distal flow and flow through the communicating veins is normally prevented by the venous valves. In order for valvular closure to occur, there must be a reversal of normal transvalvular pressure gradient. Venous flow is not in a steady state but is normally pulsatile. Hydrostatic pressure is reduced by the action of competent valves in conjunction with action of the peripheral pumps. In the resting position, with the foot flat on the floor, there is no venous flow. In the heel strike position, the venous plexus under the heel; and plantar surface of the foot is emptied. This is why you may commonly hear that one should flex their feet while on an airplane to maintain blood flow to the heart.
  • Research suggests that there are several attributing factors to valve dysfunction: Vein wall injury allows the vein to elongate and dilate thus producing the visual manifestations of varicose veins. An increase in the vein diameter is one cause of valve dysfunction that results in reflux. The effect of persistent reflux causes a chronic increase in distal venous blood pressure. Prolonged increase venous blood pressure or venous hypertension initiates a cascade of pathologic events which cause vein valves to become perforated, torn, and ever scarred to the point of near total absence. Venous hypertension commonly manifest itself as edema, pain, itching, skin discoloration, and in worst case scenarios ulceration. The earliest signs of this process is elongated and dilated veins in the epidermis and dermis known as spider veins (telangiectasias) seen as the blue-green or purplish veins beneath the skin and slightly deeper are the torturous and inflamed varicose veins (Bergan, p. 42-43). Address specific patient demographics and lifestyles which can be attributed to damaged valves, and the pathophysiology behind each specific occurrence. For example, address age (elasticity of vein walls), illness, smoking, obesity, pregnancy (hormone changes, increased blood flow, fetal head resting on left iliac vein). Address how damaged valves and lack of contraction create an incompetent vein system. When valves are incompetent blood refluxes and influx is sluggish; blood may leak through the opening in the valve causing blood “pooling”. Mention how incompetent valves contribute to pooling of blood in the legs, ankles, and feet which manifests as edema. As this occurs, pressures increase in the veins due to the need to re-direct the blood, and this leads to veins distending to accommodate increased blood volume, this further pulls the valves apart, and this cascade continues and most patients ultimately start to notice and/or address their venous condition as they notice the unsightly veins – varicose veins. Varicose Veins Frequently associated with heredity, jobs involving prolonged standing or pregnancy. Great saphenous vein and its branches are most commonly affected. May begin at the thigh and extend to the foot Can be caused by a DVT or secondary varicosities (a clot in the deep vein system).
  • There is another aspect of vein anatomy that makes veins very different from arteries, the presence of valves in the veins. Venous valves are tissue paper thin structures (cusps) that resemble upside down parachutes and are found every 2 to 7 cm. depending on the size of the vein. These valves provide a one-way flow of venous blood back to the heart and lungs. Valves are uni-directional; they allow blood to flow in only one direction, bicuspid, work against gravity and prevent reverse flow or pooling. “ The calf muscle is not the only source of venous return. Other ‘pumps’ help push the blood toward the heart. Ankle and foot pumps contract to force blood upwards. Venous valves are absent in the sole of the foot, so blood is squeezed out of the veins by body weight when standing or walking. This can also be achieved with compression treatment.”
  • Some lower extremity venous disorders that are prevented and managed by application of and wearing graduated compression therapy are: Telangiectasia (or spider veins or reticular veins) are the small red, blue, and purplish veins that appear on the skin surface. They are more of cosmetic concern versus painful. Varicose Veins can be characterized are primary or secondary in nature. PRIMARY Varicose Veins have no apparent cause, are frequently associated with heredity, jobs involving prolonged standing or pregnancy. Varicose veins are typically seen within the great saphenous vein and its branches, and may begin at the thigh and extend to the foot. SECONDARY Varicose Veins are a direct result of deep vein occlusions. If an occlusion occurs there is increased pressure within the deep vein system. Once the deep veins have been occluded by a thrombus, the resulting ambulatory venous hypertension continues to dilate the veins rendering more and more of the venous valves incompetent. The larger and longer the clot the greater the potential for multiple valve damage. The venous reflux results in higher venous pressure in the deep system which is transmitted to the superficial veins via the perforating veins and this can result in varicose dilatation of the superficial veins.
