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APJ 100

Each and every day as aestheticians we encounter various skin through effective skin-improvement strategies. Diabetes is a chronic

conditions that we are required to address and provide solutions for. condition, which means that it's long-lasting, often for someone's

Some of these are topical, while others are systemic in their origin and whole life. For our body to work properly we need to convert glucose

the result of an underlying medical condition. (sugar) from food into energy. The hormone insulin is essential for the

conversion of glucose into energy.

As responsible practitioners we are required to conduct a thorough

and meticulous skin evaluation to determine any underlying health In people with diabetes, insulin is no longer produced or not produced

concerns that may have contributed to the manifestations that we are in sufficient amounts by the body. So when people with diabetes eat

observing on the skin. This is now expected of us if our clients are glucose, which is in foods such as breads, cereals, fruit and starchy

going to continue to trust our knowledge and expertise. vegetables, legumes, milk, yoghurt and sweets, it can't be converted

into energy. Instead of being turned into energy the glucose stays in

In this article I wish to address the needs of the diabetic client, as the blood. This is why blood glucose levels are higher in people with

diabetics can be more prone to skin issues than our other clients. In diabetes. Glucose is carried around in the body through the blood.

some cases you will be faced with multiple challenges as these clients Your blood glucose level is called glycaemia. There are two types of

often suffer from rosacea or hyperpigmentation. As a skincare diabetes – type 1 and type 2.

practitioner who treats various skin conditions, an understanding of

the underlying pathology can make an enormous difference to how

you select your treatment options and strategies, especially in this era In type 1 diabetes the pancreas, which is a large gland behind the of numerous advanced technologies. stomach, stops making insulin. Without insulin, the body's cells

cannot turn glucose (sugar) into energy. Without insulin the body

burns its own fats as a substitute. Unless treated with daily injections

of insulin, people with type 1 diabetes accumulate dangerous Let's look at what the statistics tell us about diabetes? Diabetes is the chemical substances in their blood from the burning of fat. This can world's fastest-growing chronic disease. An estimated 280 cause a condition known as ketoacidosis. This condition is potentially Australians develop diabetes every day, and approximately 1 million life threatening if not treated.Australians have diabetes, but for every person diagnosed it is

estimated that there is another person that is yet to be diagnosed. To stay alive, people with type 1 diabetes depend on up to four insulin

injections every day of their lives. They must test their blood glucose

levels several times daily. The onset of type 1 diabetes typically occurs Diabetes is a chronic condition in which the levels of glucose (sugar) in people under 30 years, but can occur at any age. About 10-15% of in the blood are too high and the body cannot metabolise sugar all cases of diabetes are type 1.efficiently. This condition affects almost every organ, including the

skin. Aestheticians must be attentive to the symptomatic

manifestations of diabetic skin and carefully work with their clients to Type 2 is the most common form of diabetes, affecting 85-90% of all

maintain good skin and body health. Your diabetic clients would people with diabetes. While it usually affects older adults, more and

definitely benefit from your understanding of their health-challenges more younger people, even children, are getting type 2 diabetes.

and from your expert knowledge on how you can support them

Type 1 Diabetes

DIABETES IN AUSTRALIA

WHAT IS DIABETES?

Type 2 Diabetes

Treatment Strategies for the Diabetic ClientTreatment Strategies for the Diabetic ClientBy Matoyla Kollaras

APJ 101

In type 2 diabetes, the pancreas makes some insulin, but it is not

produced in the amount your body needs and it does not work

effectively.

Type 2 diabetes results from a combination of genetic and

environmental factors. Although there is a strong genetic

predisposition, the risk is greatly increased when associated

with lifestyle factors such as high blood pressure, overweight or

obesity, insufficient physical activity, poor diet and the classic

‘apple shape' body where extra weight is carried around the

waist.

Type 2 diabetes can often initially be managed with healthy

eating and regular physical activity. However, over time most

people with type 2 diabetes will also need tablets and many will

also need insulin. It is important to note that this is just the

natural progression of the disease, and taking tablets or insulin

as soon as they are required can result in fewer complications in

the long-term.

Diabetes can affect every part of the body, including the skin.

Indeed, sometimes skin disorders are in fact the first sign that a

person has diabetes. It is estimated that as many as one-third of

diabetics will have a skin disorder. Perhaps the most common of

these problems is dry and itchy skin. This is due to a number of

factors. Some of these include:

