El Paso has a higher percentage of diabetic residents than any other city in the U.S. Further south, in Cameron County, Texas, one in three residents is living with diabetes.
These statistics reflect the growing problem of Type-2 diabetes diagnoses blanketing the state of Texas.
While 9.4 percent of the overall U.S. population has diabetes, the figure is higher in Texas, where about 2,841.723 people—or 14.2 percent of the population—is diabetic, according to statistics released in April.
As a massage therapist, your hands contain the power to assist the diabetic client.
According to this article on massage and diabetes by massage educator Julie Goodwin, LMT, massage therapy temporarily increases circulation to the extremities, encourages effective peristalsis, relieves pain and encourages the relaxation response—all effects that your fellow Texans can benefit from.
Massage and Diabetes
There is good reason why the American Diabetes Association calls diabetes “a growing epidemic with a devastating physical, emotional and financial toll on our country.”
The incidence of Type II diabetes in America has skyrocketed in recent decades: In the late 1950s, only 1 percent of the U.S. population was diagnosed; today, nearly 10 percent of Americans have been diagnosed with Type II diabetes, according to the U.S. Centers for Disease Control and Prevention (CDC), and it is suspected that many more people go undiagnosed.
At least 27 million Americans have Type II diabetes, according to the CDC, and it therefore accounts for more than 90 percent of all diabetes diagnoses, making it one of the most common—and costly—preventable health conditions in the country.
Massage therapy has many benefits for a client with Type II diabetes, as it temporarily increases circulation to the extremities, encourages effective peristalsis, relieves pain and encourages the relaxation response.
It is vital for client safety, however, that cautions and contradictions are understood and respected, that certain assessments are performed, and that complications created by diabetes are addressed in the treatment plan.
More information about massage for diabetic clients is detailed later in this article; for now, we will look at characteristics of diabetes and traditional challenges and care experienced by the Type II diabetic client.
Characteristics of Diabetes
To understand how diabetes affects the person diagnosed, it’s helpful to review some basic information about hormone actions and the terminology that describes some of the characteristics of diabetes.
Glucose is a simple sugar that serves as the major energy source for living cells. It is transported in blood to all the cells of the body. Cells cannot function without glucose, but excess glucose can cause cell death.
Insulin is a hormone produced by beta cells in the pancreas. Insulin is secreted into the bloodstream to lower excessive blood levels of glucose.
Glucagon is a hormone produced by alpha cells in the pancreas. Glucagon is secreted into the bloodstream to raise low blood levels of glucose. The interplay of insulin and glucagon maintains homeostasis by ensuring an optimal blood level of glucose.
Type I diabetes is an autoimmune condition in which the body’s own immune system attacks pancreatic beta cells, rendering them incapable of producing insulin. Fewer than 10 percent of all diabetes diagnoses are of Type I.
Type II diabetes is a condition resulting from insulin resistance: beta cells are capable of producing insulin, but because target cells have become unresponsive to its effects, it accumulates in the blood. More than 90 percent of all diabetes diagnoses are of Type II.
Prediabetes is the designation applied when blood glucose tests reveal ongoing higher-than-normal glucose in the blood, with no sign of damage to pancreatic beta cells and not high enough to consider as a diagnosis of Type II diabetes. The latest estimates indicates that perhaps more than 85 million American adults and children fall into the prediabetic category.
Hypoglycemia is insufficient blood glucose (<100 mg/dl) and excess blood level of insulin.
Hyperglycemia is excess blood glucose (>120 ng/dl) and insufficient blood level of insulin.
Ketoacidosis represents the buildup of acids called ketones in the bloodstream and urine, caused by persistent hyperglycemia. Ketoacidosis often indicates the onset of Type I diabetes and, without intervention, can lead to coma and even death.
Type II Diabetes
Insulin resistance develops when the pancreas produces and secretes insulin, but target cells in the body become resistant to its effects. Without insulin to keep blood glucose levels within homeostasis, hyperglycemia ensues, leading to Type II diabetes.
Certain factors that contribute to insulin resistance are controllable, while others are not. We know that a sedentary lifestyle, obesity and a diet low in fiber and high in simple carbohydrates lead to insulin resistance.
Uncontrollable factors such as age (risk for developing Type II diabetes increases over 40), family history of either form of diabetes, and ethnicity also increase risk.
Ethnicity plays a strong role: African-Americans and Hispanics are at increased risk of developing Type II diabetes, and certain Native Americans are at extremely high risk.
(Due to a specific genetic susceptibility that has been identified among tribal members, Pima Indians of Arizona and Mexico have the highest reported prevalence of Type II diabetes of any population in the world.)
Although the exact causes are unknown, it is postulated that the genetic variation may be connected to increased rates of obesity due the historical change in tribal diet and rate of physical activity, following the enforced change to reservation life.
Symptoms of Type II diabetes are the same as for Type I: extreme thirst (polydipsia), intense hunger (polyphagia), and frequent, heavy urination (polyuria), accompanied by deep fatigue, muscle weakness, marked irritability, and a hyper-emotional state.
Instead of rapidly progressing, however, Type II symptoms develop slowly over time, and can be mild for a number of years.
As an unfortunate result, Type II diabetes may go undiagnosed until the organ damage caused by persistent hyperglycemia interferes with functions, compelling the client to seek medical help that leads to the accurate diagnosis of Type II diabetes.
Type II Diabetes Management
Type II diabetes management typically includes a combination of medication, lifestyle changes, and blood glucose monitoring. Each component of this multi-pronged approach is equally crucial to effective management that can prevent complications.
