By Mary Kathleen Rose, CMT
As more and more Americans incorporate alternative therapies into their program of health care, people with diabetes, too, are looking to the usefulness of different therapies to complement their lifestyle measures and medical care. One such alternative therapy is massage.
The therapeutic use of touch might be seen as a new development in health care, but there are traditions of touch therapies that date back through the centuries in cultures around the world. The Chinese have written records of therapeutic massage dating to 3000 BC, and there are ancient Egyptian pictographs showing the practice of foot massage.
In recent times, the field of massage has gained prominence in the areas of athletic training, medical massage, and spa and fitness centers. So a person with diabetes seeking to optimize his health care may well wonder whether massage therapy might be useful to him.
There are many benefits of massage therapy for people with diabetes. Most of these would be similar to the benefits of massage for the general population, but the following are of particular interest for people with diabetes.
Relaxation. The value of basic relaxation cannot be overemphasized. Living with diabetes is inherently stressful. Fluctuating blood sugar levels put tremendous strain on the body’s systems. The practical demands of balancing intake of insulin[1] or oral medicines[2], blood glucose monitoring[3], nutrition[4], and exercise[5] can seem like a daunting task for many. Worry about diabetic complications[6] or anxiety relating to work or interpersonal relationships can add to the picture of stress.
By sedating the nervous system, massage can bring a much-needed rest and an assuring sense of well-being to the body. Skillfully applied touch can have a profound effect on body chemistry, decreasing the production of stress hormones, with resulting beneficial effects to blood sugar levels. (Stress hormones generally raise blood sugar levels.)
Increased circulation. Massage increases the circulation of blood and lymph, facilitating the transport of oxygen and other nutrients into the body’s tissues. Improved circulation allows for more efficient uptake of insulin by the cells. Circulation is often impaired in people with diabetes due to the damaging effects of elevated blood sugar levels on the cells of the body.
Myofascial effects. Massage works directly with the muscles (myo) and connective tissues (fascia) in the body, helping to facilitate greater mobility in the body. This is especially important for people with diabetes, because elevated blood sugar causes a thickening of connective tissue, which affects the mobility and elasticity of the myofascial system. This may be experienced as stiffness in the muscles, tendons, and ligaments or as a decreased range of motion in the joints.
Stress hormones also contribute to chemical changes in the connective tissue, causing a stickiness between the layers of fascia. Massage therapy can significantly counter this effect. Stretching and regular exercise are also important to help encourage flexibility and health of the myofascial system.
Recently, I have supervised a clinic where my student interns give massage to people with diabetes. This has been a tremendous opportunity to observe the benefits of therapeutic massage, and to record changes in blood sugar level during the course of a session.
The students who participate in the clinic have all received their basic instruction in Swedish or Integrative Therapeutic Massage. They are in the final quarter of their massage school training, and this clinic provides them the opportunity to practice their skills, offering massage free of charge to clients as part of their community service. All protocols of professional massage practice are observed, including doing a medical history intake interview, observing client confidentiality, and using appropriate techniques.
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[7]). 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[8] (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.
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[9]. 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.
In addition to describing your symptoms of hypoglycemia or lack thereof, be sure to explain to your massage therapist how you treat it. Bring glucose tablets, juice, or your usual hypoglycemia treatment to your massage sessions. By taking these precautions, massage can be safely enjoyed by a person with diabetes.
During a massage session, your therapist is likely to ask how you’re feeling. Do not be afraid to tell the therapist what you need and to give honest feedback about your experience. This is an opportunity for both therapist and client to learn from each other, enjoying the experience of giving and receiving massage. No matter what specific type of therapy is used, it is the communication and rapport between therapist and client that is most important.
If you have particular needs and concerns, share those with the therapist. Certain diabetic complications may make certain massage techniques more or less preferable. For example, if a person has peripheral neuropathy[10] (damage to the nerves of the hands and feet) and is very sensitive to touch, the techniques of Comfort Touch, a nurturing form of acupressure, may be the most comfortable. (Click on “Further Reading About Massage”[11] for more information on Comfort Touch.) But any type of massage can be adapted by a skilled therapist. Let the therapist know what is most helpful to you.
In addition to making your needs known, do your part to make the massage comfortable and relaxing. Remember that it is OK to stop and drink some juice during a massage if you need to. Let your therapist know if you have time constraints. For example, a one-hour massage may be most appropriate. A session that is too long may put you at risk for hypoglycemia, defeating the whole purpose of a relaxing massage.
Massage can give a wonderful psychological boost to someone who is living with diabetes and striving to balance all the factors involved in maintaining a healthy lifestyle — proper nutrition, adequate exercise, blood glucose monitoring, appropriate use of medicines, and stress management. Massage therapy contributes an important piece to my diabetes regimen of care. I hope that as other people with diabetes understand and experience the benefits of massage therapy, they can consider it a valuable part of their own integrated health-care program.
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