Massage for Type I Diabetes – Part 2: Contraindications

Although massage therapy has many benefits for Type I diabetic patients, there are contraindications that must be respected and performed to avoid complications and/or patient harm. This information can be used in objective, action, and assessment areas of charting. Some information, such as “I have high blood sugar” statements can be used in subjective areas of the patient’s chart when the comments have not yet been confirmed with records request. Asking the patient to sign a records request to validate information helps ensure better patient outcomes.


  1. Record areas of hyper- and hypo- sensitivity and update regularly. Review these prior to massaging at each appointment.
  2. Keep lubricant a hand-width away from injection sites, pump tubing, or unhealed lesions and ulcers to avoid infection.
  3. Residual insulin can accumulate at fibrotic injection sites. Do not touch these sites! Avoid all direct pressure on them or a release of accumulated insulin could result, endangering the patient with unintended hypoglycemia.
  4. Symptoms of hypoglycemia require immediate medical attention. Stop the massage and dial 911 if the patient develops a pallor, sweating, extreme irritability, muscle weakness, nausea, vomiting, confusion, seizure or LOC (loss of consciousness) and/or coma.
  5. Avoid long-duration massages that may produce systemic responses such as blood pressure and glucose changes.
  6. Avoid excessive turning or repositioning that challenges mobility.
  7. Protect any prosthesis from lubricant contamination.
  8. Get approval before massaging any amputation site.

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Massage for Type I Diabetes – Part 1: Evaluation & Management

This is part one of a two-part article.

Although massage has many  benefits for Type I diabetics, there are specific evaluation and management protocols that must be respected and performed to avoid complications and/or patient harm. This information can be used in both subjective and objective charting areas.

Evaluation and Management:

  1. During intake, establish diagnosis as Type I or Type II. Well-managed Type I may not require every caution or contraindication about to be discussed. Red flag the client chart to help you remember to ALWAYS ask this patient evaluation questions before administering a massage treatment on them.
  2. Impress the patient with advice (verbal, written or both) detailing a need to inform you of any changes in their diabetes.
  3. Update medication and symptom information at regular intervals, especially if you haven’t treated the patient in a long time.
  4. Guard against pathogen exposure. If you’ve been sick or the client before your diabetic patient is sick, you may want to warn them or reschedule them entirely. Ask all patients who use the room before your diabetic patient about their health status.
  5. Ask the diabetic client to check blood glucose before the massage. If below 100 mg/dl, defer massage until the client has consumed a carb snack.
  6. Avoid extreme pressure, temperature or chemical heat creams.
  7. Examine skin carefully before massaging, especially feet and hands. Are there ingrown nails? Cuts in skin? Record information. Avoid massaging open sores of any kind. Stay a hand-width away.

Check out the detailed article in Massage Magazine at

Acupuncture for lumbar disc herniation: a systematic review and meta-analysis.

Thirty RCTs involving 3503 participants were included in the study to evaluate evidence for the effectiveness of acupuncture in the treatment of lumbar disc herniation (LDH). Meta-analysis showed that acupuncture had a higher total effective rate than lumbar traction (RR=1.1, 95% CI 1.05 to 1.15; p<0.001), ibuprofen (RR=1.24, 95% CI 1.03 to 1.48; p=0.02), diclofenac sodium (RR=1.44, 95% CI 1.24 to 1.67; p<0.001) and meloxicam (RR=1.16, 95% CI 1.03 to 1.31; p=0.01). Acupuncture was also better than lumbar traction (SMD -1.33, 95% CI -1.82 to -0.84; p<0.001) and diclofenac sodium (SMD -1.36, 95% CI -2.59 to -0.13; p=0.03) in terms of visual analogue scale (VAS) scores, and better than lumbar traction (SMD 0.96, 95% CI 0.48 to 1.45; p=0.0001) with respect to Japanese Orthopaedic Association (JOA) scores.

Integrative Approach to Endometriosis

March is National Endometriosis Awareness Month in the US.

Endometriosis is defined as functional endometrial glands and stoma outside the uterine cavity. Symptoms include, but are not limited to dysmenorrhea, dyspareunia, chronic pelvic pain, and/or subfertility. Twenty to ninety percent (20-90%) of infertile women are estimated to have this condition which is 4-10% of all women. This population is at a higher risk for asthma, autoimmune conditions, cutaneous melanoma, ovarian and breast cancer, cardiovascular disease and atopic disease (allergic reactions). Pathogenesis has three theories, all with accepted supporting evidence.

  1. Implantation of endometrial cells onto peritoneum due to retrograde menstrual flow. (For this reason, yoga inverted poses are contraindicated during menses.)
  2. Transformation of multi-potential peritoneal cells into endometrial glands.
  3. Transport of endometrial glands through vascular and lymphatic systems.

Some lab considerations IH providers should consider are:

  • celiac profile, since there is an increased prevalence;
  • assess cortisol and DHEA levels,
  • assess estrogens and estrogen metabolites,
  • assess GI function via stool sample,
  • assess IgG and IgE food allergy profiles,
  • Test for CA125 due to cancer link, and more.

