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Diabetes and Massage
Massage Uses
Diabetes has been called an epidemic in the United States. According to the American Diabetes Association,
The Extent of Diabetes:
- 7 percent of the population have diabetes
- 20.8 million people have diabetes
- 14.6 million diagnosed with diabetes
- Estimated 62 million undiagnosed.
- Estimated 41 million people with pre-diabetes
elevated blood-glucose level
at risk for developing the disease
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There were 1.5 million new cases diagnosed in 2005
With diabetes' growing prevalence, it's important that massage therapists possess basic understanding of the disease and know what to do in case a client experiences hypoglycemia.
Types of Diabetes
Diabetes is a disease of impaired glucose metabolism, which results from inadequate production or utilization of the hormone insulin, a vital substance necessary to convert food (primarily carbohydrates) into energy. Insulin facilitates the transfer of glucose (sugar) from the bloodstream into the body's cells. The disease is primarily diagnosed by the presence of abnormally high levels of glucose in the blood. The cells become starved for energy, so that the person becomes fatigued. Excess sugar spills into the urine, causing frequent urination and excessive thirst, which are the most common symptoms of the disease.
Over time, elevated blood-glucose levels lead to complications of the disease, causing damage at the cellular level. Cells especially prone to damage are those in the eyes, kidneys, heart, blood vessels and nervous system. Without good blood-sugar control, the diabetic becomes more vulnerable to retinopathy, neuropathy, and kidney and heart disease. There are also changes in the connective tissue, primarily thickening or stiffening of the fascia surrounding the muscles and organs. Most people affected by this disease have a genetic predisposition to one of the following types:
Type 1 diabetes (insulin-dependent diabetes mellitus, or IDDM)
This affects approximately 10 percent of the total number of diabetics. Because insulin-producing islet cells of the pancreas are damaged or destroyed, the individual becomes dependent on insulin from either regular injections or use of an insulin pump (a battery-driven device that pumps insulin into the abdominal wall). Though it is a genetic disease, the onset may be triggered by physical or emotional stress. It tends to develop at an earlier age than Type 2 diabetes, but age is not the determining factor for diagnosis.
Type 2 diabetes (non-insulin dependent diabetes mellitus, or NIDDM):
Affecting approximately 90 percent of total diabetics, this type is most prevalent in people over the age of 40. In these diabetics, the pancreas is producing insulin, but the cells that use insulin are resistant to it. Type 2 diabetics may take oral medications designed to decrease insulin resistance or enhance the cells' sensitivity to insulin. Some also need to take insulin. Often lifestyle measures, such as losing weight and/or increasing exercise, improve insulin's efficiency.
Though much less common, other types of diabetes have characteristics of either Type 1 or Type 2. Also, there is a significant trend toward greater numbers of children with Type 2 diabetes, with a particular link to excessive weight and a sedentary lifestyle.
Several factors are involved in maintaining good diabetic control. The non-diabetic individual maintains blood-glucose levels of 80 mg/dl to 120 mg/dl, no matter what her food intake or level of exercise. The goal in diabetes management is to approach this range:
Diabetes Management Steps
- monitoring to determine blood-glucose levels (BGs)
- Appropriate medication (insulin for Type 1 or oral medication for Type 2)
- Controlled caloric intake (particularly of carbohydrates)
- Regular exercise (which increases insulin's efficiency)
- Stress management. (Stress hormones interfere with insulin's efficiency, perpetuating a vicious cycle.)
If the Blood Glucose Levels are high, they may need to inject more insulin or otherwise adjust their treatment. If the BGs are low, they can eat or drink carbohydrates to bring them back up to the normal range. Learning to manage diabetes successfully is an ongoing process, requiring commitment as one learns to adapt to one's own individualized medical regimen.
Relaxation Massage and Diabetes
The most significant benefit of massage for the diabetic is relaxation. Living with diabetes is inherently a stressful condition, as one adjusts to the practical demands of balancing intake of insulin or oral medications with blood-glucose monitoring, nutrition and exercise. Worry about complications can add to the level of stress. Skillfully applied touch can have a profound effect on body chemistry, decreasing the production of stress hormones with resulting beneficial effects to blood-glucose levels. By calming the nervous system, massage can bring a much-needed rest and an assuring sense of well-being to the body.
Massage encourages a more physical approach to life and a higher interest in diet and exercise. Massage therapy can put you in touch with your body, and helps recognize signs of change relating to diabetes. "I feel that the massage reminds me of how my body can feel with-out stress—with full mobility. It energetically wakens me so I can do all the things I need to do."
In 1997 Diabetes Spectrum, the journal of the American Diabetes Association, published a study "Massage therapy lowers blood-glucose levels in children with diabetes mellitus." The study involved 20 diabetic children who were randomly assigned to a touch-therapy or relaxation-therapy group. Either therapy was provided by the parents for 20 minutes before bedtime each night for 30 days. The immediate effects of the touch therapy were reduced parent anxiety and depression, and reduced child anxiety, fidgetiness and depression. Over the 30-day period, compliance with insulin and food regulation improved and blood-glucose levels decreased from 159 to within the normal range of 121.
Massage, Circulation and Diabetes
Massage helps to increase local circulation of blood and lymph, thereby facilitating the process of nourishing the body on a cellular level. This can help promote wound-healing potential in surface tissues. Some people have been concerned that massage can speed the uptake of insulin at the injection site. This concern is largely unfounded, because insulin is usually injected into the subcutaneous tissue where it diffuses slowly into the bloodstream. Even vigorous massage would have less effect on the circulation of insulin than if the person went for a short walk. Also, most diabetics injecting insulin use a combination of slow-acting insulin to cover basal (back-ground) metabolism, and faster-acting insulin to cover mealtimes. Those using the insulin pump can control the rate that insulin is infused into the body.
Massage Therapy and Myofascial affects of Diabetes
Elevated blood sugars cause a thickening of connective tissue in the diabetic individual, which in turn affects mobility and elasticity of the myofascial system. This can be noted in general levels of stiffness in the muscles, tendons and ligaments, as well as decreased range of motion in the joints. 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. Massage works directly with the muscles and connective tissues in the body, helping to facilitate greater mobility in the body. Range of motion exercise and stretching are also important to help encourage flexibility and health of the myofascial system.
Cautions and considerations
Preferences for massage vary among the diabetic population, as in the general population. While massage is a worthwhile aspect of complementary health care for the diabetic who is free of complications, there are precautions to take for the client who suffers from complications from the disease. One of these concerns involves peripheral neuropathy, a condition involving damage to the motor nerves. The client suffering from this condition may experience pain, tenderness or numbness in the feet. Pressure can cause mild to extreme discomfort. Slow, broad, encompassing compression of the feet can bring relief. Pressure that is too light or too fast will be ticklish or irritating. If the client is extremely ticklish it may be best to work through socks. It is important to work with the client's feedback.
Carol, 44, has been a Type-1 diabetic for 36 years, and has some advice for massage therapists.
She receives massage for relief from stress and from chronic pain and stiffness in the neck and shoulders, as well as to improve circulation and mobility. Not only is it important to ask about the comfort of the techniques used, she says, "but ask about the client's comfort in general. For example, I hate using a face cradle and prefer putting a soft pillow under my chest and resting my forehead on a small rolled up towel, or turning my head to the side. I breathe easier that way." She emphasizes that good communication and a respectful attitude are essential to the experience of a worthwhile massage. This involves attention to other client needs, such as preferences involving warmth, choice of lotions and music.
Carl is also one of the increasing number of diabetics who use an insulin pump. She cautions massage therapists to avoid getting massage oil on the pump or it's tubing, or the infusion site. Other diabetics give injections in various parts of the body, including the abdomen, gluteal area, legs or arms. Occasionally, you may notice some localized bruising. Generally, this is not a problem, but ask the client if she prefers you not massage an injection site.
Diabetics may have other issues involving impaired circulation, resulting in ulcers or damage to the tissues, often in the extremities. Avoid any pressure on sores, open wounds or areas of bruising. For complications involving ligaments, tendons or joints, avoid using deep pressure or excessive movement. Rather, work slowly, allowing gentle movement according to the client's preference. The warmth of full-hand contact, which emphasizes contact with the palmar surface of the hand, can bring soothing relief to stiff muscles and fascia.
For clients with serious complications from diabetes, a nurturing form of acupressure massage for working with the elderly and the ill is recommended. Along with appropriate techniques, it emphasizes the importance of a respectful, non-judgmental attitude, coupled with the intention to offer comfort. This approach works whether the client is relatively active and robust, able to tolerate conventional massage, or seriously affected by complications of the disease.
Massage and Diabetes Health Care
Having diabetes is a full-time job, requiring attention and care on a daily basis. Massage provides a wonderful way to support individuals living with this chronic condition.
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