IRAIDA ICAZA

THERAPEUTIC MASSAGE AND DIABETES

I had recently graduated from massage school in 1985, and was in the process of moving. Many factors in my life were in flux at the time, so I paid little attention to the physical symptoms that presented themselves over a period of several weeks. As these symptoms persisted--fatigue, excessive thirst and frequent urination--I knew I needed medical help.

Changes In Blood Glucose Levels
To date, more than a dozen different massage therapy interns have given massage in the diabetes clinic. More than 20 different diabetics have received massage, some receiving several sessions over a period of several weeks or months. It has been an enjoyable experience for all participants. Those receiving massage have reported greater levels of physical and emotional comfort after the session than before.

Because of blood glucose testing, we are getting some useful data on the changes that occur in blood glucose levels during massage. My preliminary observations are this: Massage therapy tends to lower blood sugar levels by approximately 20 to 40 points, other factors being equal. This is not a scientifically controlled study by any means. (A truly controlled study with Type 1 diabetics could be a near impossibility, since there are so many factors that influence blood sugar.) But by tracking blood glucose before and after the session, I can clearly demonstrate that blood sugars can and do change significantly in an hour, for whatever reason. 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. I teach this to my students as an important safety issue.

In the clinic, we noted changes of as much as a 100-point decrease in an hour, as well as a 100-point increase! The more dramatic decreases could be partly accounted for by recent injections of insulin, or by vigorous exercise in the hours prior to the massage session. The dramatic increases could be due to the failure of the client to take his or her required dose of insulin. Or they may have eaten food not covered by adequate insulin. But as stated earlier, moderate drops of 20 to 40 points were the norm.

The student interns giving the massages were surprised by these changes in blood sugar levels. So were some of the diabetics. Seeing the numbers helped impress upon both interns and diabetics the importance of blood glucose testing. 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.

When people with diabetes receive repeated sessions, they can begin to understand their own patterns of response to massage, and plan accordingly. For example, I know that I tend to drop around 40 points during a relaxing session of massage. So if I am 100 points or less before the session, I'll drink a small glass of juice beforehand, or maybe have it in the room to drink during the session. If I have a reading ranging from 140 to 160 points, I will eat nothing, knowing I will drop into a more desirable range during the session. If higher than 160 points, I may take an extra injection of insulin, being careful to account for the likely drop due to massage. Sometimes I have observed the blood glucose lowering effect of the massage lasts for several hours. It is wise to continue with regular testing.

My example is only one. Each diabetic may have a different response. And often, even for the experienced recipient of massage, changes can be unpredictable. Again, I emphasize the importance of blood glucose monitoring.

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. The massage therapist also may want to further study some of the complications of diabetes, and adapt techniques accordingly. For example, if a diabetic has peripheral neuropathy (damage to the small nerves of the hands and feet), he or she may be very sensitive to touch, or may experience numbness in the extremities. It is best to use techniques of comfort touch, a nurturing form of acupressure. (See The Gift of Touch listing in the Bibliography at the end of this article.) 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.

Always listen to the feedback of the clients. Ask them for what they need and enjoy. Note changes that occur during the massage sessions, and note changes that occur over time. Always be willing to learn from your clients, encouraging them in good diabetes self-care. Massage can give a wonderful psychological boost to someone who is living with this chronic disease and striving to balance all the factors involved in maintaining a healthy lifestyle--proper nutrition, adequate exercise, blood glucose monitoring, appropriate use of medications and stress management.

•••

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. She can be reached at: 303-449-3945, or at: rosevine@comforttouch.com.

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.

Additional Resources

American Diabetes Association: 800-Diabetes or 888-342-2383 (press "0" for access to local resources); or [www.diabetes.org].

Good source of books, products, diabetes information, free newsletter and Web links: [www.diabetesnet.com].

Online version of magazine, links to numerous resources: [www.diabetes-self-mgmt.com].

Online magazine, free newsletter: [www.diabetesinterview.com].

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