Diabetes is a disease of impaired carbohydrate metabolism, which results from inadequate production or utilization of the hormone insulin. This vital substance is necessary to convert food into energy, by facilitating the transfer of glucose (sugar) from the bloodstream into the body's cells. Of the 16 million people in the United States with diabetes, most have a genetic predisposition to the disease, and can be categorized into one of the following types:

Type 1 Diabetes (Insulin Dependent Diabetes Mellitus, or IDDM): Affects 10 to 15 percent of the total number of diabetics. Because of damage to the insulin-producing islet cells of the pancreas, little or no insulin is available. Often, the onset of the disease occurs following significant physical or emotional stress, usually in childhood or early adult life. These individuals must take regular injections of insulin.

Type 2 Diabetes (Non-Insulin Dependent Diabetes Mellitus, or NIDDM): Affects more than 85 percent of the total number of diabetics, and is more prevalent in the older population. In these people, the pancreas is producing insulin, but the cells that use insulin are resistant to it. Type 2 diabetics may take one or more oral medications designed to decrease insulin resistance or enhance the cells' sensitivity to insulin. They may also need to take insulin by injection.

Symptoms: While the types have different pathologies, they have the same common symptom--high levels of glucose in the blood. Essentially, the cells become starved for energy, so the person is fatigued. Excess sugar spills into the urine, causing frequent urination and excessive thirst. The disease can be diagnosed with a simple blood test to determine the blood glucose level.

Complications: Over time, elevated glucose levels lead to complications of the disease, by causing damage at the cellular level. Cells especially prone to damage are in the eyes, kidneys, heart, blood vessels and nervous system. Without good blood sugar control, the diabetic becomes more vulnerable to retinopathy, neuropathy, as well as kidney and heart disease. Other changes may occur in the connective tissue of the body, leading to thickening or stiffening of the fascia surrounding the muscles and organs.

Treatment: Treatment of diabetes involves normalization and maintenance of healthy blood glucose levels. The diabetic must be conscientious to maintain near-normal blood glucose levels (80 to 120 mg/dl) by balancing nutrition, exercise, appropriate use of medications (insulin or oral medications), and management of stress. Diabetics use test strips and monitors to determine their blood glucose levels (BGs). If the BGs are low, they can eat or drink carbohydrates to bring them back into the normal range. If they are high, they may need to inject more insulin, or otherwise adjust their treatment.

Massage Benefits

Relaxation: By calming the nervous system, massage can bring a much-needed rest and an assuring sense of well-being to the body. Skillfully applied touch can have a profound effect on body chemistry, decreasing the production of stress hormones, with resulting beneficial effects to blood sugar levels.

Circulation: Improved circulation allows for more efficient uptake of insulin by the cells. Circulation is often impaired in diabetics due to the damaging effects of elevated blood sugar levels on the cells of the body. Massage of the hands and feet can be particularly beneficial.

Myofascial effects: Massage works directly with the muscles (myo) and connective tissues (fascia), helping to facilitate greater mobility in the body. This is especially important for the diabetic because elevated blood sugars cause a thickening of connective tissue, which in turn affects mobility and elasticity of the myofascial system. Stress hormones also contribute to chemical changes in the connective tissue, causing stickiness between the layers of fascia. Massage therapy can significantly counter this effect. Range of motion, stretching and regular exercise are also important to help encourage flexibility and health of the myofascial system.

Observations have Shown… preliminary observations are this: Massage therapy tends to lower blood sugar levels by approximately 20 to 40 points, other factors being equal. Occasionally extreme changes in blood sugar have been noted, as much as 100-point increase or decrease in an hour.

This is very important information for massage therapists who need to be alert to the dramatic changes that can occur in the blood glucose levels of diabetics during massage therapy.

Naturally, people tend to be relaxed and sometimes a little disoriented after receiving a massage. It is imperative that the possibility of a serious low blood sugar be ruled out before a client is allowed to leave the premises.

