Yoga Heals: Diabetes

More than 25 million Americans (including over 200,000 children and adolescents) are affected by diabetes, a metabolic illness in which the body is deficient in or resistant to insulin. Although having diabetes can lead to quite serious complications (including high blood pressure, heart disease and stroke, kidney disease, blindness, neuropathy and amputation), research shows that lifestyle changes, such as improvements in diet and physical activity, can help manage symptoms and improve health outcomes for those with diabetes.

There are two primary types of diabetes, type I and II. Another type of diabetes, gestational diabetes, can occur during pregnancy.

Type I, also called insulin-dependent diabetes, is caused by autoimmune destruction of the cells in the pancreas which manufacture insulin. Those who have type I diabetes depend on external sources of insulin for their bodies to regulate blood sugar levels.

In type II, which is also called insulin-resistant or adult-onset diabetes, the pancreas produces insulin, but the body is unable to use it effectively. Type II is the most common, affecting approximately 90 percent of those diagnosed with diabetes.

During pregnancy, women who experience high blood sugar levels (without prior diabetes diagnosis) have gestational diabetes. It is thought that hormones released by the placenta for the development of the baby can create insulin resistance in the mother's body, thus causing blood glucose (sugar) levels to increase. Although most hormones are unable to cross the placenta and affect the baby, glucose can, and the resulting high glucose levels in the baby's bloodstream triggers its pancreas to produce more insulin (which can lead to metabolic issues, such as hypoglycemia, after birth).

For all types of diabetes, exercise can help increase insulin sensitivity, which helps to manage blood sugar levels. Yoga exercises and techniques can also help reduce levels of stress, which improves metabolism and endocrine function, and specific techniques are thought to stimulate the pancreas more directly.

Five Yoga Techniques for Diabetes

For students with diabetes, yoga practice can improve strength, confidence, willpower and self-discipline. It can also lead to greater sense of contentment, which helps prevent stress and less healthful behaviors (such as poor eating habits).

Stress reduction leads to lower cortisol and adrenalin production (and helps reduce blood sugar); high cortisol also has been shown to promote overeating and accumulation of intra-abdominal fat, which contributes to insulin-resistance and to the risk of heart attack.

Yoga improves health of autonomic nervous system, and studies show it can improve nervous system health for those with diabetes.

Many students with type II diabetes will also be overweight, which can present a challenge especially in standing, balancing and forward bending postures. Teachers should be prepared to help students modify poses as appropriate. For instance, students can use a table, chair or wall to lean on in balancing or standing poses if they feel fatigued or uneasy about their balance.

For students with diabetes interested in beginning a yoga practice, our Intro to Yoga class or even Private Sessions would be the best place to start. Especially for those who feel intimidated by yoga's reputation as fitness for the flexible, young and thin, being with other beginners in a supportive and peaceful environment can set the stage for success.

Asana (postures)

Suryanamaskar

For diabetics whose doctors recommend physical activity and/or weight loss, sun salutations can be a great way to begin a safe and effective exercise regimen. When practiced at a brisk pace, sun salutation A and B can be an aerobic exercise. At a slower pace, the series of postures improves cardiovascular health, muscle tone, and mood.

Many variations of sun salutations exist. Students should be able to breathe easily through the movements, and teachers should monitor students for signs of weakness, dizziness or being out of breath, and provide modifications as appropriate.

Bhujangasana

Cobra Pose is a gentle backward bending pose intended to energize the body and balance the endocrine system (especially the adrenal glands and pancreas), and can be an excellent yoga pose for those with diabetes. To practice, lie down on your belly with hands to the sides of your chest, then lift your shoulders and chest away from the floor as you inhale. Lower as you exhale. Repeat several times.

Paschimottanasana

This forward fold increases intra-abdominal pressure, which improves circulation to abdominal organs (including the pancreas) and encourages relaxation, digestion and immune system function through activation of the parasympathetic nervous system. Sitting on a blanket and placing a rolled blanket under the knees will make the pose more accessible for beginning students. Students are encouraged to breathe deeply into the abdomen, as the breath creates most of the benefits of the pose.

