PART 1 OF 2: Diabetes mellitus (DM) is a group of metabolic diseases characterized by elevated blood glucose levels called hyperglycemia. There are two main types of DM, type 1 and type 2. Type 1 is caused by insulin deficiency. Type 2 is caused by insulin resistance. Gestational diabetes mellitus, which can occur during pregnancy. Gestational diabetes discussed HERE.
Type 1 diabetes mellitus (T1DM) is autoimmune destruction of pancreatic beta cells, resulting in insulin deficiency. Without insulin, glucose cannot leave the bloodstream and enter body cells, creating the condition of hyperglycemia. Individuals with T1DM develop a dependence on insulin. T1DM was formerly known as juvenile diabetes because it was largely seen in children. In fact, T1DM is the most common endocrine disease in children. T1DM was also known as insulin-dependent diabetes mellitus (IDDM) because individuals with this are dependent on insulin injections. T1DM accounts for approximately 10% of all diabetes cases and affects approximately 1.25 million Americans. Type 2 DM is discussed HERE.
Hypoglycemia is abnormally low blood glucose levels, usually below 70 mg/dL. Hypoglycemia, also called an insulin reaction, is a complication of diabetes, especially type 1. It occurs most frequently with insulin therapy, and is associated with injecting too much prescribed insulin, late or skipped meals, or overexertion in physical activity. While it can occur in type 2, hypoglycemia is a mild and infrequent side effect of treatment among this population. Signs and symptoms of hypoglycemia include confusion, disorientation, irritability, lack of muscular coordination, slurred speech (resembles drunkenness), visual disturbances, headaches, tremors, cold clammy skin, and inability to respond to verbal commands.
Double diabetes is the development of insulin resistance in someone with T1DM. Insulin resistance, the key feature of type 2 diabetes mellitus. The most common reason for developing insulin resistance in TIDM is obesity.
An autoimmune response is thought to destroy or damage pancreatic beta cells; a strong genetic factor also exists. Some viral infections, such as mumps and diseases caused by the Epstein–Barr virus have been implicated. Ten percent of cases are idiopathic.
The three Ps of DM are polyuria, or excessive urination; polydipsia, or excessive thirst; and polyphagia, or excessive hunger with weight loss. Other signs and symptoms are fatigue, blurred vision, and increased frequency of infections.
Treatment consists of a lifelong commitment of monitoring blood sugar, taking insulin, regular exercise, and maintaining weight through controlled caloric intake, particularly of carbohydrates. Because digestive enzymes interfere with the absorption of insulin, it must be administered by subcutaneous injection (most common) or by an insulin pump. Medications may be prescribed to reduce blood pressure (antihypertensives) and lipid-lowering drugs.
Hypoglycemia and First Aid. Hypoglycemia is abnormally low blood glucose levels, usually below 70 mg/dL. Hypoglycemia, also called an insulin reaction, is a complication of diabetes, especially type 1. It occurs most frequently with insulin therapy, and is associated with injecting too much prescribed insulin, late or skipped meals, or overexertion in physical activity. While hypoglycemia can occur in T2DM, it is mild and infrequent among this population. Symptoms of hypoglycemia include:
- Lack of muscular coordination
- Slurred speech (resembles drunkenness)
- Inability to respond to verbal commands
- Visual disturbances
- Cold clammy skin
If left untreated, hypoglycemia can develop into insulin shock (insulin reaction), which may lead to coma and death.
Glucose is the preferred treatment for conscious individuals experiencing symptoms of hypoglycemia. Follow the 15-15 rule. Consume glucose or sugar equal to 15 grams of carbohydrates (carbs). Rest for 15 minutes. If symptoms have not abated, consume 15 more grams of carbs. Once symptoms abate, consume a meal or snack to prevent recurrence of hypoglycemia (such as crackers with cheese or peanut butter). Use a blood glucose meter to check levels, if possible. This procedure does not harm the hyperglycemic person but could potentially save the life of a hypoglycemic person.
Foods equal to 15 grams of carbs are:
- 4 ounces of fruit juice
- 5-6 ounces (about 1/2 can) of regular soda (not diet soda)
- 7-8 gummy or regular Life Savers
- 1 Tbsp. of honey, sugar, or jelly
To prevent aspiration, fluids should not be forced. The unconscious/unresponsive person needs immediate medical attention. Call 911 (ADA, 2019; JDC, 2019).
