Diabetes is a chronic, lifelong condition. There are 2.5 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 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 therapy may initially aim to address the triggers for stress with an attempt to understand its particular manifestations for the client (i.e. how stress is noticed in the body). The aim could be both to uncover the reasons for the stress-triggers and to find ways of diminishing the experienced stress. It may also be worth finding out if the 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 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 2 diabetes. A diabetic client may come to yoga therapy with their 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; weight and glucose levels 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. Such feelings of deprivation certainly necessitate validation and therapeutic holding.
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 this the hospital visits, the accompanying physical discomforts, degenerating eyesight and so on and it is perhaps not difficult to see why people with diabetes, particularly those who have been recently diagnosed, can experience disbelief, depression and difficulty in accepting their condition. Depression itself may be a primary reason for a person with diabetes to seek yoga therapy. Yoga asanas to address depression and anxiety may, therefore, also 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). Yoga therapy can alleviate the stress and anxiety related to phobias such as these. 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. Taking a detailed history during the initial consultation for yoga therapy may alert the therapist to potential insulin abuse, particularly if the client has suffered with an eating disorder in the past, was diagnosed in their teens, or is particularly interested in sport (insulin abuse is also known to take place among athletes and body builders in particular). The involvement of other professionals should, of course, be encouraged as appropriate.
Diabetes is a complex condition with factors such as unstable blood glucose levels, weight management, stress, fears and phobias, depression and physical degeneration among others inter-playing in a multitude of ways. A client may seek out yoga therapy with very clear goals such as weight or dietary management or simply come because their condition feels overwhelming. Other professionals may be taking care of their physical needs but the emotional difficulties related to their diabetes may not have yet been addressed and explored. The use of yoga therapy for diabetes is now becoming more commonplace but there is still much to be done regarding a clear acknowledgement of the immense amount of emotional distress a person with diabetes can go through, particularly if they are newly diagnosed. Yoga therapy can be a profoundly efficacious way of addressing these 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 related to 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 potentially preventing the development of type 2 diabetes in the first place.