The inaugural Yoga in Healthcare Alliance Conference (February 2019) in London will explore the benefits of yoga for diabetes, a condition which has recently been found to cost the NHS more than £1 billion a year in prescriptions alone. This represents a £422 million increase in just ten years, with almost one in twenty prescriptions now written by doctors pertaining to diabetes treatment. With the risk of serious complications such as stroke, amputation or blindness, and 26,000 early deaths every year, diabetes can severely impact the lives of those diagnosed.

Of those who live with this illness, 90% have Type 2 diabetes – and there are an estimated further 12.3 million people at increased risk of Type 2 diabetes in the UK. According to Diabetes UK: “While Type 1 diabetes isn’t currently preventable, three in five cases of Type 2 diabetes can be prevented or delayed by making healthier choices, by helping people understand their own risk of developing the condition − and how to reduce it – and by securing early diagnosis for those known to be at high risk.”

Yoga can be beneficial for both forms of the condition. 

Diabetes is a chronic, lifelong condition. There are 3.7 million people diagnosed with diabetes in the UK alone with over 500,000 people suffering from the condition without even knowing it. The hormone insulin, produced by the pancreas, is used by the body to stimulate cells into absorbing nutrients and keeping blood glucose levels stable. In diabetes, the pancreas either produces no insulin at all or not enough to keep these levels stable thus causing dangerously high blood glucose levels. This can lead to weight loss, electrolyte imbalance, blindness, poor circulation and even death.

Fortunately for sufferers, the discovery in 1921 that purified insulin from dogs could be used in humans has since meant that diabetes is no longer eventually fatal but a manageable condition. Depending on the type and severity (Type 1 is commonly known as insulin dependent diabetes and Type 2 as non-insulin dependent), the condition may necessitate insulin injections (Type 1) and/or Metformin and dietary amendments (Type 2). It is to be remembered that no two people will suffer from diabetes in the same way and unstable blood glucose levels will affect each person in very different ways.

Diabetics may seek yoga and/or yoga therapy for a plethora of reasons including the balancing of blood-glucose levels, stress reduction (stress is known to affect blood glucose levels), weight management, the desire to come to terms with suffering from a long-term chronic condition, and help with the fear of injections to name just a few.

In a number of studies, yogic practices have produced an increase in the lean body mass and decrease in the body fat percent. This typically leads to an improvement in insulin sensitivity and reduction in insulin resistance. Insulin resistance, in fact, is the major abnormality in type 2 diabetes and precedes the development of overt diabetes by several years.

Stress is known to have an adverse effect on blood glucose levels. Stress induces the release of cortisol, the ‘fight or flight’ hormone, which increases heart rate, raises blood pressure and stimulates the release of glucose into the bloodstream. In people with diabetes, insulin is not always available to let the extra energy into the cells causing a build-up of glucose in the blood stream. The resulting high blood glucose levels are dangerous to the body, making stress reduction an important element of diabetes care.

Yoga can support in addressing the triggers for stress with an attempt to understand its particular manifestations for the client (i.e. how stress is noticed in the body); supporting the person to both uncover the reasons for the stress-triggers and to find ways of diminishing the experienced stress. It can be very helpful to explore if  stressors are accompanied by fear and if physical symptoms, aside from the poorly controlled sugar levels, are taking place (i.e. panic attacks). It would also be beneficial to determine if the stress experienced is eustress, chronic stress, episodic acute stress or traumatic stress. Trauma-sensitive yoga and yoga therapy can be utilised if the stress is, indeed, of a trauma-based nature.

Poorly controlled blood glucose levels are also known to make weight management difficult and being overweight can be a contributory factor to acquiring diabetes in the first place, particularly in the case of Type Two diabetes. A diabetic client may come to yoga with a main aim being to manage their weight or it may be that the weight is a side-issue which nevertheless needs addressing. Excess weight carried around the midriff in particular is known to make the control of blood glucose levels difficult so weight and glucose levels both have an effect on one another, interplaying in a complex manner akin to a negative feedback loop. Common feelings related to food and diabetes include feeling deprived and unable to enjoy desired foods.

