Diabetes, a group of diseases marked by high levels of blood glucose, affects 25.8 million people in the United States, or 8.3 percent of the population. One in four over the age of 65 and one in seven people between the ages of 45–65 have been diagnosed with the disease,1 and 79 million people have pre-diabetes.2 Chances of seeing a diabetic client in your massage and bodywork practice are almost certain.
For somatic therapists, it is helpful to understand the disease and its complications, to be prepared for the symptoms that might present with a diabetic client, and to address the symptoms that prevent people from being active or making healthy choices. According to the literature, the potential for delaying the onset of diabetes and its associated conditions is great.3 For optimal success, clients and their health-care team must work together to develop a treatment plan and self-care regimen. As one study says, “CAM encounters may provide opportunities to coordinate health promotion and prevention messages with patients and primary care providers.”4
Background
Diabetes is a condition resulting from defects either in the production of insulin or in the action of insulin, or both. Type 1, previously known as juvenile onset or insulin-dependent diabetes, is an autoimmune disease where the body’s immune system destroys insulin-producing pancreatic beta cells. People with type 1 diabetes must take synthetic insulin by injection or pump. There are no known ways to prevent or cure type 1 diabetes, but much can be done to prevent or minimize the complications of the disease. Fortunately, only 5–10 percent of the diabetic population has this form of the disease.5
Previously called adult-onset diabetes, type 2 diabetes accounts for 90–95 percent of all diagnosed cases. Type 2 usually begins as insulin resistance, a disorder where the cells do not use the insulin properly, and the pancreas gradually loses its ability to produce insulin. Type 2 has the most potential for prevention or delay through lifestyle modifications that decrease the demand for insulin by limiting the glucose burden and lowering blood glucose levels, such as diet and exercise, oral medication, or injections. Other forms of diabetes, such as gestational diabetes, account for the remaining 1–5 percent of diabetics.6
Complications of Diabetes
The risk of death for people with diabetes is about twice that of people of similar age without diabetes. Medical expenses for people with diabetes are more than two times higher than those without the disease, accounting for $116 billion in direct medical expenses, and $58 billion in indirect expenses such as disability, loss of work, and premature death.7
About 67 percent of people with diabetes have heart disease or high blood pressure. The risk for stroke is 2–4 times higher, depending on age. Diabetes is the leading cause of kidney failure and new cases of blindness among adults. About 60–70 percent of people with diabetes have mild to severe forms of nervous system damage, and about 30 percent have severe periodontal disease. Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5–10 percent of pregnancies and spontaneous abortions in 15–20 percent of pregnancies.8 People with diabetes are more likely to die from influenza or pneumonia and twice as likely to have depression, and their activity levels are less than those of similar age without diabetes.
Curbing Diabetes and Related Diseases
The good news is current research is showing that various lifestyle changes can prevent or delay the onset of type 2 diabetes by 58–71 percent, depending on age. These interventions are feasible, cost-effective, and successful across ethnic and racial groups, and have been shown to persist for at least 10 years.9 In those who are beyond the pre-diabetic stage, the severity of the disease can be reduced and preventative care can limit the complications and onset of associated diseases such as cardiovascular, kidney, nerve, and periodontal disease.
According to WebMD,the top seven ways to prevent or delay diabetes or its complications are:
• Exercise.
• Lose weight.
• See your doctor more often.
• Eat a healthy diet.
• Get support and get informed.
• Make sleep a priority.
• Upgrade your outlook.10
How does massage fit in? Let’s look at the research and what we know to be true about the benefits of massage and bodywork.
