I am a huge fan of massage therapy.  It seems expensive at times, but it’s always paid off in spades.  It’s an investment in my bodies health and a long term performance enhancer.  I border on addicted to exercise.  I have a hard time taking rest days because of the subtle shifts in blood glucose control that happen after a couple days rest.  The risk of all this is overtraining or overuse injuries.  I actually had an example of this happening this winter – I had gone too hard, too often, and started showing some classic overtraining symptoms.  I was borderline depressed afterwords, I had no energy, I didn’t want to get on the bike, and when I did I couldn’t turn the pedals.  I hit the wall.

So how did I deal with this – well, I took some rest days for starters.  I re-evaluated my goals – why was I pushing myself so hard; had it gone past blood sugar control.  I still wanted to train, but I needed to step back some.  Not every day can be a Sufferfest day.  I had gotten addicted to the burn and the massive gains I was making and ignoring what my body was telling me.  But, a huge thing I realized is I hadn’t gotten a massage since October!

I used to make massage therapy a monthly (if not more frequent) part of my routine.  Massage therapy helped me deal with some leg and back issues I was having.  I needed deep tissue massage to help loosen up some very overworked muscles.  Plus, desk work was not gentle to my back and shoulders (but a sit-stand desk has helped fix this).  Deep tissue is phenomenal, but it can hurt so be forewarned.  The therapist is trying to get into the scar tissue or chronically tight muscles.  It hurts, but almost immediately you see the benefit.

So, I went for my first (and shortly after second) massage here in St. John’s.  During my second session he mentioned that they do train massage therapists to handle diabetics different.  This caught me off guard – what would a well controlled diabetic require different.  He mentioned they do less “cleansing” strokes after a deep massage.  I wondered what happened to the “recovery” part of the agony! 🙂  But seriously, there was some comment about not wanting to flush stuff as much through the system.  I filed it mentally to look up afterwords.

Turns out, if you Google “Diabetes massage” you get all sorts of things – it cures diabetes, if you have diabetes don’t do it/it’s the best thing for you, etc.  The usual!  However, one interesting article written by a Type 1 diabetic massage therapist sheds some light.  Apparently, we do present differently (especially depending on activity level).  We can tend to be more fibrous as a consequence of periods of higher glucose.  Also, injections can lead to thickened skin.  I asked my therapist about this and he said he did actually notice this in his other two diabetic patients, but that it wasn’t noticeable in me.  Maybe he was trying to be polite, or maybe the level of activity has an impact on the fibrous presentation of muscles.  Tighter blood sugar control may make the muscles less fibrous which seems to support my belief that tighter control makes it easier to exercise.

But that still didn’t address why a massage would be modified, just why they may have to work harder with us.  Then, common sense clicked in after I read this site.

Basically:

  1. Massage therapy can cause hypoglycemia – if you have recently injected insulin and do not advise your therapist where you did this then there is a chance that their techniques may cause faster absorption of the insulin.  The response would be similar to injecting insulin into a working muscle group – it works fast!  I guess this is why my therapist was avoiding his cleansing techniques.
  2. If you have neuropathy you may not feel just how much pressure the therapist is applying.  Trust me, they can apply a lot of pressure as is evidenced by the sheer number of F-bombs I can drop in an hour.  If you suffer from neuropathy, deep tissue may not be for you.  Use common sense.

I guess I had never though about this.  Then, reflecting on some of my massages I’ve had after a meal I now know why I would suddenly drop in blood sugar and then rise high later.  Basically the massage was pushing that insulin into my system quickly, and it was peaking way earlier than usual.  Lesson learned.

So, long story short – what did I learn.  Well, I still believe that massage therapy is an important part of athletic training, performance and recovery.  But I’ve also learned that, as per usual, we diabetics must balance our management strategies to make the most out of a massage.  My management strategy for massages is now:

  1. Make sure the therapist knows you are a diabetic and knows where any infusion/injection sites are.  That way, they won’t think you are a human pin cushion.
  2. Time massage appointments so they do not immediately follow a bolus.  Try and schedule it so it’s not immediately after a meal, that way the risk of hypoglycemia is lower.
  3. Always have a glucometer (CGMS, traditional meter, or both) and sugar pills beside you.  Keep checking in on yourself, make sure you aren’t trending low.  Treat accordingly.  Keep your therapist in the loop on how your glucose levels are and how they are trending.  You’d be amazed at how curious they are about it all.  Some websites suggest the average response they observed (non-scientifically) in diabetics was a blood sugar reduction of  ~1-2 mmol/L.  As you learn how your body responds you can adjust your strategies.
  4. Be very aware of your signs of hypoglycemia, but also be aware that they may be confused with signs of massage response.  For me, I sweat profusely during a deep tissue massage due to the pressure (and let’s be honest, pain), and sometimes can feel light headed from that.  That’s why it’s crucial for me to have my CGMS beside me- I can’t rely on my typical hypo response to alert me.  As always, test frequently.
  5. Don’t be afraid to ask the therapist to stop if you need to test.
  6. If you have neuropathy, talk to your therapist and/or doctor about how to incorporate massage therapy.  The last thing you want to do is harm!

And as always, log what you did, how your blood glucose responded, and adjust as necessary.  My last massage I asked him to not make any accommodations for it and my blood glucose remained fairly constant.  He was curious and kept checking in to see how things were going.  It became a teachable moment about diabetes and day-to-day management of a chronic disease, and that’s a good thing.

Fellow diabetics, do you have any experiences/lessons learned or funny stories from massage therapy appointments?  I’m sure we’ve all had lots of “teachable moments”.  Do you use massage therapy?

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