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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 41 first, because people with diabetes like massage and want to use it as part of their disease management strategy; and second, because our clients need us to make informed decisions about bodywork that are in their best interests. INSULIN REVIEW To talk about the mechanisms behind diabetes we need to do a quick review of insulin. Let's start with an afternoon snack. It's 3:30 p.m. You've been working hard all day, and the tuna sandwich you had for lunch is long gone. You are hungry. Two things happen: you go in search of a snack, and your pancreas secretes glucagon, which tells your liver to release some glucose, both to burn while you're working, and to tide you over until you locate something to eat. Success! A handful of candied almonds, just the thing. Your teeth satisfyingly crush the nuts, and chemicals in your stomach begin to dissolve the bits and pieces you swallow. Within a few minutes, nutrients enter the small intestine, then the bloodstream, and ahhhhh. (This takes a little longer if the nuts are not covered in sugar.) Now your hunger is eased, and your blood sugar goes up. This is the signal for the pancreas to release insulin, a hormone that carries sugar into waiting, hopeful, hungry cells at dedicated cell receptor sites. Glucose provides efficient fuel for cellular activity, which is especially important for muscle and nerve cells. And cells have no access to glucose without insulin to unlock the receptors on the cell membranes. Insulin brings blood glucose back into normal range, and the cycle begins again. But what if the pancreas can't make enough insulin? Or what if the cell receptors stop working? Or what if there's not enough insulin and the cells are insulin resistant? SIGNS, SYMPTOMS, AND COMPLICATIONS DM2 occurs when any combination of low insulin production or insulin resistance develops. The earliest signs and symptoms connected to this are easy to miss. Frequent hunger (because cells have such limited access to sugar—the fastest and most efficient form of fuel) can lead to weight gain initially, but this may turn to weight Other Types of Diabetes While type 2 diabetes is by far the most common version of the condition, a few other types of diabetes are also worth a look to round out our understanding of this disease. TYPE 1 DIABETES MELLITUS This condition is the result of an autoimmune attack on the insulin-producing cells in the pancreas. In this situation, insulin production is not just suppressed, it is nonexistent. Type 1 diabetes is usually diagnosed in childhood. Most often, we see it develop before or during adolescence, but some people develop it later. One subtype of type 1 diabetes is called latent autoimmune diabetes of adulthood (LADA) and this may develop much later. It is often seen in the same people, or in the same families, with some other autoimmune diseases. Type 1 diabetes is diagnosed about 30,000 times each year in the United States. DOUBLE DIABETES In double diabetes, a person starts with type 1 diabetes, but eventually becomes insulin resistant, so they develop type 2 as well. GESTATIONAL DIABETES Gestational diabetes describes a situation in which a woman develops temporary diabetes while she is pregnant. This carries significant risks for both her and her baby, so it's important to treat it carefully. Also, the chance that both mother and child may later develop type 2 diabetes is high. DIABETES INSIPIDUS Diabetes insipidus is a rare pituitary dysfunction in which a person doesn't secrete enough antidiuretic hormone (ADH). Without ADH, it is impossible to retain any water. Essentially a person with diabetes insipidus constantly produces urine and is always thirsty. loss later in the disease process. Overactive kidneys lead to frequent urination, which leads to more-than-usual thirst. These three signs: hunger, thirst, and frequent urination, are often the earliest indicators that something in the system isn't working well, but these are subtle and easy to miss. The more commonly recognized signs of diabetes, other than a blood glucose reading, are the complications it brings about. With no access to sugar, the working cells have to revert to burning other sources of fuel (i.e., protein and fat). This produces much more metabolic debris, so waste accumulates in the bloodstream along with excessive sugar—this is hyperglycemia. Now blood vessels and kidneys have to function with sugary, waste-filled blood. This is hard on the arteries—think of it as having sand in the circulatory