PART 2 OF 2: Type 2 diabetes mellitus (DM) is the most common form of DM & accounts for more than 90% of all cases. The National Diabetes Statistics states that over 9.3 % of the population has type 2 diabetes, & this rate is growing annually. Young people are more likely now than ever to be diagnosed with type 2 DM, & it is the most common chronic disease in children & adolescents. Diabetic neuropathy can occur is some cases & massage can help ameliorate symptoms.
In type 2 DM, pancreatic beta cells produce insulin but cells are resistant to it, called insulin resistance. In rare cases, the body does not produce enough insulin. Type 2 DM can be controlled with regular exercise, proper nutrition, & maintaining weight through reduced caloric intake. In contrast to persons with type 1 diabetes, persons with type 2 diabetes often can be treated with oral medications. This type of DM is called non–insulin-dependent diabetes mellitus (NIDDM). Many persons with NIDDM, however, take insulin when their bodies do not produce sufficient amounts. This type of DM is called insulin-requiring diabetes mellitus (IRDM).
Complications can arise after the onset of diabetes, especially if it is not managed & blood glucose levels stay consistently high, which is called hyperglycemia. Examples of diabetic complications are:
- Gangrene infection
- Peripheral neuropathy
- Diabetic retinopathy & cataracts
- Kidney diseases & conditions including glomerulosclerosis & kidney failure
- Cardiovascular diseases & conditions including hypertension, coronary atherosclerosis, occlusive atherosclerosis, & peripheral arterial disease
- Neurologic diseases & conditions including stroke
- Fungal infections including thrush, jock itch, & athlete’s foot
Massage Therapy & Type 2 DM – Ask the client about his or her diabetic complications & modify your massage accordingly. For example, if the client has athletes foot, neuropathy, or visual impairments, modify the massage for those specific conditions. Complications associated with diabetes are far less common & less severe in people whose disease is well controlled.
Ask if the client carries a glucose meter or glucose tablets or gel & where they are in case they are needed during a possible hypoglycemic episode.
Massage decreased glucose levels to within normal range in children (1,2). Children experienced increased dietary compliance when massaged by their parents (1). An interesting finding in the previously mentioned study was that anxiety & depression decreased in children & in their parents from the massage experience. Pandey et al (3) conducted a systematic review of the literature & supported the use of massage to help manage diabetes, including normalizing blood glucose levels, reducing symptoms of peripheral neuropathy, reducing tension, & promoting relaxation.
Some clients who are type 2 require insulin. If this is the case, 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 (4,5). The increased absorption produced by massage could cause or contribute to complications such as hypoglycemia.
Massage can be performed over areas of peripheral neuropathy (PN) & can improve symptoms. Thai foot massage improved balance, foot & ankle range of motion, & foot sensations in people with PN related to diabetes (6). In people with chemotherapy-induced PN (CIPN), massage greatly decreased symptoms (7, 8), increased skin temperature in fingers & toes, & improved the quality of life in person affected by CIPN (7). Be sure to request client feedback about levels of pressure & modify techniques according to his or her comments. Clients with PN of the lower extremities may be prone to additional nerve injury at pressure points (eg, behind the knee, front of the ankle). For this reason, use a soft rather than stiff bolster in these areas.
Safety is an important consideration for people with neuropathy. Lack of muscle control & reduced sensation increase the risk of falls & other injuries. Be sure to take proper precautions to reduce the likelihood of falls which includes removing throw rugs & securing carpet edges, avoiding waxy floors, removing low furniture & objects located on the floor, removing cords & wires on the floor, installing a raised toilet seat if the seat is too low, & checking light sources for adequate illumination.
Articles and Journals Referenced:
- Field T, et al: Massage therapy lowers blood glucose levels in children with diabetes mellitus, Diabetes Spectrum 10:237–239, 1997.
- Sajedi F, Kashaninia Z, Hoseinzadeh S, Abedinipoor A: How effective is Swedish massage on blood glucose level in children with diabetes mellitus? Acta Med Iran 49(9):592–597, 2011
- Pandey A, et al: Alternative therapies useful in the management of diabetes: a systematic review, J Pharm Bioallied Sci 3(4):504–512, 2011.
- Berger M, et al: Absorption kinetics and biologic effects of subcutaneously injected insulin preparation, Diabetes Care 5(2):77–91, 1982
- Linde B: Dissociation of insulin absorption and blood flow during massage of a subcutaneous injection site, Diabetes Care 9(6):570–574, 1986.
- Chatchawan U, Eungpinichpong W, Plandee P, Yamauchi J: Effects of Thai foot massage on balance performance in diabetic patients with peripheral neuropathy: a randomized parallel-controlled trial, Med Sci Monit Basic Res 21:68–75, 2015.
- Cunningham JE, et al: Case report of a patient with chemotherapy-induced peripheral neuropathy treated with manual therapy (massage), Support Care Cancer 19(9):1473–1476, 2011.
- Menendez AG, Cobb R, Carvajal AR, et al. Effectiveness of massage therapy (MT) as a treatment strategy and preventive modality for chemotherapy-induced peripheral neuropathy (CIPN) symptoms. Poster presented at: 2016 Palliative Care in Oncology Symposium; September 9-10, 2016; San Francisco, CA
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 firstname.lastname@example.org.