Diabetes Mellitus, or diabetes, is a condition where your body cannot control the levels of glucose (sugar) in the blood. Your body either does not make enough insulin (the hormone that removes sugar from the blood) or does not use insulin correctly and blood sugar remains high. When this happens, your kidneys make a large amount of urine to remove the excess blood sugar, resulting in frequent urination.
10 Symptoms of Diabetes
Common symptoms of diabetes can include:
- Frequent urination
- Excessive thirst
- Dry mouth
- Itchy skin
- Vision problems
- Yeast infections
- Slow healing wounds
- Pain in the feet and legs
Being overweight or obese and leading a sedentary lifestyle are major factors that contribute to higher risk of diabetes. There is also an increased risk for those over age 45, and certain ethnic groups such as Latinos, African-Americans, Native Americans, Asian-Americans, and Pacific Islanders.
Gestational diabetes is a specific type of diabetes brought on by the physical demands of pregnancy and will often resolve after giving birth. If a client has been diagnosed with gestational diabetes, they will need to work closely with their physician to manage the remainder of the pregnancy.
Diabetes, Peripheral Arterial Disease, and Massage
A common problem for those with diabetes is peripheral arterial disease (PAD). PAD is the result of narrowing of arteries, typically in the lower limbs (legs), causing circulation problems and constrictive pain in the legs and feet. Diabetes is a major cause of PAD because it reduces the ability of the arteries to relax and limits vasodilation. Massage, specifically massage of the connective tissue, has been shown in studies to reduce these symptoms and increase blood circulation to the musculature. Skin temperature, oxygenation and vasodilation were increased in the legs and feet.
Diabetic neuropathy can often result from peripheral arterial disease, resulting in pain, burning, itching, tingling, restless legs and a loss of reflexes. In a review of massage therapy used for diabetic patients, it was found that neuropathy symptoms where significantly reduced after receiving massage.
A related problem from diabetes is the loss of balance resulting from peripheral arterial disease and diabetic neuropathy. A 2015 Thai study demonstrated a significant improvement of balance and increase in foot flexibility and range of motion (ROM) of the feet, along with improved sensation and reduced peripheral neuropathy.
In addition, those who received massage had lower levels of anxiety and depression resulting from the difficulties associated with diabetes. In fact, in children and adults who maintained a healthy weight and had controlled blood sugar, massage therapy was shown to reduce the base levels of blood glucose in diabetic patients.
Massage therapy has long been proven to increase circulation, a common problem for those with diabetes. Because of the damage to cardiovascular system, diabetes often results in swelling in the lower limbs. The increase in circulation from massage aids in reducing edema and increasing blood and lymph return.
The high blood sugar from diabetes can also result in a thickening of the connective tissue throughout the body, causing a decrease in flexibility and all-over pain. Massage, especially friction massage, has a demonstrated ability to restore myofascial flexibility and elasticity, a significant benefit to those with diabetes.
Precautions for Working with Diabetic Clients
Clients with diabetes may be suffering from neuropathy because of peripheral arterial disease and vascular damage. They may experience either pain, burning, or numbness in their limbs, especially in their legs and feet. For this reason, it is important that the therapist works with light to medium effleurage with light, gentle friction as necessary. It is important to check in regularly with these clients and at the beginning of each session, take a few moments to rate their PAD and neuropathy symptoms before you begin working.
Also, because massage therapy can actually result in reduced blood sugar, it is important that clients with diabetes test themselves after their massage to ensure their sugar remains stable. It is also critical that the therapist is familiar with the signs of hypoglycemia, in case the client is unable to recognize the need to adjust their medications or sugar intake to remain healthy.
Understand, too, that a client with diabetes who is suffering from neuropathy may have intense symptoms one week and require extremely light pressure, and have few symptoms during the next session and want much deeper work. It is imperative to check in every time you see a client with diabetes, as well as throughout the session, to ensure the client is not in undue pain.
Massage therapy is an excellent way to reduce stress, anxiety and depression, along with physical pain. It has been proven to improve sleep and help in coping with stress, illness and pain from a variety of physical conditions. All the benefits of massage apply to those with diabetes, along with the added benefit of improved neuropathy symptoms, reduced blood sugar, better balance and foot flexibility, and improved circulation.