A diagnosis of diabetes may bring with it a form of bereavement with the client lamenting the life they had and expected to continue having. Any life change necessitates the need for acceptance. Diabetics need to change their lifestyles, quite dramatically in some cases, and may also have to come to terms with injecting themselves multiple times a day. Add to that the hospital visits, the accompanying physical discomforts, degenerating eyesight etc and it is easy to see why people with diabetes, particularly those who have been recently diagnosed, can suffer with disbelief, depression and difficulty in accepting their condition. Depression itself may be a primary reason for seeking yoga. Yoga postures to address depression and anxiety have been found in research studies to be useful for this population.

For some people, the fear of needles is a very real and tangible phobia. Other phobias related to diabetes may include fear of hospitals, fear of blood tests, fear of gaining weight, and fear of fainting (related to hypoglycemia) etc. Yoga can also alleviate the stress and anxiety related to phobias such as these, which could be a learned response or fear inheritance or may indeed be both. It is to be noted that some individuals with a pathological fear of gaining weight may adjust their dosage of insulin to prevent such an occurrence, an extremely dangerous practice which can lead to coma and even death. Yoga has also been found to be beneficial for body image concerns in multiple research studies also.

Diabetes is a complex condition with factors such as unstable blood glucose levels, weight management, stress, fears and phobias, depression and physical degeneration amongst others interplaying in a myriad of ways. A person with diabetes may seek out yoga with very clear goals such as weight or dietary management or simply come because their condition feels overwhelming. Yoga can be a profoundly efficacious way of addressing deeper emotional responses to diabetes whilst also promoting multiple physical benefits such as better blood sugar control, reduced insulin resistance, the reduction of free fatty acids, diminished lipotoxicity and beneficial effects on beta cell function. It is also reasonable to postulate that the beneficial effect of yogic asanas on the insulin kinetics and the lipid metabolism, prevents the beta cell exhaustion and the development of a beta-cell secretory defect, thereby preventing the development of type 2 diabetes in the first place.

The research firmly suggests that  yoga has huge potential benefits to offer people experiencing diabetes. The Yoga in Healthcare Alliance (YiHA) is a social enterprise that is supporting and enabling the National Health Service to both train healthcare professionals in therapeutic yoga techniques and make yoga available to them directly. It also aims to lobby, raise awareness and provide support for yoga’s infusion into the NHS. In February 2019 (15th-17th) the first Yoga in Healthcare Alliance Conference will take place at Westminster University in London. The aim is to discuss how we can collaboratively incorporate yoga into healthcare, share success stories, raise the profile of yoga in healthcare, and effectively move towards a future where yoga is offered on prescription. Specific benefits of yoga for diabetes will be explored from a multitude of angles.

Places for the Conference are filling up fast. To find out more and to claim one of the remaining tickets, visit the Conference page at https://yogainhealthcarealliance.com/YIHA2019/ . For health, yoga and psychological professionals, attendance of the conference will be marked with a certificate from the College of Medicine, which can be used to contribute to CPD points. 

References

Cui, J., Yan, J. H., Yan, L. M., Pan, L., Le, J. J., & Guo, Y. Z. (2016). Effects of yoga in adults with type 2 diabetes mellitus: A meta‐analysis. Journal of Diabetes Investigation.

Bijlani, R. L., Vempati, R. P., Yadav, R. K., Ray, R. B., Gupta, V., Sharma, R., … & Mahapatra, S. C. (2005). A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. Journal of Alternative & Complementary Medicine, 11(2), 267-274.

Hegde, S. V., Adhikari, P., Kotian, S., Pinto, V. J., D’souza, S., & D’souza, V. (2011). Effect of 3-month yoga on oxidative stress in type 2 diabetes with or without complications: a controlled clinical trial. Diabetes care, 34(10), 2208-2210.

Kyizom, T., Singh, S., Singh, K. P., Tandon, O. P., & Kumar, R. (2010). Effect of pranayama & yoga-asana on cognitive brain functions in type 2 diabetes-P3 event related evoked potential (ERP). Indian Journal of Medical Research, 131(5).

Singh, S., Kyizom, T., Singh, K. P., Tandon, O. P., & Madhu, S. V. (2008). Influence of pranayamas and yoga-asanas on serum insulin, blood glucose and lipid profile in type 2 diabetes. Indian Journal of Clinical Biochemistry, 23(4), 365-368.

Sobana, R., Parthasarathy, S., DuRaiSamy, K. J., & Vadivel, S. (2013). The effect of yoga therapy on selected psychological variables among male patients with insomnia. Journal of clinical and diagnostic research: JCDR, 7(1), 55.

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