Diabetes Care

Specialized services can improve the overall well-being of diabetic clients.

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Diabetes affects 24 million people in the United States—7.8% of the population—and 57 million more are considered to be in the “prediabetes” stage, according to the American Diabetes Association. Increasing obesity rates point to the likelihood of those numbers rising—which means that today’s spa professionals must prepare to meet the needs of this specialized clientele.

There are multiple approaches to working with spa clients suffering from diabetes. Therapists can help these guests achieve increased wellness by paying attention to some of the disease’s most common challenges: persistent stress, decreased circulation and fluctuating blood sugar levels. You will be better able to determine the treatment that best suits these guests through an in-take consultation or questionnaire. (See the In-take Tip boxes sprinkled throughout this article.)

Here, we explore specialized services that are deemed useful in the management of diabetes: acupuncture, mind and body treatments, and pedicures.

Targeted Acupuncture

Before you prescribe a course of acupuncture for a diabetic guest, it’s imperative to conduct a thorough consultation to target that client’s concerns. “We ask a variety of specific questions—about sleep patterns, energy levels, diet, hunger and thirst levels, body temperatures, stress or pain—to assess clients’ overall well-being,” says Erica Appenzeller, a licensed acupuncturist at My Acu Spa in San Diego. “Their symptoms comprise a big picture, or pattern, that we can take into account to create an individual treatment plan.” My Acu Spa encourages clients to visit regularly over the long term, starting with frequent treatments (twice per week), then, once the body achieves balance, more staggered appointments (weekly, then monthly or quarterly) to help maintain results.

Appenzeller reports success in countering advanced symptoms of diabetes, such as numbness in the feet or hands, poor circulation, slow healing, and fatigue or lethargy, with the application of acupuncture.
Some spas use acupuncture in tandem with other forms of Chinese medicine. I’ao Acupuncture & Spa in Maui, Hawaii, incorporates acupuncture, Chinese herbs, tui na (Chinese massage), TurboSonic whole-body vibration, and far-infrared sauna therapy to holistically treat diabetic clients.

“Acupuncture and Chinese herbs have shown to lower and regulate glucose levels; addressing polyphagia (the urge to eat too much), polydipsia (excessive thirst) and polyuria (excessive urination). They can also boost immunity, improve circulation and vision, and decrease fatigue,” says Christine Asuncion, an acupuncturist and practitioner of Traditional Chinese Medicine at I’ao. “Overall, acupuncture for diabetes focuses on regulating the circulation of blood and qi, balancing the organ systems to improve pancreatic function, and addressing internal heat and depletion of fluids.” Chinese herbal formulas, paired with acupuncture, may improve glucose tolerance and address symptoms such as peripheral neuropathy (loss of sensation) and blurry vision.

Mind and Body

Other types of holistic treatments also benefit diabetic clients by promoting harmony between body and mind. Ayurveda is a perfect example. Because of the wide range of diabetes types (ayurveda recognizes 20) and complications, prescribed ayurvedic programs might include purification involving steam bath, oil massage, or a variety of warm bolus massage, says Mark Toomey, Ph.D., director of Maharishi Ayurvedic programs at The Raj in Fairfield, Iowa. Here, technicians provide ayurvedic pulse assessment, synchronized-stroke massage called abhyanga, and transcendental meditation to combat symptoms.

In-take Tip
“A comprehensive health evaluation form is filled out by our clients, and they’re asked to bring in medical diagnostic reports such as blood panel work. The type and stage of the diabetes is of utmost importance, as well as their current medical history, because most diabetic clients have other health complications, from arthritis to high blood pressure. Everything must be considered.” —Christine Asuncion, practitioner of Traditional Chinese Medicine/acupuncturist, I’ao Acupuncture & Spa, Maui, HI

An ayurvedic approach is also employed successfully at The Chopra Center for Well-Being at La Costa Resort and Spa in Carlsbad, California, where each guest, diabetic or not, receives an initial, in-depth consultation to facilitate individualized treatments and postservice recommendations. Massage is performed to improve circulation and relaxation, and lifestyle choices—diet, exercise, meditation and stress release—are considered equally important for overall health.

