Issue link: https://www.massageandbodyworkdigital.com/i/1509769
A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 55 People on dialysis for renal failure related to diabetes get some benefit from receiving work to their legs and feet during their treatment, and one interesting study found that massage was helpful for foot function and balance—a very important benefit for people who are at risk for falls. BE THE SUPPORT THEY NEED Diabetes is common, expensive, serious, and usually manageable. Some aspects of this disease can be mitigated by massage, but our work is mainly supportive as our clients look for the best ways to cope with and control this difficult disease. Massage therapy won't cure diabetes, but it can bring our clients some relief. Notes 1. National Kidney Foundation, "Diabetes and Chronic Kidney Disease," last updated January 2016, www.kidney.org/news/ newsroom/factsheets/Diabetes-And-CKD. 2. Donate Life, "Kidney Donation," https:// donatelife.net/donation/organs/kidney-donation; National Kidney Foundation, "Transplants for All: Saving Lives, One Kidney at a Time," April 18, 2023, www.kidney.org/newsletter/ transplants-all-saving-lives-one-kidney-time. 3. Allan Boike, Michael Maier, and Daniel Logan, Cleveland Clinic, "Prevention and Treatment of Leg and Foot Ulcers in Diabetes Mellitus," Accessed July 3, 2023, www. clevelandclinicmeded.com/medicalpubs/ diseasemanagement/endocrinology/prevention- treatment-diabetic-leg-and-foot-ulcers. 4. Sunarmi Sunarmi et al., "The Effectiveness of Massage Therapy on Healing of Diabetic Neuropathy in Diabetes Mellitus Patients," Open Access Macedonian Journal of Medical Sciences 10, no. G (2022): 190-4, https:// doi.org/10.3889/oamjms.2022.8564. Ruth Werner is a former massage therapist, a writer, and an NCBTMB- approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at booksofdiscovery. com), now in its seventh edition, which is used in massage schools worldwide. Werner is available at ruthwerner.com. gain weight more than usual because insulin makes sugar available for storage in the cells. Some people experience some edema and problems with fat deposits, but this is relatively rare. However, because insulin must be injected, it's important to know where the injection site is. Clients who manually inject insulin into the subcutaneous skin need to not rub on that area in a way that might disrupt the speed of uptake. Those who use an insulin pump will need adjustments in positioning and may also find that the skin around the site becomes indurated and thick. Also, it's best to schedule a massage for the middle of the insulin cycle if possible, when their levels are most stable— not right after they've eaten or when they are very hungry. This will reduce the chance they might have an insulin-related problem. Finally, it's a good idea to find out ahead of time what your client wants you to do if they have a hypoglycemic (low blood sugar) episode. Some clients may be equipped with a blood glucose monitoring device—either an insulin pump or a skin patch that communicates with an app on their phone—so they receive an alarm about low blood sugar. Since massage lowers blood sugar, at least temporarily, they may receive an alert during their session. Each client with diabetes may have a different preference for an easily accessible source of sugar: Some might like candy (or even carry some with them), while others might prefer milk or juice. This is why it's good to get this information ahead of time. What Does the Research Say? The research about massage therapy for people with diabetes is mostly positive, but also very small-scale. We see that massage tends to drop blood sugar, but how much and for how long is difficult to predict. There is some indication that massage might help with the numbness related to peripheral neuropathy, but this was only a small pilot study. 4 Cardiovascular and Renal Damage Does your client have kidney disease? These are people who may not tolerate the sudden increase in f luid f low that vigorous, full-body massage might create. Do they have high blood pressure and other risks for cardiovascular disease? It's important to get a clear sense of their tolerance for physical activity and to make sure that whatever homeostatic challenges our work creates stays within those boundaries. Nerve Damage Peripheral neuropathy can affect motor, sensory, and parasympathetic nerves. Weakness, numbness, tingling, pain, or dysautonomia can be the result. This doesn't mean massage must be avoided, but it must be done with extra care to track areas of numbness and to avoid causing (more) pain. Skin Damage We have already discussed the role of massage therapy in identifying signs of diabetic ulcers as early as possible. Bear in mind that these lesions are often not painful, and if they occur in an area that is numb and/or not immediately visible, they are easy to ignore—with the risk of infection, gangrene, and amputation. Medications Are your clients with diabetes taking medications to manage blood pressure? (Answer: probably yes.) It would be a good idea to find out if the medications have any side effects, like lethargy or dizziness—this requires some changes in massage, like ending the session with stimulating strokes and allowing more time to transition off the table. Other medications like statins or metformin can also cause problems, like nausea or gallbladder issues. Insulin Supplemented insulin usually leads to a marked improvement in many symptoms, although it can sometimes cause new side effects. Many people find that they