The client is unclothed to his level of comfort and draped for modesty and warmth. A light, unscented lotion or oil is applied with the massage strokes. Basic strokes of Swedish massage are used, including gliding, kneading, and wringing. Acupressure strokes of general compression and specific contact pressure are also used. The therapist responds to the client’s feedback to address specific needs and preferences for areas of the body massaged, depth of pressure applied, and types of strokes used.
Most of the people who have received a massage at the clinic have had Type 1 diabetes, and they have ranged in age from 25 to 50 years old. Prior massage experience has varied, but all have been enthusiastic to receive the massages. Sessions last about an hour, with the actual hands-on massage lasting about 45 to 50 minutes. Each person is required to check his blood glucose level before the session and to note the time of his most recent meal or snack and what he ate. He also notes the time and amount of his most recent injection of insulin (or bolus of insulin if using an insulin pump). After the session, he checks his blood glucose level again.
To date, five student massage therapy interns have given massage in the diabetes clinic. More than 20 people with diabetes have received massage, some more than once. 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.
The clinic has also produced some useful data on the changes that occur in blood glucose levels during massage. We have seen changes of as much as a 100-mg/dl decrease in an hour, as well as a 100-mg/dl increase. In general, however, massage therapy tends to lower blood sugar levels by approximately 20 mg/dl to 40 mg/dl. The more dramatic decreases could usually be accounted for by recent injections of insulin or by vigorous exercise in the hours preceding the massage session. The dramatic increases were attributed to a missed insulin dose or a dose that did not adequately cover a snack or meal.
While the massage clinic is not a scientifically controlled study by any means, it does raise an important safety issue. Since massage can have a dramatic effect on a person’s blood sugar level, both massage therapists and those receiving massages need to be aware of that and be prepared to treat hypoglycemia (low blood sugar). In addition, since people naturally tend to be relaxed and sometimes a little “spacey” or disoriented after receiving a massage, getting a massage may raise the possibility that a person will not recognize his usual warning symptoms of hypoglycemia. This underscores the importance of checking for low blood sugar before leaving the premises where the massage took place. And since the blood-glucose-lowering effect of a massage can last for several hours, it is wise to continue with regular monitoring throughout the day.
When people with diabetes receive repeated sessions, they can begin to understand their own patterns of response to massage and plan accordingly. For example, a person whose blood sugar tends to drop around 40 points during a session of massage might want to drink a small glass of juice before a massage if his blood sugar is 100 mg/dl or lower before the session. He could also choose to have a glass of juice in the room to drink during the session. Each person has a different response, and even an experienced massage recipient may sometimes have unexpected blood sugar changes.
Enjoying massage safely
Because changes in blood glucose level can and do occur when people with diabetes receive massage, it’s important to inform your massage therapist about your diabetes. It is also important to describe the signs and symptoms you experience when your blood sugar is low. Signs and symptoms of hypoglycemia vary widely from person to person. Any one or more of the following may occur: excessive sweating (skin may feel clammy), faintness, headache, an inability to awaken, “spaceyness” (a person may talk or move very slowly or not be able to speak coherently), irritability, change in personality, and rapid heartbeat. In addition, some people have lost the ability to sense when their blood sugar is getting low, a condition called hypoglycemia unawareness. For these people especially, it can be helpful to know that the massage therapist is keeping an eye out for signs of low blood sugar.