I have been working with people with various health challenges from the importance of playing games to Alzheimer's Disease, and from tai chi to the benefits of sleep, for more than 30 years. A colleague of mine, Lynda Solien-Wolfe, is the Vice President of Massage and Spa at Performance Health and has been a practicing massage therapist since 1993. We began talking about the topic of diabetes, and Lynda shared that she has been living with diabetes for 23 years. Our discussion about how massage helps her manage some symptoms of diabetes made me realize this was a topic I have yet to cover in an article. Since this issue is now so widespread, I think this topic will be relevant and beneficial for many readers.

According to the American Diabetes Association, one out of every 11 people currently has diabetes. But what is more worrisome, is that one out of every four of people in the United States do not know they have diabetes. Diabetes comes in two forms: Type I, which is not preventable and in which the body does not produce enough insulin, or Type II, which is preventable and in which the body cannot process insulin correctly. "I was diagnosed when I was pregnant," said Solien-Wolfe, a common occurrence for women. She now has Type II diabetes.

American society's shift to a more sedentary lifestyle combined with its shift in diet to consuming more processed foods high in sugar and high fructose corn syrup are cited as common causes of the rise in Type II diabetes in the U.S. The cost of lost work time and healthcare associated with diabetes is mind-numbing: an estimated $245 billion a year. This is a serious condition that is impacting the quality of life for many Americans. As a massage therapist, it is important for you to know some common complications of diabetes, and how you can help manage them.

"I was thirsty all the time and was having significant mood swings - even for a woman who was pregnant," recalls Solien-Wolfe, when asked about her first symptoms of diabetes, which are very typical. And the constant rise and fall of glucose levels - those sugar "highs" and "lows" all of us can experience when consuming foods high in sugar - are magnified for people with diabetes and cause dramatic mood swings. "Many of my clients that have diabetes also experience tender areas, leg cramps, puffy feet, and loss of sensitivity in their feet."

These symptoms are very representative of some of the complications that people living with diabetes experience: nerve damage, foot problems and skin conditions.

Nerve damage from diabetes is called diabetic neuropathy, a condition Solien-Wolfe experiences. According to the American Diabetic Association, about half of all people with diabetes have some form of nerve damage. Regulating blood glucose levels is the best way to delay diabetic neuropathy or prevent further damage. The most common form of neuropathy is called peripheral neuropathy, which affects the legs and feet (enter foot complications). Peripheral neuropathy can cause loss of feeling, so one can injure their foot and not know it. This can lead to untreated injuries or infections. Diabetes causes poor circulation in general, and one of the areas most commonly affected by this is the feet. Blood vessels can narrow and harden, leading to a reduced ability to fight infection and heal, and chronic cold feet. This is why people living with diabetes are more likely to have lower limbs amputated than others.

Massage therapy is one of the best ways for diabetics to manage peripheral neuropathy. Massage of the lower extremities improves circulation in the legs and feet. In one of my advanced geriatric massage classes, I teach a modality for the legs and feet that is specific to people living with diabetes.

Solien-Wolf continues, "Massage has really helped me manage muscle pain and foot pain. It has been instrumental in helping improve my circulation and balance my stress levels, which helps alleviate the mood swings that can result from changes in glucose levels." She is not alone in this thinking. Evidently massage has been recommended as a treatment for conditions related to diabetes for more than 100 years. A recent literature review on alternative therapies for diabetes was published in the Journal of Pharmacy & Bioallied Sciences. It touts the benefits of massage for people living with diabetes: "Three published results of two trials and one unpublished preliminary study have examined the positive effect of massage on normalizing blood glucose. One trial also assessed the improvement in 56% of cases of diabetic neuropathy of the lower extremities by syncardial massage. Massage has been demonstrated to reduce muscle tension in both subjective self-reports an objective electromyographic testing. Relaxation from massage has been demonstrated to be greater than that brought about from rest alone. Massage can reduce heart rate and blood pressure, two features of the relaxation response. The extreme stress-reducing benefits of massage have raised the possibility that massage may be of benefit to people with diabetes by including the relaxation response, thereby controlling the counter-regulatory stress hormones and permitting the body to use insulin more effectively."

"I get massage by a licensed massage therapist at least twice a week and I give myself a foot massage twice a day. This helps to manage my pain and increase blood circulation. It also serves as a self-awareness check for my feet," says Solien-Wolf.

My conversation with Lynda confirmed that massage therapy can truly help people living with diabetes manage some of their symptoms. As practitioners, it is worth learning more about this, since massage is a drug-free, noninvasive, and minimal-risk pain management option for diabetics. For more information, please talk to a doctor, or visit the American Diabetes Association and the Mayo Clinic.