  • Edema may be attributable to anti-diabetes medications such as Actos, Avandia, ACTOplus met, Byetta, or simply venous insufficiency.
  • Eighteen subjects (9 males, 9 females) average age of 61 years with diabetes, lower extremity edema, and a mean ABI of 1.10 completed the study. Subjects were fitted and dispensed 4-7 pair of stockings and instructed to wear them during all walking hours. Edema quantified through manual circumference measurements midfoot ankle calf Cutaneous edema measurements in the calf quantified via MoistureMeter handheld device that measures the difference in relative humidity between the ambient air and the measured skin
  • Graduated compression stockings are not TEDS! Read slide. Discussion Points: Emphasize the patient population who should be wearing and receive a recommendation for “graduated” compression stockings vs. antiembolism stockings. Point out that as a pharmacist who receives an antiembolism prescription or request for an ambulatory patient, it is their role to educate and provide a proper recommendation. Also, to discuss the differences with the prescribing physician. Highlight
  • To assess this question, lets first look at what are graduated compression stockings? It is important that graduated compression socks and stockings are measured and fit for each patient by a person who has been properly trained (also referred to as a compression specialist). When graduated compression stockings are not properly fit, it can cause: Reduced blood flow and tissue oxygenation Pressure ulcers Arterial occlusion Thrombosis Gangrene Ok, so now, why would one need graduated compression therapy…in other words, what types of conditions would these socks and stockings help? Let’s look at some examples of Lower Extremity Venous Disorders…
  • SIGVARIS diabetic compression sock is ideal for: Pre-diabetic patients Newly diagnosed patients Diabetic patients with edema Expecting mothers diagnosed with gestational diabetes Because of the precaution of graduated compression therapy in diabetic patients, it is recommended to rule out neuropathy and determine the patients arterial sufficiency. Patients with an ABI>0.6 and no claudication could benefit from graduated compression therapy, but if the patient has cladication refer them to their physician for further evaluation. Most importantly for these patients, your recommendations of SIGVARIS diabetic compression graduated sock will help their legs to feel better because their circulation has improved…with improved ciruclation, your patients are more likely to be compliant with the need and your recommendation to exercise!
  • Below 0.4 is the threshold An index of <0.9 indicates PVD. Lower extremity arterial disease is defined by a low ABI, usually ≤0.9 but ranging in the literature from <0.80 to <0.97.
  • Meticulous foot care and the choice of suitable foot wear can prevent serious damage which is likely to occur in diabetics.
  • You can’t share what you don’t wear!
  • Compression consultations for the diabetic patient new orleans dinner program

    1. 1. Compression Consultations for the Diabetic Patient Kimberly Simmons, PharmD, MBA US Pharmacy Relations Manager SIGVARIS, Inc. Adjunct Associate Professor of Pharmacy Practice Mercer University College of Pharmacy and Health Sciences University of Georgia College of Pharmacy
    2. 2. Program Sponsored by SIGVARIS Global leader in graduated compression garments for prevention and management of venous insufficiency/diseaseThis is commercial program; no CE credits will be offered!
    3. 3. =
    4. 4. =
    5. 5. =
    6. 6. The SIGVARIS Difference… Covered spandex Double Covered Yarns • Increased durability 2nd covering (S-twist) • Omission of ‘shininess’ • Provides for anatomically correct fit 1st covering (Z-twist) • Enhances patient level of comfort in donning and doffing • Improved patient compliance 8
    7. 7. The SIGVARIS Difference… SIGVARIS offers flexible ready-to-wear sizing options to fit 98.2% of the population while ensuring maximum comfort and increasing compliance
    8. 8. The SIGVARIS Difference… …we work for you & with you to so you can generate alternative revenue! Pharmacist managed  Provide complimentary pharmacy relations customized & generic department for marketing materials business support  Quarterly business Healthy leg days reviews Physician detailing  Training & education Online dealer locator programs Distributed dealer list
    9. 9. o you currently carry and/or consultpatients on graduated compressionsocks or stockings for your patients?
    10. 10. Objectives• Discuss the epidemiology of lower extremity complications in the diabetic patient• Discuss graduated compression therapy and it’s uses• Explain the etiology of lower extremity edema in the diabetic patient• Describe lower extremity edema management with graduated compression therapy• Discuss compression consultation points for diabetic patients
    11. 11. Diabetic Patient use of Pharmacy ServicesGeorgetown University. Center on an Aging Society. Sept. 2002 (5). 1-6. Available at: Accessed 05/03/12.
    12. 12. 25.8 $174 BILLION1 American Diabetes Association. Data from the 2011 National Diabetes Fact Sheet (released Jan. 26, 2011). Available at: Accessed 05/03/12
    13. 13. 1 American Diabetes Association. Data from the 2011 National Diabetes Fact Sheet (released Jan. 26, 2011).Available at: Accessed 05/03/12
    14. 14. The old saying “An ounce ofprevention is worth a pound ofcure” was never as true as it iswhen preventing amputations!
    15. 15. Factors Leading toLower Extremity Amputations• Peripheral neuropathy• Infection ▫ Antibodies respond slower to infections secondary to the poor circulation• Deformity of the feet ▫ Diabetes can affect the joints making them stiffer• Vascular disease ▫ Poor circulation can affect the body’s ability to heal when damage occurs
    16. 16. Vascular Disease: Arterial & Venous Disease Arterial Disease (PAD) Venous Disease (PVD) Narrowing of the arteries, commonly Inadequate return of venous the pelvis & legs blood from the legs to the heart Clinical Symptoms: Clinical Symptoms: cramping, pain, tired/heavy, achy cramping in tired legs or hip muscles that worsens the legs; pain worsens when during walking/activity and subsides standing and improves with leg with rest elevation and activityPAD=peripheral arterial disease; PVD=peripheral venous disease
    17. 17. Epidemiology of Vascular Disease  60% of American suffer from vascular disease and its sequelae  More people lose time from work and are affected by venous disease than from arterial disease  50% of Americans are affected by vein disease  Diabetic patients have a 2-5 times greater risk for developing PAD vs. non-diabetic patients  Approx. 1 in 3 diabetic patients >50 years has concomitant PADPAD= Peripheral arterial diseaseNational Heart Lung and Blood Institute (NHLBI). Available at: Accessed 01/27/11.Society of Interventional Radiology (SIR) Website. 2003. Available at: Accessed 05/28/2009/Vascular Disease Foundation Newsletter. Spring 2005; Volume 5, N2
    18. 18. 100 Most of 90 the The venous system containsPercent Distribution 80 blood most of the blood as it moves 70 through the circulatory system. 60 50 40 30 20 10 0 Veins Lungs Heart Arteries Capillaries 60-70% 10-12% 8-11% 10-12% 4-5%Hole’s Human Anatomy and Physiology, 7th Edition, 1996
    19. 19. Audience Response What etiologic factors directly contribute to the development and progression of venous disease? C.Incompetent valves D.High blood pressure E.Improper venous return F.A and B G.All of the above
    20. 20. Physiology of the Normal Venous Circulation:Competent Valves Valve Open Valve Closed Pumps blood against Inhibits gravitational reflux of gravity towards heart pumped blood
    21. 21. Physiology of the Normal Venous Circulation:Incompetent Valves Vein Wall Injury ↑ ↑ Venous Hypertension ↑ ↑ Damaged Valves
    22. 22. Sources of Venous Return• Calf muscle (2nd heart)• External foot pump• Arterial pressure• Abdominal/intrathoracic pressure
    23. 23. Examples of Vein Disease Complications Telangiectasia Varicose Veins Lipodermatosclerosis (spider veins) Deep Vein Thrombosis Superficial Phlebitis
    24. 24. Examples of Vein DiseaseComplications Venous Ulcers Chronic Venous Leg Edema Insufficiency Venous Hypertension
    25. 25. Lower Extremity Edema: A Complication of Poor Circulation• Lower extremity edema is a common clinical finding in diabetic patients ▫ Graduated compression therapy is the standard treatment for edema ▫ Graduated compression therapy is a precaution in diabetic patients because of concomitant arterial disease• Lack of reliable measures to objectively quantify edema makes it difficult to assess it’s prevalence in diabetic patients• Edema in diabetics is difficult to isolate and may have multiple etiologies ▫ Edema may be attributable to anti-diabeties meds such as: Actos, Avandia, ACTOplus met, ByettaBrodovicz KG, et al. Clin Med Res. 2009;7(1-2):21-31.Fries R. MMW Fortschr Med. 2004;146(16):39-41.Powell AA, et al. Am Fam Physician. 1997;55(5):1721-6.