Exercise
People age 60 or older with diabetes are 2–3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, or do housework compared to people without diabetes.11 Exercise may be limited in this population and others due to pain, loss of balance, or limited flexibility. Massage therapy has been shown to reduce pain and improve flexibility and balance, encouraging an increase in activity.12
Lose Weight/Eat a Healthy Diet
A diabetes prevention trial found that people who did 30 minutes a day of moderate exercise and lost 5–7 percent of their body weight were able to cut their odds of getting diabetes by 58 percent.13 Nutritional consultations and advice on healthy eating habits are not within the scope of practice of most somatic therapists. However, as shown in Elizabeth Summers’ WIN-WIN Hands On project, massage therapy was effective when combined with nutritional consulting and exercise in increasing the body awareness and enhancing the body image of obese adolescent girls to better enable them to make healthy choices about diet and exercise.14
See Your doctor More Often
Many conditions associated with diabetes require regular monitoring. Early detection can save teeth and eyesight, and prevent amputations of the feet and hands. For example, sores that may heal quickly on the foot of a person without diabetes can often become ulcerated and eventually infected in the diabetic client, potentially leading to necrotic tissue that requires amputation. Somatic therapists in contact with the skin can spot sores on the feet that may otherwise go unnoticed. We can teach healthy foot-care habits such as self-massage and the application of topical foot creams and gels, both of which increase blood flow and nerve function to the feet.15 Foot ulcers due to ischemia are caused by peripheral artery disease (PAD), common on the edges of the feet—toes and heel—or are the result of neuropathy, common on the plantar surfaces of the feet.16
Manual lymphatic drainage was found to improve joint mobility, reduce swelling, and improve chronic ulcerated lesions.17 Foot massage can reduce neuropathy, ischemia, and swelling, as well as speed healing, and identify sores and calluses that, if left untreated, may lead to serious complications.18
Blood pressure control can reduce blindness, heart disease, hypertension, kidney failure, vascular disease, and neurological disease. Massage therapy has been shown to reduce systolic and diastolic pressures, increase oxygen saturation, reduce heart rate, and improve arterial pressure and skin blood flow.19 A combination of exercise and massage has been shown to improve arterial blood flow and ankle-brachial index in patients with PAD.20
Get Support and Get Informed
Emotional support is important for any chronic disease. As discussed earlier, people with diabetes are twice as likely to suffer from depression and anxiety, which can complicate the management of diabetes. Massage therapy has been found to reduce depression and anxiety, encouraging more social behavior and increasing activity levels.21
Blood glucose levels and blood pressure readings provide information that can motivate a person with diabetes to make better choices, especially if they know the complications that may result from poor numbers. Know what these numbers mean to your treatment plan. Blood sugars can drop with massage, similar to exercise. Keep fruit juice handy, or ask the client if they carry glucose tablets with them. Make sure blood sugars are within the normal range or higher before the session begins. Blood pressure has also been shown to drop with massage. When blood pressure is below normal, people can feel lightheaded and dizzy. Ask clients to sit up slowly before standing up to make sure they can get off the table safely.
Make Sleep a Priority
Lack of sleep increases stress hormones in your body, which causes the body to store fat and makes it hard to lose weight. It also interferes with the body’s ability to use insulin effectively, and may be a risk factor to diabetes.22 Massage therapy has been shown to improve sleep in several studies and is preferred over relaxation tapes as a sleep aid.23
Upgrade Your Outlook
A positive attitude is an important component in managing any chronic condition. Studies demonstrate that a person’s habitual outlook on life and their ability to sustain positive emotions in the face of adversity or stress (what psychologists call psychological resilience) can make a dramatic difference in their experience of chronic conditions.24 Being a cheerleader for our clients is one way we can contribute to their overall health.
Summary
A client with diabetes is likely already a regular in your practice. Learn about the disease and how massage can assist in preventing or delaying its complications. Have the client monitor blood glucose and blood pressure, while you document symptoms that may point to complications of diabetes, such as nerve pain, numbness, tingling, swelling, range of motion, and conditions of the feet. Provide massage that can improve function, digestion, circulation, and nerve flow. Keep a positive attitude, encourage social activities, and support the physician’s plan for care.
Notes
1. Centers for Disease Control (CDC), “2011 National Diabetes Fact Sheet: Diagnosed and Undiagnosed Diabetes in the United States,” accessed November 2011, www.cdc.gov/diabetes/pubs/estimates11.htm.
2. American Diabetes Association, “Diabetes Statistics,” accessed November 2011, www.diabetes.org/diabetes-basics/diabetes-statistics.
3. CDC, “2011 National Diabetes Fact Sheet: General Information,” accessed November 2011, www.cdc.gov/diabetes/pubs/general11.htm#what.
4. C. Hawk, H. Ndetan, and M.W. Evans Jr., “Potential Role of Complementary and Alternative Health Care Providers in Chronic Disease Prevention and Health Promotion: An Analysis of National Health Interview Survey Data,” Preventive Medicine (July 13, 2011).