Safety Concerns: As noted above, changes in blood glucose levels can and do occur when people with diabetes receive massage. These changes may happen, regardless of massage. But because of the relaxing nature of massage, and the somewhat altered state of awareness that can occur, a drop in blood sugar can be difficult to notice. Some diabetics can tell when their sugar level is dropping. Others experience what is called hypoglycemic unawareness, in which they are not aware of a serious drop in blood sugar. Even people who usually are aware can occasionally experience hypoglycemic unawareness. Hypoglycemia (low blood sugar) is a serious condition and can lead to unconsciousness and, rarely, death.

Due to the frequent unpredictable nature of the disease, it is important for the massage therapist to recognize the signs and symptoms of hypoglycemia. Any one or more of these symptoms may occur:

• Excessive sweating (skin may feel clammy);
• Faintness or headache;
• Unable to awaken;
• Certain spaced-out tendencies--the person may talk or move very slowly, or not be able to speak coherently;
• Irritability;
• Change in personality;
• Rapid heartbeat

The therapist can ask the person how he feels. Does he seem fully cognizant when questioned? If there is any doubt, be prepared to treat the client. Treatment is simple. If blood sugar is low, the diabetic needs sugar fast! This may be in the form of fruit juice, honey, a sugary drink or glucose tablets, if you have access to them. (Many diabetics carry glucose tablets with them.) These forms of sugar all act quickly to raise the blood glucose levels. A cup of juice or sweet drink, or the equivalent of 15 to 20 grams of carbohydrate (read the jar or can), will be sufficient to raise the blood glucose to a safe level. Changes will be noted in the diabetic within minutes. It is wise, then, to make sure the diabetic is feeling better before leaving. He may need to eat more, or to test blood sugar again after awhile.

Some Further Advice
With awareness of these precautions, massage can be safely enjoyed by the person with diabetes. Learn about the complications from Diabetes, and adapt massage techniques accordingly. For example, if a diabetic has peripheral neuropathy, he or she may be very sensitive to touch, or may experience numbness in the extremities. It is best to use techniques acupressure or comfort touch. In this approach to massage, broad, direct pressure is applied to the part of the body being touched. Where there is impaired circulation, this is less likely to cause further discomfort or damage than strokes, such as petrissage, deep effleurage or friction.

There are many different forms of massage and bodywork, which, I believe, can be helpful for the person with diabetes. In our diabetes massage clinic, the massage therapy interns used primarily techniques from Swedish, integrative therapeutic massage and comfort touch. Other techniques that I employ in my private practice, or have enjoyed receiving, include: shiatsu, acupressure, body energy therapies, polarity balancing, manual lymph drainage, therapeutic touch, deep tissue therapy, reiki and CranioSacral® Therapy.

Compiled by - Sara H., L.M.T.

Massage Therapy Journal; Winter 2002

Title: Therapeutic Massage And Diabetes
Author: Rose, Mary Kathleen
Issue: WI02
Page Number: 80
Volume: 40:4

Article by - Mary Kathleen Rose is a licensed massage therapist with a B.A. in integrative healing. She has been actively involved in the holistic health field for more than 25 years, teaching massage and wellness education in massage schools and medical settings. She is the developer of Comfort Touch, a style of massage appropriate for the elderly and ill, and is the supervisor of the massage therapy program at Hospice of Boulder County in Boulder, Colorado. She is a founding member of the Boulder Valley Diabetic Support Group, which has provided education and support for diabetics and their families since 1987.

Bibliography
Rose, Mary Kathleen. The Gift of Touch--Comfort Touch: Massage for the Elderly and the Chronically Ill. Boulder, Colorado: Hospice of Boulder County, 1996.

Thomas, Clayton (editor). Taber's Cyclopedic Medical Dictionary, 17th Edition. Philadelphia: Davis Company, 1993.

Walsh, John, Ruth Roberts and Lois Jovanovic-Peterson. Stop the Rollercoaster: How to Take Charge of Your Blood Sugars in Diabetes. Torrey Pines, California: Torrey Pines Press, 1996.