    26. 26. Safety and Efficacy of Mild Compression (18-25mmHg) Therapy in Patients with Diabetes and Lower Extremity Edema Wu SC, Crews RT, Najafi B, et al. J Diabetes Sci Technol 2012 Vol 6 Issue 3 • 4-week pilot study • N=18 ▫ Diabetes ▫ Lower extremity edema of the leg, foot, and ankle ▫ Ankle-brachial index (ABI) >0.6 • Assess whether diabetic compression socks* can reduce LE edema in diabetic patients without compromising vascularity • Mild graduated compression socks (18-25mmHg) decreased swelling in diabetic patients with LE edema without compromising vascularityLE=lower extremity
    27. 27. Defining Anti-embolisms (TEDs) “TEDS are for BEDS” Anti-embolisms Therapeutic Compression Ranges: 18-8mmHg, 20-10mmHg Utilized in the hospital or nursing home setting For bed-ridden patients Anti-embolisms Indicated for prevention of thromboembolisms in recumbent patientsClass A (8-15mmHg) compression reflects the standard in some countries but there is insufficient clinicalevidence to support it’s use in practice. (European Prestandard, 2001)TEDS=Thromboembolic Deterrent Stockings
    28. 28. Defining Graduated Compression Therapy “Stockings are for Walking” • Compression therapy is the application of controlled graduated external pressure to the 20 - 40% limb to reduce venous pressure within the limb. 50 - 80% 100% • Strongest at the ankle and decreasing in the proximal direction • To be effective, must fit over the calf • Require measurement, fitting, and patient counseling by a certified and trained compression specialistPictures obtained from Accessed 09/02/10.
    29. 29. Audience Response How do you know what level of compression pressure is appropriate for the patient? C.Physician prescription D.Patient request E.Assessment of venous complications F.A and B only G.All of the above
    30. 30. Graduated Compression Indications Shoe Size Precisely Measured 15-20mmHg 18-25mmHg 20-30mmHg 30-40mmHg 40+mmHg• Tired, achy legs • Lower extremity • Heavy, fatigued, • Moderate • Severe• Occupational or edema in diabetic aching legs varicosities w/ varicosities evening edema patients without • Mild edema in mild-moderate • Severe edema• Leg discomfortsimple change of socks!!! ± A contraindications lower extremities edema • CEAP C4, C5, from prolonged and ABI >0.6 • Mild varicosities pregnancy C6 standing/sitting w/ minimal • Post-procedure • Recurrent• Preventing edema of larger veins venous pregnancy • Mild varicosities • CEAP C3, C4, ulceration varicosities & pregnancy C5, C6 • Severe post &swelling edema • Recurrent or traumatic,• Predisposed risk • Post-procedure active venous fracture edema• Reduce travel of small veins ulceration • Severe PTS swelling • DVT prevention • DVT prevention• Prevention of or management or management traveler’s • DVT or PTS thrombosis treatmentThere is insufficient clinical evidence to support the clinical efficacy of compression pressures <15mmHg tosupport ambulatory patients. (European Prestandard, 2001)
    31. 31. Why are graduated compressiongarments sized and measured toprecisely fit patients?
