MANAGING DIABETES MELLITUS:

The four main areas for the management of DM are –

Diet, Exercises, Yoga, Medications – Oral AntiDiabetics & Insulin

DIET

  • Right Food Choice, Balanced Meal 
  • Regulating Life Style, Managing Personal Preferences
  • Strict Limitation on Food with High Sugar Content
  • Regulating Blood Sugar is the Best Management for Diabetes Mellitus to Protect Long Term Health
  • For Type II & Overweight -Ensure Right Kinds of Foods & Eat Less
  • For Type I -Satisfy Appetite & Maintain Healthy Weight
  • Keep off Honey, Syrup, Chocolates, Sweets, Candies, Cake, Biscuits, Sweet Bread, Soft Drinks, Icecreams
  • Avoid Maida, Processed & Refined Food, Fried Foods, Butter, Ghee, Margarine, Cheese, Nonveg, Frozen Foods, Canned Soups, Pickles, Extra Salt
  • Adopt Fruits, Vegetables, Cereals, Low Fat Dairy Products, Thin Butter Milk, Bran, Whole Grain, Chapattis, Edible Skins & Peels
  • Consume Lots of Water for Proper Digestion
  • Take in More Fibre in the form of Indigestible Plant Cell Component which is Water Insoluble, adds Bulk & creates a Laxative Effect e.g. Peels & Husk Of Fruits & Vegetables, Whole Grains
  • Also, Water Soluble varieties like Oats & Barley, that Hold Water to Form Gel and Increase Bulk, which bring about a Feeling of Fullness and in effect Lower the Calorie Intake and help to Maintain Weight
  • Go for Artificial Sweeteners that Cultivate Appreciation for Natural Flavors of Foods & Beverages, being Nutritive & Calorigenic such as Fructose, Sorbitol, & Honey, in place of Saccharin & