November 2017 Issue 6
This blog provides a brief introduction to diabetes and the benefit of massage. It marks Tuesday 14 November – World Diabetes Day.
There are two types of diabetes:
Type 1 Insulin dependent diabetes Mellitus – where the pancreas produces little or no insulin. Despite there being a general genetic predisposition, onset can occur after a physical or emotional stressful episode. Diabetics with type 1 diabetes need to take regular injections of insulin and comprise around 15% of those with diabetes.
Type 2 Non-insulin dependent diabetes mellitus – where the bodies cells develop resistance to insulin despite the pancreas producing the hormone. The resistance to insulin means that cells are unable to transfer glucose from the bloodstream, blood sugars become elevated – the lack of energy in cells leading to fatigue. Type 2 diabetics comprise around 85% of those with diabetes.
Signs and Symptoms
Hyperglycemia – abnormally high blood glucose with symptoms of excessive thirst, hunger and urination. Onset can be gradual.
Hypoglycemia – abnormally low blood sugar with symptoms of irritability, sudden changes of mood, personality or behaviour, slow speech, confusion and poor attention. Low blood sugar can result from an increase in insulin, exercise and delayed meals. Onset is usually sudden and can become an emergency and be fatal if untreated.
High blood glucose for Type 1 can lead to complications due to the burning of fat tissues for energy producing an accumulation of ketones leading to more acidic blood with resultant symptoms of headache, nausea and fatigue. In Type 2 high blood glucose can result from stress caused by an infection resulting in fluid imbalance with dehydration, confusion and lack of consciousness.
Diabetes can also lead to serious chronic conditions such as cardiovascular plaque, nerve damage to the hands and feet, skin issues such as poor healing of wounds, infection and ultimately gangrene, impaired kidney function, thickening of connective tissue and poor immunity to infection.
Diabetic management includes long term aspects such as diet and exercise to maintain blood sugars within a normal range. Type 2 can be reversed with suitable diet and exercise. Type 1 requires regular injections of insulin.
Massage and diabetes
A massage therapist needs to conduct a very thorough preliminary consultation for those with diabetes as the range of severity can be very diverse. This ranges from well managed blood sugar levels with no complications, advanced complications (say, in terms of peripheral neuropathy) and/or poor blood sugar stability with the potential for an acute episode. It is important that current health, possible contraindications and ability to tolerate massage are clearly established. In general, the more advanced the diabetes the more contraindications there will be.
Should a low blood sugar episode occur during or immediately after massage then if it important to ensure that sweets or glucose are consumed; if little recovery after 10 minutes more sweets should be consumed; if no recovery after that then emergency medical help should be sought.
Massaging a local insulin injection site should be avoided within 1 hour of injection. Massage improves blood circulation and therefore the transport of blood sugar around the body – but unlike exercise it does not increase the utilisation of blood sugar.
A major potential complication is cardiovascular disease – heart disease, thinning of the coronary arteries and/or angina. Massage pressure should be adjusted accordingly particularly around the carotid arteries.
One complication of diabetes is potential loss of feeling – particularly in the hands and feet. This is often combined with poor blood circulation in the hands and feet. Massage pressure should be conservative with light pressure.
Another complication is thickening of connective tissue – massage, and myofascial release in particular, can greatly aid elasticity of the muscle tissues and connective tissues and improve the range of mobility.
Depression can arise from the stresses of constant management of diabetes. One study indicates that around 20% of diabetics can have clinical depression. Massage is a major help with relaxation – the release of endorphins calming the nervous system and therefore combating stress. The reduction in stress can assist in achieving control of blood sugar levels. Regular massage can help to alleviate the symptoms of depression.
Careful aftercare is essential for diabetic clients and it is important that a client should be encouraged to rest for a while following massage in the therapists premises to ensure that serious low blood sugar levels do not emerge.
Do you have diabetes? Massage can provide significant benefits to augment your existing diabetes management. Book a massage today on 07504 554936
Huang Y et al (2013) “Collaborative care for patients with depression and diabetes mellitus: a systemic review and meta analysis” BMC Psychiatry, 13:260 [Accessed 13 November 2017 https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-260]
Rose, Mary Kathleen (2003) “Diabetes” in Massagetherapy.com [Accessed 6 November 2017 http://www.massagetherapy.com/articles/index.php/article_id/96/Diabetes]
Walton, Tracy (2011) “Medical Conditions and Massage Therapy: A Decision Tree Approach” Lippincott Williams & Wilkins
The impact of diabetes can be serious – consult your doctor if you experience extreme, acute or prolonged symptoms.