Poor microcirculation due to vascular issues resulting in a

reduced availability of nutrition to reach the skin

Frequent urination (polyuria) results in reduced availability

of moisture to the skin

Damaged nerves that no longer tell the skin to sweat, thus

reducing the production of the skin’s natural oils

Diabetic neuropathy due to damaged nerves can result in

numbness, tingling, pain or even 'wasting' in the toes, feet,

legs, hands, arms and fingers. Another condition that you may observe in diabetic patients is

acanthosis nigricans. This is a condition that results in the darkening The dryness and accompanying itching can start small cracks in the and thickening of the skin in body folds and creases. Often areas of tan skin that can lead to the onslaught of bacterial or fungal infections. or brown skin, sometimes slightly raised, appear on the sides of the

neck, the armpits and groin. Acanthosis nigricans usually occurs in Recent scientific research has identified a set of compounds called people who are very overweight, and is most common in Indigenous "AGE" (Advanced Glycation Endproducts). When excess sugar and darker-skinned people. enters the blood-stream it binds to skin proteins such as collagen and

elastin. Once the sugars bind to the collagen and elastin, the proteins Most importantly you must keep in mind that diabetics suffer poor, mutate creating damaging new molecules known as A.G.Es, and as a slow or incomplete wound healing. result the proteins become cross-linked, more brittle and less elastic,

resulting in significantly prematurely aged skin. This glycation

condition cannot be reversed. A thorough medical history and a detailed and thorough skin and body

analysis that examines the cellular activity of the skin and its tolerance As a professional, you should remain vigilant for telltale signs on the levels is essential for every client, but even more importantly for your skin when delivering facial treatments, waxing, massage or during diabetic client before embarking on any treatments for face or body. manicure and pedicure procedures. Treatments should be carried out ONLY by qualified aestheticians

who have training and knowledge in advanced skin analysis, and Diabetic-related skin conditions such as diabetic dermopathy will always look out for the possibility of sensitivity and allergic reactions manifest as light-brown circular or round scaly patches, most often due to medications, infection and delayed wound healing. occurring on the front of both legs (often mistaken for age spots). You

may notice a thinning of the skin that causes shininess, cracked feet The other consideration with a diabetic client is to meticulously and and heels, painful infection of the nails and cuticles, or yellowish progressively monitor their skin's response to any treatment you plaque that forms over shins. undertake and when in doubt, tread slowly and cautiously. Always

employ best practice techniques taking into consideration the Diabetic clients are also more prone to folliculitis, boils, carbuncles, precautions necessary for this condition. By understanding the disease styes as well as thinning or loss of hair. Fungal infections are also from a mind/body and skin perspective you can make the correct conditions that frequently occur in diabetics and often occur in the recommendations and/or adjust treatments and homecare so that the moist folds of the skin such as under the breasts, around nails, between experience and the results are both safe and beneficial.fingers or toes, the groin and even under the armpits.

IDENTIFYING DIABETIC SYMPTOMS IN THE CLINIC

CONDUCTING SAFE AND BENEFICIAL TREATMENTS

Here are some useful recommendations for the diabetic client:

Reduce sugar and processed foods in their diet and increase the

intake of vegetables, especially dark green leafy vegetables.

Maintain adequate amounts of water – 6-8 glasses a day.

A routine exercise program is very important. Exercise that

promotes blood circulation is not just for cardiac health, but also

for healthy skin.

Keep the skin dry, especially in skin-fold areas such as between

the toes, armpits, groin area and under the breast or any place

where skin touches skin.

Avoid protracted hot baths and showers. If having a bath the

addition of Dead Sea or Epsom salts is recommended. Avoid

bubble bath.

Use mild soaps, or better still, moisturising body washes. Follow

with a nourishing body cream or lotion preferably rich in

minerals.

Prevent dry and itchy skin that can become chapped and cracked

by frequently applying a non-irritating body cream or lotion that

not only hydrates the skin, but also replaces the lost oils.

Recommend they carry a good hand cream in their bag.

Reduce risk of infections in the feet by drying the skin between

the toes carefully after a shower or bath. Moisturising lotions

should never be applied to skin between the toes. Clients should

also regularly check their feet for any sores or cuts.

Apply sunscreen to the tops of their feet and hands. This is

sometimes overlooked and can result in burns or sun damage.

Diabetics can very easily burn their feet and hands, especially if

they have nerve damage and cannot easily feel pain. Avoid being

in the sun during peak hours, which is 11am to 2pm.

TREATMENT CONSIDERATION FOR THE FACE3. Facial and Eyebrow Threading1. Facial treatments

4. IPL/Laser hair removal

5. Manicure and Pedicure

2. Acids and enzyme Peels

3. Microdermabrasion6. Hot and Cold Stone Therapy

4. Dermal Needling7. Paraffin Wax

PRODUCT INGREDIENTS BEST SUITED TO THE SKIN

NEEDS OF DIABETICS

5. IPL/Laser treatments

1. Anti-glycation agents –

2. Anti-inflammatory agents –

6. Electrolysis

7. Cosmetic Tattoo3. Anti-oxidants –

8. LED Light therapy

4. Water-binding agents –

BODY TREATMENTS5. Natural Moisturising Factors –

1. Massage

TAKE A WHOLISTIC APPROACH

2. Waxing

Matoyla Kollaras Director, Skin Factors Pty Ltd, Distributors of CHRISTINA

COSMECEUTICALS, AHAVA, and ANNA LOTAN.

diabetics and can lead to bacteria being trapped under the skin.

