Issue link: https://www.massageandbodyworkdigital.com/i/867515
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 43 safe to say that as a culture we fetishize food—especially food that is perceived as decadent or indulgent. This is our media trend, and it is a potentially life-threatening message for people with diabetes. But lots of people appear to have the answers. Do a Google search for "diet to treat diabetes" and you will get 30 million results. And yet, we still have almost 30 million Americans with diabetes. Type 2 diabetes can often be managed with diet and exercise, if the person can establish and sustain habits that are helpful and supportive. Nothing changes overnight in this condition; patients must take control of their own situation and work for long-term benefits. Currently, the main treatment goals for DM2 focus on stopping its progression and limiting secondary organ damage as much as possible. This starts with diet and exercise, but usually also involves medication and possibly supplemented insulin. Some nutritional specialists have had success with reversing this condition, but it is safe to say that what works for one patient is not guaranteed to work for the next one. IMPLICATIONS FOR MASSAGE The answer to the question, "Is massage therapy OK for people with ?" is always "It depends." It depends on the type of manual therapy, and in the context of diabetes, it depends on many variables about the client's health, complications, and general resilience. If we think about what risks are present with a client who has diabetes, the worst ones that leap to mind are the consequences of inadequate disease management. Examples might include things like diabetic ulcers on the feet, which can progress to extremes partly because of an impaired ability to sense potential damage. Skin ulcers of any kind are dangerous for massage therapy, because of the risk of infection that could lead to gangrene and a need for amputation. PATHOLOGY PERSPECTIVES Even if the skin is healthy and intact, massage therapists need to have an idea about kidney and cardiovascular health. Poorly managed diabetes is a setup for heart disease and renal failure, and both of these conditions—and the medications that manage them—have repercussions for massage therapy decisions. We need to consider that clients with advanced diabetes have a compromised fluid management system. Their circulatory and urinary systems may not be able to keep up with challenges, so any massage that intends to move a lot of fluid is not a good choice in this situation. Even if a client's diabetes is well- managed, some practical decisions about insulin, hypoglycemia, and massage therapy must be considered. Blood sugar often appears to drop during or after a massage session. How much, and for how long, is hard to predict. Because our clients with diabetes may have a difficult time regulating blood sugar, it's important for them to know this might happen. Our clients must not skip their insulin dose because they're getting a massage. Even though both interventions reduce blood sugar, we do not allow massage to interrupt a person's prescribed medication use. But because some people experience sudden episodes of hypoglycemia after a massage, it is a good idea to find out in advance how they'd like to deal with that. Some clients will keep sugar tablets or a favorite candy with them; others will prefer a quick sip of milk or juice to get some sugar into their system. I hope it's obvious that diet soda and sugarless candy are not good options in this situation. Another thing you can do to reduce the risk of a precipitous drop in blood sugar is to try to schedule massage sessions for the middle of your client's insulin cycle: not right at the beginning when they've just taken insulin before a meal, and not later when they're getting hungry and blood sugar is dropping, but as close to the middle—the most stable part of the hormone cycle—that you can manage. These actions—planning ahead in case of a drop in blood sugar and working to schedule sessions in the middle of the insulin cycle—help engage our clients in the decision-making process. People with diabetes often do best when they can take charge of their own care, and massage therapy fits well into this model. Are there benefits we can reliably offer? The research on massage therapy and diabetes is scattered, inconsistent, and mostly small in scale. But within our evidence base we can point to studies that demonstrate that massage therapy is a popular choice for people with diabetes for stress and anxiety relief. Some small-scale studies suggest that massage may positively affect diabetes biomarkers, that it may be an appropriate intervention for people with diabetes and peripheral artery disease in the legs, and it may even improve balance and gait for people with foot problems. Diabetes doesn't progress in exactly the same way in any two people, and every person with diabetes will have their own unique challenges with managing it. We cannot rubber stamp whether massage therapy is appropriate for a person with this condition. It is the job of every massage therapist to carefully weigh possible risks and benefits, to plan appropriate accommodations, and to involve the client in setting achievable goals for relaxation, wellness, and long- term successful management of this condition. To do that, we need to know not just about the pathophysiology of diabetes, but also about the function of virtually every system in the body. If we do that well, our clients can benefit from reduced stress and improved function. Why do massage therapists need to know about pathology? Diabetes. That's why. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2016), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com.