by Pat Mayrhofer Diabetes is a disease that results from the body’s lack of, or insufficient production of, insulin. Insulin is a hormone that is produced by the pancreas. It allows the body’s cells to convert sugars, starches and other foods to energy, which the body needs to perform daily activities. Most of the food people eat is broken down into glucose (sugar) in the bloodstream, and is the main source of fuel for the body. During digestion, the pancreas produces the right amount of insulin to move glucose from blood into the cells. However, people with diabetes have a pancreas that works inefficiently by producing little or no insulin. The body loses large amounts of fuel because the glucose increases in the bloodstream, is released into the urine and is passed out of the body. The loss of energy is only one effect this disease has on the body. Diabetes also affects the eyes, kidneys, heart, nerves and blood vessels. Most problems are a result of damage to the blood vessels. Blood vessels become thicker and less elastic. Moreover, due to excessive glucose that attaches to the proteins in the blood, it is more difficult for blood to pass through. The lack of blood flow affects other organs in the body. With impaired circulation, small cuts and infections are less likely to heal; and nerves become damaged, affecting the sense of temperature, pressure, texture and pain on a person’s skin. Most diabetics develop a nerve disease called neuropathy, which affects the feet and lower legs, causing numbness and tingling. It is important for people with diabetes to monitor their medication, diet, exercise and stress level; these factors affect the glucose levels in the blood. It is also important for diabetics to be proactive in their treatment and the control of their disease. Research has shown how massage positively affects a person with diabetes. Massage can affect the glucose level, energy level, circulation, stress, myofascial improvement and comfort level for the individual suffering with this debilitating disease. Massage releases endorphins, which calm the nervous system. This, in turn, decreases stress hormones and creates homeostasis in the blood glucose level. Massage and stretching will facilitate mobility and elasticity of the tissue. Diabetics experience thickening of their connective tissue, which can be greatly improved with massage techniques. Administered properly, hot-stone massage can increase all the advantages of manual massage for a diabetic client. It is important to keep in mind the decreased sensation of the extremities when performing stone therapy; therefore, the therapist must be in charge. Therapists cannot depend on their clients to tell them if the stones are too hot; they must be vigilant in checking the color and condition of the skin. Stone massage performed improperly and without adequate training is unsafe. It is important to implement an introductory stroke, which sends a subconscious signal to the brain that the therapist will be incorporating a hot stone in the massage. It is imperative to control the temperature of the stones , which should be maintained between 125 degrees and 128 degrees Fahrenheit; too hot could burn the skin and too cool is uncomfortable and ineffective. A sufficient amount of pressure needs to be applied when massaging with the stones. Some therapists believe they should use light pressure when massaging with hot stones; however, the opposite is true. The therapist needs to push the heat past the nerve endings on the surface of the skin and into the muscle tissue. The severity of the disease should determine if the client should receive a full-body treatment or a spot treatment. If the diabetes is controlled and is not advanced, then a full-body, hot-stone treatment would be indicated with caution. The therapist must check in with the client and observe his/her condition, and always listen to the client’s feedback. It is also a good idea to have some orange juice, candy or pretzels available if the client’s sugar level drops too low. If the client’s diabetes is more advanced, then spot treatments with the stones would be suggested with caution. Remember, extremes in temperature, whether hot or cold, should be avoided. Clients wearing an insulin pump need some special consideration. It is necessary to avoid the insertion site of the pump; do not massage the immediate area with stones or hands, and make sure the area is kept sterile. It is not a problem for the client to lie on the pump insertion site. Additionally, it is of the utmost importance that the stones be washed and the water changed after each treatment. The therapist cannot take a chance that a client with diabetes could contract a skin disorder like a staph infection. Due to a diabetic client’s reduced circulation, healing would be impaired. If a therapist is aware of these precautions, hot-stone massage can be safely offered to a person with diabetes. Stone massage can greatly improve the psychological effects to someone who is living with this chronic disease. It is important for the sufferer to strive to balance a healthy lifestyle with proper nutrition, adequate exercise, blood glucose monitoring, appropriate use of medications and stress management. It has been proven that massage is effective for reducing stress.