    32. 32. Graduated compression therapy is “Medicine you Wear”
    33. 33. “Your labs show you have diabetes. I know your legs hurt but you need to exercise to improve your circulation, and start Actoplus met!”What compression consultation would you offer this diabetic patient presenting to your pharmacy?
    34. 34. Selecting the ‘Right’ Diabetic Compression Sock • Promotes circulation • Fiber blend of cotton, acrylic, nylon, and elastic ▫ Regular 100% wool or cotton socks are too tight on the foot, reduce circulation, and are not cool and do not keep the foot dry • Cushioned ▫ Regular socks do not provide comfort and protection • Flat seams ▫ Coarse seams on regular socks rub the foot and . cause blisters and calluses to emergeFeldman CB, et al. Diabetes Spectrum.14(2), 59-613Herring KM, et al. J Amer Pod Med Assn. 80, 63-70.
    35. 35. Diabetic Compression SockTarget Patient Population • Pre-diabetic • Newly diagnosed • Edema • Gestational diabetes • No neuropathy • ABI >0.6 without claudication Diabetic patients a more likely to exercise when their legs feel good!
    36. 36. Diabetic Compression Sock Key Benefits: •Clinically proven to reduce swelling and improve circulation •American Podiatric Medical Association (APMA) Seal of Approval •Non-binding calf band •Flat toe seam •Extra padding on foot •DriRelease fiber blend for moisture wicking, odor control, and softness •Latex free •True graduated compression Compression Level: 18-25mmHg Style(s): Over the Calf Color(s): White Retail Price: $30-40
    37. 37. Diabetic-friendly Compression SockCushioned Cotton Key Benefits: •Diabetic-friendly •Non-binding calf band •Flat toe seam •Extra padding on foot •DriRelease fiber blend for moisture wicking, odor control, and softness •Latex free •True graduated compression Compression Level: 15-20mmHg & 20-30mmHg 15-20mmHg Style(s): Over the Calf Color(s): White & Black Shoe size, ankle & calf measurements20-30mmHg Retail Price: $30-60
    38. 38. Compression Consultation Points for the Diabetic Patient• Avoid diabetic compression socks upon development of: ▫ Severe arterial insufficiency ▫ Intermittent claudication ▫ Ischemia ▫ Weeping wounds ▫ Uncontrolled CHF• Seek physician consultation and approval to wear diabetic compression socks if neuropathy presents• Remove socks if they cause persistent pain to lower extremities and pain does not improve with activity
    39. 39. Compression Consultation Pointsfor the Diabetic Patient • Put on diabetic compression socks daily upon waking & remove at bedtime • Launder socks every night in a mild washing detergent • Diabetic compression socks will decrease LE edema & improve circulation to help legs & feet feel better • Moisturize feet daily before & after sock application with a foot cream to minimize dry, cracked skin
    40. 40. Compression Consultation Pointsfor the Diabetic Patient • When donning and doffing stockings, it’s best to wear gloves. • To don, do not bunch the garment like ordinary socks. • Use the ‘pull-on’ or ‘sock-puppet’ method to don graduated compression garments. • To doff the garment, pull off like a banana.
    41. 41. Foot Care Consultation Points • Wash feet daily with luke warm water • Dry feet and between toes well • Keep skin supple with moisturizing lotion • Use soft socks or stockings, which must neither be too big or small • Avoid walking bare-foot • Examine shoes daily for abnormalities/defects • A brisk walk daily stimulates circulation and makes patient feel betterPalaian S, et al. The Internet Journal of Pharmacology. 2005 Volume 4 Number 1. Available at: Accessed 05/04/12.
    42. 42. SIGVARIS Graduated Compression Socks … “It’s Medicine you Wear” Questions & Discussion
    43. 43. Thank You for Attending! Kimberly Simmons, PharmD, MBA US Pharmacy Relations Manager SIGVARIS Inc. 770-632-2571 (office) 770-632-2973 (fax)