Creating Healing Massage Spaces for Diabetics
In the United States alone, more than 29 million people have diabetes, and I'm one of them. Specifically I have type 2 diabetes, which was once also considered 'adult-onset' diabetes, but in today's world, people of all ages are experiencing this condition.
In 2012, 86 million U.S. adults had pre-diabetes, and without exercise and better nutrition, up to 30% of those people were predicted to have type 2 diabetes within five years. People of color and people without access to healthy nutrition options are most at risk for developing type 2 diabetes. And diabetics of all types experience increased risk of heart disease, stroke, vision loss, and other debilitating complications.
As grim as these facts may seem, our diagnosis is not a prescribed destiny. And massage therapy can play a critical role in our healing journey, whether we are seeking to kick our condition into remission or just making peace with it as best we can.
Creating Space Beyond Diet & Lifestyle Advice
Health conscious and wellness-oriented people generally get the part where type 2 diabetes is thought to be caused by lifestyle and diet, but what they often miss are the very real economic constraints that narrow the lifestyles and diets we can choose from, which subsequently corrals us into a lifetime of chronic pain and disabling illness.
Diet and lifestyle are important to the health of diabetics. But what isn't helpful, especially coming from able-bodied wellness professionals or activists, are loud reminders of these facts accompanied by an implicit shaming of the progress others assume we haven't made. Believe it or not, diabetics are reminded about our health throughout the day. It happens every time we check our blood sugar level, every time we medicate, and every time we try to negotiate the food landscapes of this modern world for anything remotely healthy for us to eat.
Healing spaces do not need to be about invasive health reminders, fat shaming, diet shaming, or really what is largely class shaming when it comes to clients with type 2 diabetes. To paraphrase comedian Christela Alonzo, "When you grow up poor, it's not about eating healthy, it's about eating because who knows when your next meal is going to be."
To contextualize this in more familiar wellness industry terms, type 2 diabetes is a disease of scarcity. And you can't heal a scarcity mindset through adding to the insecurities people feel. On a metaphysical level, this is where our healing spaces must start: with cultivating an environment of security, safety, and compassion to aid these people on their health journeys.
Tangible Benefits of Massage Therapy
Massage isn't all about metaphysics though. Bodywork has some scientifically demonstrated, tangible benefits to offer diabetic clients, whether they have type 1 or type 2 diabetes.
For clients living with peripheral neuropathy, the increased circulation resulting from massage is known to offset the disabling effects of this condition as many as 50% of diabetics experience. For me personally, I know when I experienced periods of neuropathic pain, massage treatment was all about finding the right balance of pressure and muscular cradling. Even therapists who have experienced this pain firsthand will need to rely on verbal guidance from their clients to navigate this kind of therapeutic work.
For clients living with type 1 diabetes, massage around insulin injection sites is known to immediately lower blood glucose levels as well as A1Cs after 3-6 months of regular massage.
Even 15 minutes of light massage along with breathing exercises have been shown to lower blood glucose levels. And for type 2 diabetics, regular massage (studied at 3x/week) has been linked to decreased A1C numbers.
Tips for Therapists
To be a guide on the healing journey for diabetics, there are a few way-points you'll want to mind.
First, increase the amount of effleurage you do. Circulation can be an issue for diabetics, and doubling-down on the amount of light, preparatory movements you do before going in for deeper work can make all the difference in the world. For clients who have received massage before, ask if they experienced bruising. For new clients, be cautious that deeper work can have a deeper and longer impact on diabetics.
You'll also want to check in more frequently about pressure, particularly on lower limbs and extremities. Ask your client about complications related to their diabetes, specifically if they're experiencing neuropathy. This is a common question for other healthcare providers to ask diabetic patients, and likely won't come across as invasive, especially if you contextualize it with concern for making sure you know where to be extra-mindful of pressure and deeper work.
Since massage can lower blood glucose levels, you may also want to keep a few snacks like granola bars or crackers available for diabetic clients. Clif bars are sometimes suitable for clients who may be vegan as well, but you'll have to read the ingredients to be sure. Let your client know ahead of time that they may experience a drop and that you have some snack options if they need them after the session. Diabetic clients may experience dizziness or feel lightheaded at the end of the session due to these internal changes.
Lastly, and most importantly, strive to be a non-judgmental provider of healing assistance for people like us. You don't have to overdo it, but I cannot emphasize enough how much cultural shame is put on being diabetic. Being open about our condition with anyone, regardless of whether they have medical training or not, is often to open ourselves to unsolicited assessments and advice regarding diet, body shape, and lifestyle.
The best advice I can give therapists is to be active listeners with your diabetic clients. If we come to you for nutritional help and you're qualified, by all means, help us. If we're just there for a massage, keep it on that level. Be friendly, be kind, be compassionate. There's important healing work taking place on your table.
Pat Mosley (NC LMBT #16882) is a licensed massage and bodywork therapist in the Winston-Salem area. His work is rooted in compassionate touch, permaculture, and deep ecology with the resilience of all Earth's children in mind. Connect with him via email to firstname.lastname@example.org