The Problem

It is time that the full scope of Type 1 diabetes is acknowledged, which includes millions of adults who are too frequently misdiagnosed as having Type 2 diabetes, an altogether different disease.

Sunday, January 31, 2016

Yoga and Diabetes: Seeking Balance

Note: An abbreviated version of this blog was published by Rachel Zinman on her excellent website Yoga for Diabetes.

I started practicing yoga in 1994, six months before I noticed my first symptoms of diabetes. When I was newly diagnosed with Type 1 diabetes, at the age of 35, I was in extreme despair—I thought my life was ruined. But yoga saved my life then by allowing me some space and freedom from constant thoughts about my disease, and yoga continues to save my life today by helping me stay calm and focused despite the daily grind of self-care that those of us with Type 1 diabetes must do. I recommend yoga to anyone who has to live with the stress of chronic illness.

Yoga is a practice that uses poses, breathing techniques, relaxation, and meditation to balance mind, body, and spirit. In the West, hatha yoga, which involves stretching the body and forming different poses while keeping breathing slow and controlled, is most commonly practiced.  Yoga has much to offer people with diabetes, and probably its greatest benefit is stress reduction.  Diabetes is exacerbated by stress, and yoga is a useful tool to reduce stress.  It can both set the stage for better overall health and also reduce the stress associated with the myriad of details necessary for our daily diabetes care.  High levels of the stress hormones adrenaline and cortisol raise blood glucose levels, and thus reducing stress is integral to good blood glucose control.  Yoga cannot cure diabetes, but the many benefits of yoga (stress reduction, increased sense of well-being, discipline, and focus) can help make the disease more manageable and have beneficial impacts on blood glucose control and on our lives.

For me, exercise, yoga, and meditation are my “magic pills.”  If only it were so easy as to pop a pill!  To give you an idea of my routine, I attend a weekly class with a wonderful, experienced teacher.  I also have a morning home yoga and meditation practice.  My simple back care yoga routine plus meditation gets my day off to a good start.  Yoga has an immediate physical and practical impact on my health but it also affords me an emotional benefit over time.  Below are some of my tips for practicing yoga with diabetes:

Asanas:  As with any physical activity, one must listen to and respect what your body tells you in the moment.  It can be risky to practice some poses, for example crow pose (bakasana), when you have low blood sugar or even close to low blood sugar.  Also, if you have diabetic complications such as retinopathy, many inverted poses are contraindicated.  This is where a good yoga instructor (or doctor or your own research) is worth his/her weight in gold.  Come to class early and don’t be afraid to talk with the teacher and ask questions.

Insulin pumps and continuous glucose monitors (CGMs):  I almost always turn my insulin pump down for yoga class.  I am a “blood sugar burner,” meaning physical activity drops my blood sugar significantly, and I need to be careful to avoid hypoglycemia.  I always have rapid-acting glucose handy.  For a particularly vigorous yoga class, I turn my pump down by 80% at least one hour prior to class and for the duration.  For my regular yoga class, I turn my pump down by 50% one hour prior to class and for the duration.  I place my CGM on a block or some other raised space so that no one steps on it.

Meditation:  Many people say that they can’t meditate because they can’t keep their minds still.  Thoughts end up swinging through their mind like monkeys swinging from branch to branch in the jungle.  But virtually everyone will have “monkey mind!”  The point is to meditate, to be mindful, and to be in the present moment.  I practice a very simple style of meditation, breath meditation or Insight Meditation; meditation teacher Sharon Salzberg is my guide and resource.  There are countless tools to help you with your meditation practice.  Just find a quiet space, and give it a try.  Even a moment of quieting your mind can bring you a sense of peace.

Magic Pixie Dust:  Sadly, within the yoga and meditation communities there can exist “magical thinking” that is harmful to those of us with Type 1 diabetes, or any other serious disease.  Yoga cannot cure us; yoga cannot get us off of exogenous insulin.  A yoga teacher once yelled at me in the middle of class and said “Why do you have to wear that [my insulin pump], why can’t you take it off for class, how can you do inverted poses with your insulin pump on?”  This kind of ignorance and lack of compassion can push people away from yoga when it could be a beneficial part of their healthy lifestyle.  Because of that incident, I now do more to inform yoga teachers about my Type 1 diabetes and the medical devices I use to manage it (insulin pump and continuous glucose monitor).  Before a recent yoga and meditation retreat, I let the teachers know I have Type 1 diabetes, and let them know that my devices are on vibrate mode, but still make some noise.  I received the most compassionate response.  Yoga should foster compassion within us and for others; teachers who truly care for their students demonstrate compassion and not judgment.

If you are new to yoga, the best way to start a yoga practice is to find a competent teacher with whom you feel comfortable, and whose style speaks to you.  Many yoga studios now offer Yoga Basics classes or an introductory yoga series of classes.  These “yoga training wheels” classes can be especially beneficial for those who have no experience with yoga, because even beginning classes can be too advanced for those just starting out.

About Type 1 diabetes:  Type 1 diabetes is an autoimmune disease in which an immune-mediated process destroys the beta cells of the pancreas (the insulin-producing cells are destroyed).  People with Type 1 diabetes depend on exogenous insulin for survival, and there is no cure.  Although Type 1 diabetes used to be called “juvenile diabetes,” it is now recognized that people of all ages acquire Type 1 diabetes, including the elderly.  More than 85% of people with Type 1 diabetes are adults.

Yoga and Meditation Resources:  There are so many excellent resources, but here are a few of my favorites:
  • Yoga for Healthy Aging Blog (http://yogaforhealthyaging.blogspot.com; by my forever friend and yoga buddy, Nina Zolotow).
  • Moving Toward Balance:  8 Weeks of Yoga. Rodney Yee and Nina Zolotow.  Rodale, 2004.
  • The Yoga Tradition:  Its History, Literature, Philosophy, and Practice. Georg Feuerstein.  Hohm Press, 2001.  [This is a weighty book, if you want to delve deeper into the history and philosophy of yoga]
  • Real Happiness: The Power of Meditation.  Sharon Salzberg.  Workman Publishing, New York, 2011.
  • Yoga as Medicine: The Yogic Prescription for Health and Healing.  Timothy McCall MD. Bantam Dell, 2007.
  • Full Catastrophe Living:  Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness.  Jon Kabat-Zinn.  Bantam, 2013.
  • Excellent yoga classes, including classes taught by Tias Little, are available at YogaGlo (www.yogaglo.com).

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