Biology

Type I diabetes mellitus is a chronic disease characterized by high blood sugar. The disease is mainly juvenile although it can develop at any age. Diabetes mellitus type I patients have their beta pancreatic cells producing insufficient insulin or no insulin at all.  This is due to the destruction of the beta pancreatic cells that secrete insulin due to autoimmune disease, removal of the pancreas or even alcoholism. Dehydration is a main characteristic of the disease due too frequent urination. Others symptoms include loss of body weight and general malaise. Complications in diabetes type I include ketoacidosis which leads to coma and death as well as neuropathy, nephropathy, cardiovascular diseases and retinopathy as chronic complications. The incidence of diabetes type I shows a geographical variation with Chinese having the least incidence. Racially, the Whites have a higher incidence than the Blacks and Hispanics. In terms of risk factors, individuals whose close relatives have diabetes type I are more likely to develop the disease. Other factors include congenital causes such as infection by cancer causing viruses and persons whose pancreas has been removed.

Diabetes type I is primarily treated by insulin injections hence it is called insulin-dependent diabetes mellitus. It is also important to maintain a blood glucose balance by watching the diet for glucose levels as well as engaging in physical activities. Complementary therapeutic approaches include massage therapy and bodyworks. Although these are effective in management of type I diabetes, close monitoring by the clinician and the therapist should be done to prevent possible adverse effects like hypoglycemia or vascular injury. The clinician should guide the patient on where to get accredited massage therapists.

Introduction
In general diabetes is a disease characterized by abnormally high blood glucose. There are two main types of diabetes Type I diabetes mellitus and type II diabetes mellitus. Diabetes mellitus type I (which is the focus of this paper) is a disease that is chronic that results from the pancreas being unable to secret sufficient insulin (or no insulin at all) necessary for regulating blood sugar. This inability is not only marked but it also occurs progressively. In diabetes mellitus I, the -cells of the pancreas that are responsible for secretion of insulin are progressively destroyed by through autoimmune reactions. Although this disease occurs generally at any age, its onset is mainly at childhood or adolescence.  It is also possible to have adults develop Type I diabetes if the beta pancreatic cells are destroyed by diseases, pancreatomy or alcohol. Diseases that end up destroying the  hepatocytes lead to type I diabetes mellitus. Such diseases include pancreatitis, and cancer of the pancreas or diseases such as Cushing syndrome which cause insulin resistance (Votey  Peters, para 1).  Type I diabetes mellitus is also commonly known as insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes (Medline Plus, para 1).

Symptoms
Although diabetes type I is characterized by various symptoms in the long run, there are certain main symptoms that are observable. A person suffering from Type I diabetes mellitus will experience thirst frequently due to dehydration brought about by frequent urination. The diabetic patient also presents with problems with eyesight usually occurring as blurry vision as a result of fluctuating blood sugar. If the blood sugar levels rise too much, the individual may get experience coma. The individual also experiences unintended loss of weight and he or she may feel tired or hungry. If a diabetic individual gets wounded or develops sores, it takes time a longer time to heal with infections being more common. Infections mainly occur in the bladder, skin and the birth canal. Such individuals also have itchy skin which is most of the times dry. The feet may of a diabetic person are likely to experience a tingling feeling or loss of sensation. It is notable that as blood glucose increases, the severity of the above symptoms increases.

Type I diabetes mellitus is associated with various complications that are generally common with diabetes. Nevertheless, the complications seem to occur earlier and early death is common. Often, type I diabetes patients experience diabetic ketoacidosis characterized by nausea and abdominal pain and eventually leads to coma or death. Chronic complications associated with type I diabetes include atherosclerosis and eventually cardiovascular diseases. Eye complications such as retinopathy and cataracts are common whereas diabetic nephropathy is a kidney complication.

Epidemiology
As earlier stated, type I diabetes is a common childhood diabetes and it is recognized as one of the main chronic disorders affecting children in the U.S. It is estimated that about 186,300 persons aged below 20 years in the United States have diabetes in general with most of these individual suffering from type I diabetes. Amongst all adults suffering from diabetes, 5 to10 percent have insulin-dependent diabetes mellitus. It is notable that type I diabetes constitute about 10 percent of all the diabetes cases globally. In the U.S., the annual incidence of type I diabetes has risen from 16 cases in 100,000 people during the 1990s to about 24.3 cases in 100,000 currently with roughly 15,000 annual new cases. Globally, type I diabetes incidence various as per geographical distribution with China having 0.61 cases in 100,000 whereas Finland has an incidence of 41.4 100,000. In the island of Sardinia, the incidence is 36.9 cases in every 100,000 persons.