Massage & Type 1 DM – Query the client about his or her diabetic complications and modify your massage accordingly. Complications associated with diabetes are far less common and less severe in people whose disease is well controlled. Ask if the client carries a blood glucose meter and, if so, where it is in case it is needed during a possible hypoglycemic episode. Clients with T1DM are insulin-dependent. Avoid vigorous massage over sites of recent injection for 24 hours as this may increase absorption rates (Berger et al, 1982; Linde, 1986) and thereby decrease blood glucose levels and possibly cause hypoglycemia. In addition, Tosun et al (2019) found injection site complications were significantly more common in those who massaged the area after injection. Consider teaching parents or caregivers how to massage the child with T1DM, making massage more accessible to the child and giving parents/caregivers another way to care for and nurture the child. Limit techniques taught to gliding and kneading and convey the same precautions licensed practitioners follow, such as avoiding skin lesions and sites of recent insulin injection.
Insulin Pumps and Massage. An insulin pump, or continuous subcutaneous insulin infusion (CSII), is the constant administration of short-acting insulin delivered through a needle or soft cannula inserted beneath the skin. A pump is used to push insulin into the tissues. This drug-delivering device is lightweight, waterproof, pager-sized, and conveniently fits into a pocket or can be worn on a belt clip. Insulin pumps are used by approximately 30–40% of people with T1DM and an increasing number of insulin-requiring individuals with T2DM are using pump and sensor technology. The device includes the pump itself (A), tubing leading to insulin delivery site (B), a glucose sensor (C), and a data transmitter which sends glucose readings to the pump via wireless technology (D).
Avoid vigorous massage over sites of recent injection for 24 hours as this may increase absorption rates and thereby decrease blood glucose levels and possibly cause hypoglycemia. Do not get massage lubricant on the sensor, transmitter, pump, or its tubing. For added comfort, offer the client a soft cushion to place over the pump while lying prone.
Research. Children with diabetes who were massaged by their parents were less anxious, fidgety, and less depressed after massage. After 30-days of continued massage from parents, these children were more compliant with insulin therapy and food requirements, which resulted in decreased mean blood glucose levels compared with the parent-child group who participated in relaxation therapy alone. Additionally, parents who massaged their children reported less parental anxiety and depressed mood (Field et al, 1997).
After three months of massage (15 minutes, 3 times per week), children with diabetes had lower A1C levels compared with the control group, which suggest massage may improve glucose metabolism (Kashaninia et al, 2011). Sajedi et al (2011) also found the same dosage of massage lowered blood glucose levels in children with diabetes, and recommended massage added to the daily routines in addition to exercise, diet, and medication regimens as effective interventions to reduce blood glucose levels in diabetic children.
American Diabetes Association. (2019). Standards of medical care in diabetes—2019 abridged for primary care providers. Retrieved from https://clinical.diabetesjournals.org/content/37/1/11
Berger, M., Cüppers, H.J., Hegner, H., Jörgens, V., Berchtold, P. (1982). Absorption kinetics and biologic effects of subcutaneously injected insulin preparation. Diabetes Care, 5(2), 77–91.
Field, T., Hernandez, R.M., LaGreca, A., Shaw, K., Schlanberg, S., Kuhn, C. (1997). Massage therapy lowers blood glucose levels in children with diabetes mellitus. Diabetes Spectrum, 10, 237–9.
Joslin Diabetes Center. (2019). How to treat a low blood glucose. Retrieved from https://www.joslin.org/info/how_to_treat_a_low_blood_glucose.html
Kashaninia, Z., Abedinipoor, A., Hoseinzadeh, S., Sajedi, F. (2011). The effect of Swedish massage on glycohemoglobin in children with diabetes mellitus. Iranian Rehabilitation Journal, 9, 16-20.
Linde, B. (1986). Dissociation of insulin absorption and blood flow during massage of a subcutaneous injection site. Diabetes Care, 9(6), 570–574.
Sajedi, F., Kashaninia, Z., Hoseinzadeh, S., Abedinipoor, A. (2011). How effective is Swedish massage on blood glucose level in children with diabetes mellitus? Acta Med Iran, 49(9), 592-597.
Tosun, B., Cinar, F.I., Topcu, Z., Masatoglu, B., Ozen, N., Bağçivan, G., Kilic, O., Demirci, C., Altunbas, A., Sõnmez, A. (2019). Do patients with diabetes use the insulin pen properly? African Health Science, 19(1), 1628–1637.
Dr. Susan Salvo is a massage therapist, author, educator, researcher, explorer, and perpetual student. To learn more, check out the “About Susan” tab. You can contact Susan at email@example.com.