PART 1 OF 2: Diabetes mellitus (DM) is a group of diseases characterized by chronic elevated blood glucose levels. It is caused by insufficient amounts of insulin, resistance to insulin by the cells, or both. Several types of DM have been identified such as type 1 & type 2. Gestational diabetes discussed HERE.

In type 1 DM, pancreatic beta cells are damaged or destroyed, creating a lack of insulin. Without insulin, glucose cannot enter cells. Hence the individual develops a dependence on insulin. Another term used to describe type 1 DM is insulin-dependent diabetes mellitus (IDDM). Type 1 accounts for approximately 5-10% of all diabetes cases (1) & affects approximately 1.25 million people in the United States (2).

Glucose is the body’s main source of fuel & energy. Glucose can only enter cells with the help of the hormone, insulin. Insulin is produced by beta cells located in the pancreas. When glucose enters body cells, blood glucose levels are lowered. Without insulin, glucose does not enter the insulin-in-type-1-diabetescells & blood glucose levels remain high called hyperglycemia.

Signs and symptoms of DM are excessive urination, excessive thirst, & excessive hunger. Others include fatigue, blurred vision, unexplained weight loss, & increased frequency of infections. Persistent hyperglycemia damages cells & leads to complications such as vision problems or diabetic retinopathy, reduced sensations or diabetic neuropathy, & kidney, cardiovascular, & neurologic diseases.

Treatment consists of a lifelong commitment of monitoring blood sugar, taking insulin, regular exercise, & controlled caloric intake.

Some individuals check their levels daily with a glucose meter. This meter is also used to determine if a person with diabetes has hypoglycemia or low blood sugar, which needs immediate attention. Hypoglycemia can occur in all types of DM but is more common in type 1. The major cause of hypoglycemia in diabetic persons is an overdose of prescribed insulin; the second major cause is eating too little food.


Hypoglycemia requires immediate attention. If left untreated, hypoglycemia can develop into insulin shock, which may lead to coma & death (3,4).

Signs & symptoms of hypoglycemia include:

  • Mental confusion, disorientation, & slurred speech (may resemble intoxication)
  • Visual disturbances
  • Cool, clammy, pale skin
  • Tremors

If a client with DM has the above signs & symptoms, is conscious & coherent, & has a glucose meter, have them check for hypoglycemia. If hypoglycemia is confirmed, follow the steps below. If the above signs & symptoms are not related to hypoglycemia, CALL 911.

If a client with DM has the above signs & symptoms, is conscious & coherent, & does not have a glucose meter, treat as hypoglycemia and follow the steps below.

  1. Give the client a substance that contains sugar such as 4 oz of orange juice, or 6 oz of regular (not diet) soda, 5 hard candies, contents of a honey packet, or cake frosting in a tube. If they have their own glucose tables or gel, give it to them.
  2. If the client improves quickly, give something more substantial that includes protein, fat, & carbohydrates such as such as bread or crackers with cheese or peanut butter.

CALL 911 if the client does not improve quickly or becomes unresponsive.

Note: If you are uncertain whether the person is hypoglycemic or hyperglycemic (high blood sugar), provide a substance that contains sugar anyway because hypoglycemia is a more serious condition.


Massage Therapy & DM, Type 1 – Ask if the client carries a glucose meter or glucose tablets or gel &, if so, where they are in case they are needed during a possible hypoglycemic episode.

Clients who are type 1 are insulin-dependent: Avoid vigorous massage & heat/ice applications over sites of recent insulin injection for 24 hours. Massage therapy was found to increase insulin absorption administered by subcutaneous injection (5,6). The increased absorption produced by massage could cause or contribute to complications such as hypoglycemia.

If the client uses an insulin pump, do not get massage lubricant on the sensor, transmitter, pump, or its tubing. For added comfort, offer your client a soft cushion to place over the pump while lying prone.

Picture Credits:

Articles and Journals Referenced:

  1. Center for Disease Control and Prevention: Diabetes.
  2. Juvenile Diabetes Research Foundation: Type 1 Diabetes Facts.
  3. First aid & Emergencies: Low blood sugar (hypoglycemia) treatment.
  4. Diabetic emergency.
  5. Berger M, et al. (1982). Absorption kinetics and biologic effects of subcutaneously injected insulin preparation, Diabetes Care, 5(2), 77–91.
  6. Linde B. (1986). Dissociation of insulin absorption and blood flow during massage of a subcutaneous injection site. Diabetes Care, 9(6), 570–574.



Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at