5. WebMD, “Type 1 Diabetes,” accessed November 2011, http://diabetes.webmd.com/guide/type-1-diabetes.
6. CDC, “2011 National Diabetes Fact Sheet: General Information.”
7. CDC, “2011 National Diabetes Fact Sheet: Diagnosed and Undiagnosed Diabetes in the United States.”
8. Ibid.
9. CDC, “2011 National Diabetes Fact Sheet: General Information.”
10. WebMD, “Prediabetes: 7 Steps to Take Now,” accessed November 2011, http://diabetes.webmd.com/features/prediabetes-diagnosis-what-to-do.
11. CDC, “2011 National Diabetes Fact Sheet: Diagnosed and Undiagnosed Diabetes in the United States.”
12. J. Vaillant et al., “Massage and Mobilization of the Feet and Ankles in Elderly Adults: Effect on Clinical Balance Performance,” Manual Therapy (2009). doi:10.101.
13. WebMD, “Prediabetes: 7 Steps to Take Now.”
14. Massage Therapy Foundation, “Community Service Grants,” accessed November 2011, http://www.massagetherapyfoundation.org/grants_community.html.
15. M.Y. Zhao and H. Chang, “Effect of Medicated Bath Plus Acupoint Massage on Limbs in Treating 42 Patients with Diabetic Peripheral Neuropathy,” Zhongguo Zhong Xi Yi Jie He Za Zhi 26, no. 11 (November 2006): 1,026–8; T. Fields, “Hand Pain is Reduced by Massage Therapy Plus Biofreeze,” Proceedings of the 13th Annual Thera-Band Research Advisory Committee (San Francisco, California, July 2011).
16. S. Vuorisalo, M. Venermo, and M. Lepäntalo, “Treatment of Diabetic Foot Ulcers,” Journal of Cardiovascular Surgery (June 2009): 275–91.
17. J.M. Pereira de Godoy, D.M. Braile, and M. de Fátima Guerreiro Godoy, “Lymph Drainage in Patients with Joint Immobility Due to Chronic Ulcerated Lesions,” Phlebology 23, no. 1 (2008): 32–4.
18. Vuorisalo, “Treatment of Diabetic Foot Ulcers,” 275–91; A.M. Castro-Sánchez et al., “Connective Tissue Reflex Massage for Type 2 Diabetic Patients with Peripheral Arterial Disease: Randomized Controlled Trial,” Evidence-based Complementary and Alternative Medicine (November 23, 2009); Pereira de Godoy, “Lymph Drainage in Patients with Joint Immobility Due to Chronic Ulcerated Lesions,” 32–4; M. Mars, Y. Desai, and M.A. Gregory, “Compressed Air Massage Hastens Healing of the Diabetic Foot,” Diabetes Technology and Therapeutics 10, no. 1 (February 2008): 39–45.
19. A.M. Castro-Sánchez, “Connective Tissue Reflex Massage for Type 2 Diabetic Patients with Peripheral Arterial Disease: Randomized Controlled Trial.”
20. A.M. Castro-Sánchez et al., “Efficacy of a Massage and Exercise Programme on the Ankle-Brachial Index and Blood Pressure in Patients with Diabetes Mellitus Type 2 and Peripheral Arterial Disease: A Randomized Clinical Trial,” Medicina Clinica 134 no. 3 (February 2010): 107–10.
21. M.C. Reid et al., “Self-Management Strategies to Reduce Pain and Improve Function Among Older Adults in Community Settings: A Review of the Evidence,” Pain Medicine 9, no. 4 (2008): 409–424.
22. WebMD, “Prediabetes: 7 Steps to Take Now.”
23. N.S. Gooneratne, “Complementary and Alternative Medicine for Sleep Disturbances in Older Adults,” Clinics in Geriatric Medicine 24 (2008): 121–138.
24. Cornell University, “Study Finds that Positive Outlook on Life Eases Chronic Pain,” accessed November 2011, www.news.cornell.edu/stories/Jan11/PainPositiveEmotions.html.
A licensed massage practitioner since 1984, Diana Thompson has created a varied and interesting career out of massage: from specializing in pre- and postsurgical lymph drainage to teaching, writing, consulting, and volunteering. Her consulting includes assisting insurance carriers on integrating massage into insurance plans and educating researchers on massage therapy theory and practice to ensure research projects and protocols are designed to match how we practice. Contact her at soapsage@comcast.net.