Ardha Matsyendrasana Variation

This twist also creates intra-abdominal pressure and is therefore beneficial for the same reasons as paschimottanasana. For this variation, the sit with one leg extended and one knee bent. You may be able to cross the foot of the bent knee across the extended leg (the foot should be flat on the floor and knee pointing up). On an exhale, twist away from the bent knee, bringing one hand behind the back for support and hugging the knee close to the body to twist. Hold for three to five breaths, then repeat on the other side.

Pranayama (breathwork)

Anuloma Viloma Pranayama

This breath is similar to nadi shodana, or alternate nostril breathing. However, in anuloma pranayama, students inhale through both open nostrils, and exhale using the thumb and ring finger of the right hand to alternately close the right and left nostril.

Students will be seated comfortably, and inhale using the viloma technique, taking small "sips" of air in through the nose, or in other words, taking several brief pauses through the length of their inhale.

The exhale is done as one long breath out, with one nostril completely closed and the other partially closed, alternating with each exhale.

Research

Research has shown that yoga supports management of diabetes, and often can either reduce symptoms and even the need for medication.

Several small studies of individuals doing a gentle daily yoga practice (either alone or as a complementary therapy) have resulted in a significant reduction of blood sugar, showing that yoga can be a powerful complementary tool in managing diabetes, and its complications.

In another study, subjects with type 2 diabetes participated in a 40-day residential program which included asana, pranayama, cleansing techniques, and a vegetarian diet.  Subjects showed a significant reduction in blood sugar levels, and over a third of the subjects showed enough improvement that they were able to discontinue the use of diabetes medication to manage symptoms.

Tips, Contraindications and Considerations

Those with diabetes should carefully monitor their bodies' reactions to any new physical activity, especially if taking medication to manage symptoms. If over the course of practicing yoga their blood sugar lowers, their doctor may choose to prescribe a lowered dose, or suggest eliminating medication entirely.

Many teachers recommend practicing yoga on an empty stomach, but those taking diabetes medication may need a light snack or to even bring a piece of hard candy to class in case their blood sugar drops too low (a hypoglycemic reaction).

Students with type 1 diabetes are at greater risk of hypoglycemic reaction or other complications during yoga practice. A vigorous yoga practice could precipitate ketoacidosis--a medical emergency caused by extremely high blood sugar--especially if the student's blood sugar is very high at the beginning of the session. Symptoms of ketoacidosis include thirst, weakness, lethargy, nausea and confusion. If you suspect your student is experiencing ketoacidosis during a class, call 911.

Because of the risks associated with vigorous exercise and the effect of high temperatures, students are advised to practice a relatively predictable type of yoga, so they can be aware of any unusual reactions in their bodies, and in a comfortable room (hot or Bikram style yoga are not recommended for those who have experienced complications related to diabetes).

Those with diabetes are at greater risk for retinal detachment or bleeding. Students with diabetes are advised to refrain from practicing inversion poses (headstand, shoulderstand, and sometimes mild inversions like downward dog) until they have consulted with an eye doctor.

An additional complication of diabetes is peripheral neuropathy, in which the nerves of the limbs are damaged. Students must be careful of cuts and minor injuries to the limbs (which could lead to infection), and they are advised to take care in balancing poses (using a wall as necessary to prevent falling) and to avoid jumping between postures. A related complication, autonomic neuropathy, causes dizzyness when sitting or standing abruptly due to a drop in blood pressure, and students are advised to enter and come out of poses slowly, perhaps pausing for a breath or two halfway up.

Additional Resources

American Diabetes Association

How Does Yoga Prevent or Relieve Diabetes? - YogaU Online

Best Beginning Yoga Postures for Diabetes - YogaU Online

Dealing with Diabetes - Yoga Journal