This is a more suitable hair-removal alternative, especially for the Insulin is usually injected in the morning. For clients on intermediate face.acting insulin, schedule treatments for mid to late afternoon. For

clients on rapid-acting insulin, schedule treatments 2-3 hours after As mentioned above this is considered a high risk for the type 1 injection. The timings of both are important in order to avoid peak diabetic, however, for milder conditions a full assessment is insulin activity. For advanced or poorly cared for diabetes, face imperative to determine suitability.treatments are contraindicated. Use only treatments and products that

contain ingredients that are beneficial for diabetic skin. Below I have

indicated some recommendations as well as identified some Treat with care and use only sterilised equipment when conducting a contraindications: manicure or pedicure. Do not cut cuticles, do not scrub feet with

pumice or metal files, monitor water temperature and keep it

lukewarm and ensure that you dry between toes and fingers It is recommended that you only use very mild acid or enzyme peels as thoroughly. Be aware that fungal infections, especially of the toenails, diabetic skins are usually very fragile.are common in diabetics.

As a rule microdermabrasion is contraindicated as diabetic skin is Hot stone therapy is contraindicated, especially in the extremities due often very thin and any abrasive action can pose a risk of tearing the to diabetic neuropathy. However, cold stones are indicated, but not skin.iced stones.

A thorough skin evaluation is needed to determine if the use of a This treatment is also contraindicated.dermal roller is safe to use for product penetration. This is with a

needle depth of 0.3mm or 0.5mm or less, which only reaches the

epidermal layers. Collagen Induction Therapy with needle lengths of

above 0.5mm that may create a trauma is contra-indicated due to the

body's poor healing capabilities and is contraindicated for type 1 Strong scientific evidence suggests that the following ingredients are diabetics.some of the most beneficial for the diabetic client – look for these in

treatments and homecare products:Before such treatments a thorough investigative skin analysis must be

We cannot reverse the existing glycation conducted to determine the client's healing capabilities. As a rule non-damage, but we can try and prevent future damage. Look for ablative lasers such as Alexandrite and ND YAG at the right ingredients such as Bilberry, Coffeeberry, L-Carnitine, Lycopene, wavelengths are usually beneficial, but meticulous care must be taken Niacinamide, Pomegranate, Pycnogenol.to ensure this. However, ablative lasers such as Co2 Urbian YAG

Your objective is to reduce cell lasers are definitely contraindicated. Either way, treatment parameters damage from inflammation, redness, swelling and pain as well as should be carefully considered when undergoing any laser treatments.soothe irritated skin, thus improving skin health and preventing

disease and premature ageing. Look for ingredients such as Aloe, Particularly for insulin-dependent diabetes this is definitely Centella Asiatica, Cinammon, Fenugreek, Ginseng, Omega 3, 6 and 9 contraindicated.fatty acids, Vitamin E, Sulphur and Zinc.

These are important in helping fight and reduce A thorough skin-healing assessment is needed to determine suitability free radical damage, fortify the entire skin and repair DNA damage. for this treatment, but as a rule insulin-dependent diabetes type 1 They also help restore the skin's defence barrier and support the skin's diabetics are contraindicated for this procedure.ability to heal. Ingredients to look for include Alpha-Lipoic-Acid

(ALA), B-Complex, Green Tea, Calcium, Chromium, Magnesium, Near-infrared LED light therapy has healing properties as well as

Selenium, Probiotics and Venuceane.Yellow LED, which is good for lymphatic drainage and improving

These are important to restore and blood circulation. Both these are beneficial for diabetic skin maintain the hydration levels of typically dry diabetic skin, and help conditions.prevent TEWL (Trans-epidermal water loss). Good ingredients

include Algae extract, Glycerine, Hyaluronic Acid and Sodium PCA.

One of the primary elements in With diabetic clients caution is also needed with body treatments. Due

keeping skin healthy is making sure the structure of the epidermis and to diabetic neuropathy, clients often have reduced or no feeling in the

in particular the stratum corneum is intact. The repairing components lower extremities of their arms and legs, therefore great caution is

that do this are often called natural moisturising factor (NMF) or needed when performing any treatments to hands or feet as the skin

ingredients that mimic the structure and function of healthy skin. The may easily tear, while they may not feel any sensation from heat or

include amino acids such as Arginine, Jojoba Oil, Olive Oil, Sesame cuts.

Oil, Seabuckthorn, Shea Butter.

This modality can actually increase insulin activity and thus reduce

blood glucose levels, as will the relaxing nature of massage. As a professional aesthetician, you play a vital role in taking care of Therefore, although this treatment is beneficial, keep an eye on your skin and dealing with clients that may manifest with different diseases client and ask questions intermittently during the treatment to check both of the skin and systemically. Making your diabetic clients aware that they are not going into a hypoglycaemic state. The treatment itself of their skin health through active self-monitoring should also be an should be gentle rather than vigorous and do not overwork the body.important part of your communication with them.

As a rule waxing is contraindicated in diabetics. The potential for

micro-tears due to fragile and dry skin gives bacteria the ability to

enter the body. Folliculitis is also an increased risk when waxing

APJ 102