The contraindications are because of slow healing and possible fluid retention.Their extremities may be more fragile because of poor blood flow. They may bruise easier and have problems healing. With sensation loss (neuropathy), they may not be able to tell you how much pressure is comfortable or if your hot stones are too hot. What feels good to them may actually be damaging. Any skin damage to legs or feet with little blood flow can lead to huge sores, infection, and possible amputation or death because they just don't heal. If they have a lot of swelling in their extremities, pushing the fluid around can be a bad thing. Since their circulatory system is compromised, the fluid could build up in their lungs or around their heart.If either one of these situations are present, I still massage, but I keep it light on the extremities. I do normal deep tissue on back and shoulders. The anterior neck I might not pursue as aggressively on someone with diabetes because of their increased risk of stroke and heart problems. I'd also leave the light in the massage room a bit brighter and make sure there isn't anything to bumb against. Diabetes is so common now, and there are lots of different symptoms and seforum.xxxes. Some people can manage it with diet alone and are relatively symptom free. For them I wouldn't bother with a doctor note. If the client has obvious severe health problems though, its probably a good idea to get a MD oppinion.Were you wondering just because, or do you have a client with diabetes?Katykangaroo