Children aged between 1 and 4 years mainly die from diabetic ketoacidosis. Racially, type I diabetes I more common among the Whites (1.5 times higher than in black Americans) with Chinese having the lowest incidence.  In areas that have high incidence of type I diabetes, males are likely to be suffering the disease whereas females are mainly affected in low incidence areas.

Risk factors
Several factors are associated with increased risk of type I diabetes. Since the disease can be inherited, having a first-degree relative (e.g. father or mother) predisposes one to type I diabetes. It is therefore no wonder that screening for the presence of this disease along the family tree is one preventive approach. Alcoholics are also at a higher risk of developing type I diabetes due to the risk of destruction of beta hepatocytes. Individuals suffering from any autoimmune disease affecting beta pancreatic cells are also predisposed to develop type I diabetes mellitus. Such individuals are said to have latent autoimmune diabetes. If the infant is infected with rubella virus congenitally or by other viruses that can cause autoimmunity or cancer of the pancreas during pregnancy, type I diabetes is likely to develop. It has also been identified that the risk of developing type I diabetes increased if exposure to UV light is reduced or the levels of vitamin D are low. On another note, milk proteins such as bovine serum albumin initiate autoimmunity of the pancreas cells and the resultant diabetes type I.

Treatment  
Essentially, type I diabetes has been traditionally treated using insulin injections. Type I diabetes individuals have to depend on external insulin since the pancreas produces insufficient or no insulin at all. In addition to insulin injections as a management approach for type I diabetes, diet and exercise are alternative forms of managing type I diabetes. Generally, diabetic individuals should avoid foods that are high in glucosesugar content. Daily activities such as exercise should also be incorporated in the management process. Importantly, regular monitoring of the glucose levels should be done in order to ensure a balance between insulin injections, diet and physical activities. When this is done, the patient rarely becomes hypoglycemic or hyperglycemic. It is advisable that the services of diabetologists, opthalmologists and endocrinologists be sought in case of complications. It is notable that pancreas transplantation can be done to correct diabetes type I although the risk of immune rejection and severe side effects of immunosuppressive drugs is very high. Preventive approaches such as encouraging screening of close relatives for the disease as well as encouraging dietary and exercise measures is also an important preventive approach.

Alternative treatment approaches such as massage and bodyworks have also been explored in management of diabetes. According to Ezzo et al (p 220) Swedish massage is increasingly being used in the U.S. as a complementary therapy for diabetes type I. although there are not many studies regarding the effectiveness of massage in enhancing insulin absorption in type I diabetes, Ezzo and colleagues report that massage at the injection site increases insulin bioavailability thus regulating glucose levels. Massage can decrease blood glucose levels to normal values. Acupressure and breathing exercises also decrease glucose levels in diabetes as reported by Ezzo and colleagues. Syncardial massage has also been demonstrated as effective in relieving diabetic neuropathy symptoms.

Despite the potential effectiveness of massage therapy and bodyworks, it is important to note that some adverse effects can result. In type I diabetes patients, it is possible to induce hypoglycemia when massage therapy is used. As a result of the potential benefits and risks of massage in treatment of type I diabetes, it is necessary that the levels of glucose be constantly monitored to ensure a balance. This means that the massage therapist ahs to co-work with the physician in order to enhance patient benefits and reduce possible risks. It is the responsibility of the clinician to guide a diabetic patient on massage therapy especially on monitoring blood glucose prior to and after the therapy. It is also necessary that the clinician suggest a massage therapist who is familiar with Swedish therapy since it is the well known massage in research. On another note, a certified massage therapist should be sought. The National Board of Therapeutic Massage and Bodywork is an example of a certifying body. It is the responsibility of the massage therapist to enquire whether a person has diabetes and the current state of the individual before administering massage.

Ezzo and colleagues advise that continuous effleurage should be used in the initial stages of the massage and the massage should starts from back, then to the thigh and then the calf. If the patient has peripheral neuropathy the lower extremities should be gently pressed only after enough effleurage. The friction of the extremities should be gentle enough to prevent vascular damage for patients with vascular dysfunction.