Diabetes Insipidus

[Chris Haggard]

Hi,I am taking my massage final exam.  It is open book and I've finished every question but one.  Is massage indicated or contraindicated for diabetes insipidus?  How would I go about finding out?  I've searched exhaustively on the web, I've looked in my pathology book (Ruth Werner), I've sent an e-mail to Ruth and I've left a message on an endocrinologist's voicemail.  This is like the question of the ages because no one seems to know the anwser.  Maybe someone here has run across it in their textbooks.  If so, let me know and the reference from which it came.  I need to have proof to back up my answer.  Thanks.

 

[Sexy Beast 123]

Diabetes Insipidus

I think you stumped the band! You got me, anyway.When is your exam? I can ask when I go to Pathology class Tuesday if that helps.

 

[rae rae shorty]

Diabetes Insipidus

I wonder if this test question isn't meant to force you outside of the books, as will happen in your practice!  I found this article by Googling the condition name; it's from the Nat'l Institutes of Health.

http://www.nlm.nih.gov/medlineplus/ency/article/000377.htm

Here's a partial quote:

"Central diabetes insipidus is caused by damage to the hypothalamus or pituitary gland as a result of surgery, infection, tumor, or head injury. Although rare, central DI is more common than nephrogenic DI.

"Nephrogenic DI involves a defect in the parts of the kidneys that reabsorb water back into the bloodstream. It occurs less often than central DI. Nephrogenic DI may occur as an inherited disorder in which male children receive the abnormal gene that causes the disease on the X chromosome from their mothers.

Nephrogenic DI may also be caused by diseases of the kidney (for example, polycystic kidney disease) and the effects of certain drugs (for example, lithium, amphotericin B, demeclocycline).

If thirst mechanisms are normal and adequate fluids are consumed, there are no significant effects on body fluid or salt balance. If inadequate fluids are consumed, the large amount of water lost in the urine may cause dehydration and high sodium levels in the blood."

It looks like we can guess that massage is not c/i if the condition is controlled, esp. w/doc input.  If the excessive urine output due to nephrogenic DI is uncontrolled, we'd be putting a strain on the kidneys, but otherwise my guess would be request med list, request doc involvement (send doc massage-effects info), and work on client.  Especially if it's treatment work rather than circulatory.  But if there's a different opinion I'd like to hear it; I'm not a c/i expert and I usually try to find ways to work on people.

 

[cwilz]

Diabetes Insipidus

I had found the same information regarding insipidus. I can say that we did learn about Diabetes Meletus in school, and working on the client would not be contraindicated, but you need to find out where the last injection site was as you would not want to be working on the site area itself.

 

[parkcaitlan]

I'm sorry I didn't see this post earlier. Don't know if my answer will be too late to be of any help. In any case,  I had also researched this question because I ran across a question about diabetes insipidus in one of my exam study guides (Daphne Moore's?).  The following explanation is taken from The Massage Connection Anatomy & Physiology by Kalyani Premkumar:Vasopressin, or antidiuretic hormone, is formed in the hypothalamus and secreted by the posterior pituitary gland.  "If vasopressin is deficient, diabetes insipidus (diabetes, overflow; insipidus, tasteless) results. Diabetes insipidus may result from hyposecretion of ADH from the pituitary (neurogenic diabetes insipidus) or reduced response of of the kidney to ADH (nephrogenic diabetes insipidus). The symptoms include polydipsia (excessive thirst) and polyuria (passage of large amounts of dilute urine). Urine output increases tremendously - to as much as 20 liters (normal, 1-2 liters). Dehydration is another symptom of diabetes insipidus and may cause death if a person with this condition is deprived of water even for a day or so."

 

[mrsCULLEN]

I believe DI to be contra-indicated.  If I remember correctly there are 4 types of DI.  Diabetes insipidus and diabetes mellitus are unrelated, although they can have similar signs and symptoms, like excessive thirst and excessive urination.  The patients body processes fluids differently then normal (why this happens is why there are 4 types- one for each reason).  Just because of the effects of massage I would be cautious about this (always side with caution)  DO NO HARM..

 

[Andrea Vanessa]

Tried looking in all of my books and no answer there. I did find a section in  Massage for the Hospital Patient and Medically Frail Client that discusses Diabetes but does mention any type. Here are some excerpts from the section:Massage therapists will encounter this health situation more than any other.  Long term diabetes damages blood vessels and nerves.  Nerve damage leads mainly to peripheral neuropathy. Deterioration of the larger blood vessels increases people's risk for heart disease, hypertention, stoke and aneurysm, while small blood vessel damage causes kidney and eye problems. Artherosclerosis develops at a more aggressive rate.  Plaque can be deposited throughout the body.  Poor circulation also gives rise to edema in the limbs as well as dimished wound healing and fragile skin. In the advanced seforum.xxxes of diabetes the connective tissues can be very fragile and easily injured. The medical history of a person who has had the disease for a long time can be complicated and may require a number of massage adjustments. Diabetes is characterized by periods of instability. Massage should not be demanding on the body and thereby contributing to a disruption of the homeostatic equilibriu.  In his book, Massage Therapy and Medications, Randall Persad warns against increasing the metabolic demands on the body or the workload of the heart for those with advanced diabetes. Shorter sessions, perhaps 30 minutes are advisable at the beginning to guage the person's response to the massage. Noninvasive modalities may be the best during periods of severe instability.  Due to chance of infection practitioners need to practice exceptional Standard Precautions, especially near areas of fragile skin or open lesions. Good handwashing is a must. The tissue in areas that have received repeated insulin injections tend to become fibrotic. It may have poor color and sensation. Likew a scar it can cause tugging on nearby structures, reduce range of motion and create edema distal to t he area. Massage or stretching to these sites should be performed with care.It seems to me that is in indicated with the OK of the doctor and special care taken for the condtition. In reading this I assume all types of diabetes cause the same bodily reactions or they would have specified.  This is a Lippincott Williams & Wilkins book that I purchased a few months ago.

 

[akluis]

Diabetes Insipidus

According to "A Massage Thrapists Guide to Pathology"SE by Ruth WernerChapter 8 Page 419'Diabetes indicates massage as long as tissues are healthy and circulation is un impaired. Many people with advanced or poorly treated diabetes experiance numbness, cardiovascular problems, and or kidney failure. Circulatory massage in these situations is not appropiate." I would do it with an okay from a doctor.

 

[RockIt]

I have been in the health field as an EMT for 9 years, and I have only come across "ONE" single patient with this condition.  It is so rare that I honestly don't know why it is a question, only to fool you with mellitus vs. insipidus.  Diabetes Mellitus is usually what you hear of when people refer to them as being Diabetic, type 1 and type 2.  I am actually imbarrassed because when the guy told me that he had Diabetes Insipidus I really thought he said he had Diabetes and Syphillus!  I am probably one of a few EMT's that knows about it due to my Pre-med background.  So it actually took me about 20 minutes to realize that I had made a mistake in hearing him.  As for the above 2 posts, that is part of the problem where Diabetes Mellitus is referred to as just Diabetes, and the above 2 posts does not refer to Diabetes Insipidus.  It is not contraindicated as long as the person is being treated and takes their medications as indicated.  I would get a note from an MD just to cover myself and get their blessing for massage. I will look and see if I have any further info on it, but I think a few people posted covering the info.  We just need to clarify when people refer to Diabetes, just to be safe.