Treatment considerations include hormonal therapy, anti-inflammatory diets and/or medications, support of gut health, improve lymph drainage and circulatory function, lifestyle changes and surgery. (Select information from The College of Integrative Medicine in Hampstead, MD 2015 training module on endometriosis.)

This article offers comprehensive supplement treatment options as well.

Stuck in an opioids crisis, officials turn to acupuncture

About a decade ago, the military and Veteran Affairs began promoting a range of alternative approaches to pain treatment, including acupuncture, yoga, and chiropractic care. Federal research evaluators say there’s some good evidence acupuncture can help some patients manage some forms of pain. In government surveys, 1 in 67 U.S. adults say they get acupuncture every year, up from 1 in 91 a decade earlier. That growth has taken place even though most patients pay for it themselves: 2012 figures show only a quarter of adults getting acupuncture had insurance covering the cost.

Impact of acupuncture on antihistamine use in patients suffering seasonal allergic rhinitis

Seasonal allergic rhinitis (SAR) is a common disease that has detrimental effects on the quality of life (QoL) of affected individuals. Approximately 18% of patients try to alleviate their symptoms through acupuncture. The data from 414 patients were analyzed. The acupuncture group used antihistamines significantly less often compared with the other groups (acupuncture vs sham acupuncture: mean difference -4.49 days, p=0.01; acupuncture vs RM: mean difference -9.15 days, p<0.001). Approximately 38% of the acupuncture group did not use any antihistamine in contrast to only 16% in the RM group. The pre-post comparison suggested that the acupuncture patients did not need to increase the days of antihistamine use to alleviate their symptoms, unlike the other groups.

Conclusion: Acupuncture appeared to significantly reduce the number of days of antihistamine use while improving RQoL and SAR symptoms; it can therefore be considered a valuable, additional treatment option for patients with SAR.

Patient Request Model Form Available

If you are covered entity under HIPAA, your patients have a right to access their protected health information (PHI) such as clinical records. The American Health Information Management Association (AHIMA) has developed a model Patient Request for Health Information form to assist patients and providers in understanding and complying with patients “individual right of access” to their information. This form is not required by HIPAA but is a template for provider use that can be customized to fit your needs. Click here for more information:

A case report on acupuncture and temporal arteritis vasculitis

Temporal arteritis is a form of vasculitis that involves the large and medium-diameter arteries and leads to progressive headache. Symptoms may be accompanied by vision disorder, subfebrile temperature, fatigue, lack of appetite, weight loss, sweating and joint pains.

A 75-year-old woman presented with pain on both sides of the head. The pain occurred in the form of agonizing attacks 2-3 times a week. Accompanying neck pain was present, together with continuous lethargy and fatigue. Physical examination revealed decreased cutaneous elasticity and muscle mass, and a depressive mood state was present. The patient was first administered six sessions of acupuncture therapy directed toward the migraine etiology. When no response was achieved, we investigated temporal and parietal region points associated with headache in the literature. Points GB1,8,18, ST8, SI19 and BL8 were added to the treatment.

The conclusion: A decrease in the pain attacks and their frequency occurred following acupuncture therapy.

Heart-damaging effects of sitting can be reversed

Sedentary people are at greater risk of heart muscle shrinkage and stiffening, which increases risk of heart failure. The American Heart Association News reports a study on 50 sedentary men and women, ages 45-64 participating in aerobic exercise and yoga, at least four days a week, for two years. Those doing aerobic activity showed improvements in oxygen uptake and less cardiac stiffness. Those doing only yoga did not show a change in oxygen uptake or reduced heart stiffness. The ‘sweet spot’ for improvement is participating in aerobic activity, done for approximately 30 minutes, 4-5 days a week. The exercise should include ‘interval’ type exercise where the participant increases intensity to 95% of maximum heart rate (the hardest they can do) for 4 minutes, then 3 minutes of recovery. They repeat this session plan for 30 minutes.

Although yoga did not change heart muscle shrinkage and stiffening, it did show great promise with balance and decreased ‘fall risk’, which is a leading cause of failing health in the elderly. Integrative healthcare providers (IH) would do well advising patients to combine both types of exercise for better health of all geriatric patients. It should be noted that although this study was done on geriatric patients, this plan would also be recommended for younger populations.

Use of Acupuncture in the United States Military Healthcare System

The Military Healthcare System (MHS) shows increasing interest in acupuncture as an alternative to opioids for pain control. In a 2018 article in Med Acupunct, a total of 15,761 people received acupuncture in the MHS in FY 2014. Use of acupuncture was greater for Army service, white race, and senior enlisted rank overall, and for males ages 26-35 among active-duty and females ages 46-64 among nonactive-duty beneficiaries. A cumulative 76% of diagnoses were for musculoskeletal or nerve and system issues. Approximately 60% of patients received acupuncture from physicians, 16% from physical therapists or chiropractors, and 9.7% from physician extenders.

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