Strict adherence to recommended lifestyle changes can be difficult for many people with Type II diabetes: the habits that allowed insulin resistance to develop are difficult to break, especially when complications of diabetes have not yet been experienced.
Because the pancreas usually continues to produce insulin in a person with Type II diabetes, oral antidiabetic drugs rather than injected insulin are prescribed. Commonly prescribed oral antidiabtics include Januvia (sitagliptin); Glucotrol (glipizide); Glucophage (metformin), and Farxiga (dapagliflozin).
Possible side effects include episodes of hypoglycemia, and these drugs may interact with other prescribed medications. Jardiance (empagliflozin) may also cause painful urination and back pain and, in women, candisiasis.
A recently FDA-approved injectable antidiabetic drug, Tanzeum (albiglutide), can cause common cold symptoms, diarrhea, muscle-and-joint pain and stiffness, and facial or eye pain and tenderness.
The three components of effective Type II diabetes management are weight control, alternative dietary choices and exercise.
Loss of excess weight is critical in avoiding Type II’s potential complications: Obesity places strain on the cardiovascular, respiratory and musculoskeletal systems, and creates challenges to regular exercise.
A diet that focuses on lean proteins and whole grains and relies heavily on fresh fruits and vegetables can reap immediate results in lower blood glucose levels.
Recent British research has indicated that aggressive dietary management may actually reverse Type II diabetes, upending decades of assumed thought.
Regular aerobic exercise utilizes excess blood glucose, quickly reducing hyperglycemia, while regular anaerobic exercise such as weightlifting builds muscle mass, effectively reducing blood glucose levels over time.
Blood Glucose Monitoring
Every person with Type II diabetes should regularly monitor blood glucose using a glucometer, a digital, programmable device that provides instant, precise measurements, using a drop of blood, usually from a fingertip, that is applied to a strip inserted into the device.
A client with poorly managed Type II diabetes is at risk for heart disease, hypertension and stroke, kidney failure requiring transplant, neuropathy, and retinopathy leading to blindness; diabetic capsulitis, and frequent leg ulcers that can lead to amputation.
Poorly managed Type II diabetes can devolve into Type I diabetes, with all its complications and dangers, requiring insulin instead of oral antidiabetics.
Massage Treatment Planning
As noted previously, massage therapy has many benefits for a client with Type II diabetes, as it temporarily increases circulation to the extremities, encourages effective peristalsis, relieves pain and encourages the relaxation response.
Cautions and contradictions related to diabetes must be understood and respected by the massage therapist. Certain assessments are necessary, and complications created by diabetes must be addressed in the treatment plan.
During intake, establish whether the client has been diagnosed with Type I or Type II diabetes; this will help guide the treatment plan. For a client whose Type II diabetes is well-managed on an ongoing basis, few adjustments may be needed to accommodate the condition.
It is always wise, however, to regularly update health and medication information with any client who has a chronic health condition, to ensure that changes are documented and addressed in the treatment plan.
1. Cautions. Because the effect of massage therapy on blood glucose levels in a client with Type II diabetes is unknown, it is prudent to perform massage only when blood glucose levels are with the normal range, generally accepted to be between 100 and120 mg/dl.
Persistent higher-than-normal blood glucose readings should be evaluated by the client’s physician before performing strokes with circulatory intent.
Avoid extremes of temperature and pressure; the client may be unable to provide accurate feedback about pressure, pain and temperature. When using thermotherapy, keep the temperature range narrow: warm (92 to 100 degrees F) or cool (70 to 80 degrees F), not hot or cold.
2. Contraindication. Avoid areas of poor sensation or hypersensitivity to touch. Symptoms of significant hypoglycemia are rare in a client with Type II diabetes, but can occur and require immediate medical intervention.
Stop the massage, call 911, and follow the instructions of emergency medical personnel. Symptoms of hypoglycemia can progress rapidly, from pallor, sweating, and extreme hunger, to irritability, muscle weakness; from nausea, vomiting, confusion, to seizure, loss of consciousness, and eventually, coma.
3. Assessments. Examine the client’s legs, feet and toes very carefully before direct touch: any cut, ingrown toenail or fungal infection must be avoided. Palpate areas of neuropathy to gauge appropriateness of touch and pressure. When complications have developed, evaluate side effects of additional medical treatments and medications.
4. Complications Guidelines. Certain long-term complications that can arise when Type II diabetes is not well-managed require additional treatment considerations. An in-depth initial health history and interview are recommended, with updates as conditions develop.
For cardiovascular conditions, avoid deep pressure, prolonged duration of massage, and techniques that may produce significant systemic responses.
For a client on renal dialysis, avoid touch near dialysis ports on the arm or the abdomen, depending on the type of dialysis.
Following kidney transplant, take steps to prevent pathogen transmission.
When a client has been approved to receive massage following amputation, ask permission before working on or near the site; protect any prosthesis from lubricant contamination, and handle with care and respect; prevent extremes of touch, temperature if sensory function is not intact, and avoid turning or repositioning that challenges mobility.
Monitor the client’s ability to provide accurate feedback regarding pressure, temperature and pain. If phantom pain occurs, massaging the intact limb may provide relief.
With caring, comprehensive treatment planning, clients with Type II diabetes can fully experience the benefits of massage therapy that contribute to well-being and overall health.
About the Author
Julie Goodwin, LMT, is an author, bodywork educator, National Certification Board for Therapeutic Massage & Bodywork-approved provider and creator of TxPlanner.org. Her 32-year massage practice focused on elders and people in treatment for cancer. She has presented at American Massage Therapy National Conventions and the AMTA Schools Summit, and is the 2016 Alliance for Massage Therapy Education Educator of the Year.