“There’s a close relationship between insulin, blood sugar and emotions,” says Valencia Porter, M.D., director of women’s health at the Chopra Center. “Stress has a great influence on the course of diabetes, because when faced with it, the body releases adrenaline and cortisol, which have a direct effect on blood sugar and sugar-regulating hormones.” Therapists must maintain an open dialogue with clients, particularly during a relaxing massage, because changes in blood sugar levels are known to occur. A vulnerable client may be at risk for hypoglycemia, which can lead to dizziness or lightheadedness, rapid heartbeat or sweating. In fact, the client may need to monitor her blood sugar throughout the service.

In-take Tip
“When a client arrives, have her fill out a health questionnaire, listing medical issues. Do a consultation and create an appropriate treatment plan but do the research to make sure that the treatment will truly benefit her. Also, ensure that the client’s healthcare provider approves of the service you offer.”
—Martha Revis, owner, and Nathaly Tanner, esthetician, Skin & Beyond Day Spa, Franklin, TN

Many believe that body wrap treatments may also help assuage the symptoms of diabetes. A body contour wrap can stimulate the lymphatic and circulatory systems in diabetic clients, according to Martha Revis, owner, and Nathaly Tanner, esthetician, at Skin & Beyond Day Spa in Franklin, Tennessee. Stimulating the circulatory system, especially within the lower extremities, has helped many diabetic clients. (One caveat: As Revis notes, any diabetic client who has open sores should not be treated on or around the affected area until the skin has healed. In this instance, Skin & Beyond Day Spa requests a doctor’s approval before the treatment is provided.)

Reflexology and massage can indeed benefit diabetics, though the stage of the disease will dictate the treatment approach. “If it’s not too far progressed, we’ll offer reflexology on feet,” says Lois Arsenault, owner of Euro Day Spa & Salon in Winter Park, Florida. “In general, massage, particularly a medium-pressure Swedish one, is helpful, especially when providing neuromuscular therapy in the neck or shoulders.” For diabetic clients in advanced stages, the spa requests a physician’s approval before providing services.

In-take Tip
“Find out what kind of medication the client takes, how she takes it and, if it’s by injection, where she injects. If the area is sore or swollen, it should be avoided in massages. Also, add a question to your intake form: ‘Are you under a doctor’s care for diabetes?’ We have a standard intake form, but as we interview and follow up on specific concerns, that’s when most information is revealed.” —Angela Howard, certified health coach, Positive Touch Triad, High Point, NC

Perceptive Pedicures

A pedicure on a diabetic client requires heightened vigilance. Of utmost importance is a rigorous sanitation regimen. “Diabetes renders individuals more susceptible to infections, especially with bacteria and fungi,” explains Nanette B. Silverberg, M.D., a clinical associate professor of dermatology at Columbia University College of Physicians and Surgeons in New York. “Diabetics may develop loss of sensation in distal digits, especially on feet, which can result in trauma, possible ulcerations, superinfection, and risk of cellulitis and gangrene.” Although this should be standard procedure for any nail client, it bears repeating: Technicians should sterilize equipment before and after use, and avoid manipulating cuticles or nicking the skin. For diabetic clients, vigorous use of a pumice stone or foot file is discouraged.

Some spas have taken even greater steps to minimize the infection risks associated with foot baths. “We have a high percentage of clients with diabetes, so we decided to offer the waterless pedicure,” says Ke Norman, owner of Nailphoria Day Spa in Oakland, California. “This prevents our client from soaking in a spa pedi chair, water basin or bowl.”

The dry pedicure focuses on diabetic foot care techniques: gentle cuticle pushing (no nipping); light sloughing of dry and cracked calluses; vigilant attention to signs of fungus; and gentle massage for improved circulation. Because diabetes affects sensation in the extremities, a therapist may avoid using heat because these clients’ feet may not register the pain of burning.

“We’re very careful when treating diabetic guests, especially when corns or calluses are present,” says Maria Georgakou, owner of Beauty Harmony Spa in Agria, Greece. For clients who are unaware they’re diabetic, nail technicians at Beauty Harmony can identify telltale signs, such as dark splotches on the dermis, thinning of skin that causes shininess, or a yellowish plaque that forms over shins.

Diabetics deal with a plethora of health concerns, but with a few adjustments, you can make sure that your services cater to their specialized needs. By incorporating detailed client consultations into your spa’s protocol, providing services that address specific symptoms, and following through with personalized recommendations, you’ll improve the health of these clients. In turn, they’ll prove loyal over the long haul. •