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An Integrative approach to diabetes care. 

 

Diabetes Mellitus is a disease in which the body does not produce or properly use insulin. Insulin is a vital hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes is currently unknown, however, both genetics and environmental factors such as obesity, and lack of exercise are suspected. There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, 5.7 million people are unaware that they have the disease.

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform. With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes. In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.

There are two major types of Diabetes.Type-1 Diabetes results from the body's failure to produce insulin, the hormone that allows glucose to enter and fuel the cells of the body. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1-Diabetes.Type-2 Diabetes results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have Type-2 Diabetes. Gestational Diabetes can occur immediately after pregnancy. 5% to 10% of women with Gestational Diabetes are found to have Type-2 Diabetes. Pre-Diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of Type-2 Diabetes. There are 57 million Americans who have Pre-Diabetes, in addition to the 23.6 million who are diagnosed with full Diabetes Mellitus.



While the types have different pathologies, they have the same common symptom--high levels of glucose in the blood. Essentially, the cells become starved for energy, so the person is fatigued. Excess sugar spills into the urine, causing frequent urination and excessive thirst. The disease can be diagnosed with a simple blood test to determine the blood glucose level.


Over time, elevated glucose levels lead to complications of the disease, by causing damage at the cellular level. Cells especially prone to damage are in the eyes, kidneys, heart, blood vessels and nervous system. Without good blood sugar control, the diabetic becomes more vulnerable to retinopathy, neuropathy, as well as kidney and heart disease. Other changes may occur in the connective tissue of the body, leading to thickening or stiffening of the fascia surrounding the muscles and organs.


Treatment of diabetes involves normalization and maintenance of healthy blood glucose levels. The diabetic must be conscientious to maintain near-normal blood glucose levels (80 to 120 mg/dl) by balancing nutrition, exercise, appropriate use of medications (insulin or oral medications), and management of stress. Diabetics use test strips and monitors to determine their blood glucose levels (BGs). If the BGs are low, they can eat or drink carbohydrates to bring them back into the normal range. If they are high, they may need to inject more insulin, or otherwise adjust their treatment.


There are many benefits of massage therapy for people with diabetes. Most of these would be similar to the general benefits of massage; however, the following advantages should be emphasized. These are of special interest to diabetics.


Living with diabetes is inherently a stressful condition. Fluctuating blood sugar levels put tremendous strain on the body's systems. The practical demands of balancing the intake of insulin, or oral medications, blood glucose monitoring, nutrition and exercise can cause high stress levels. Worry about complications of the disease, or anxiety relating to work or interpersonal relationships, can significantly raise stress-levels. By calming 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 positive effect on body chemistry, decreasing the production of stress hormones, with resulting beneficial effects to blood sugar levels. 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 a more efficient use of insulin by the cells. Circulation is often impaired in diabetics due to the damaging effects of elevated blood-sugar levels. Massage of the hands and feet can be particularly beneficial. Massage works directly with the muscles, and connective tissues, helping to facilitate greater mobility in the body. This is especially important for the diabetic because elevated blood sugars cause a thickening of connective tissue, which in turn affects mobility and elasticity of the myofascial system. This can be noted in general levels of stiffness in muscles, tendons and ligaments, as well as decreased range of motion in the joints. Stress hormones also contribute to chemical changes in the connective tissue, causing a binding between the layers of fascia. Massage therapy can significantly counter this effect. A range of motion, stretching and regular exercise are also important to help encourage flexibility and health of the myofascial system.


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 the therapy, 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. Do they 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 enough to raise the blood glucose to a safe level. Changes will be noted in the diabetic within minutes. Make sure the diabetic is feeling better before leaving. It may be best to have them call someone to come get them. They may need to eat more, or to test blood sugar again after awhile.

With awareness of these precautions, Therapeutic Massage can be safely applied to a person with diabetes. The massage therapist may also want to study some of the complications of diabetes, and adapt techniques accordingly. For example, if a diabetic has peripheral neuropathy, 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. 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. Techniques that I employ in my practice, include: acupressure, body energy therapies, manual lymph drainage, therapeutic touch, and general massage, supported with herbal therapies.

A Therapist should always listen to the feedback of the clients and ask them what they need and enjoy. Changes that occur during the massage sessions and changes that occur over time should be noted. A Therapist should always be willing to learn from their 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.



This article is not intended as medical advice, and is for informational purposes only. Always check with your physician anytime you suspect something is wrong, or before starting any programs. Inform your Primary Health Care Provider of any and all herbal supplements, and CAM (Complimentary and Alternative Medicine) modalities you are using. CAM is not a substitute for Medical Care.





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Dr. Joel C. Brothers is a practicing Traditional Naturopath, and uses many modalitiies.

A general massage once a month can have many health benefits for most people, when performed by a licensed therapist.

Written by Joel C. Brothers, ND, SHD, LMT

natural.path@yahoo.com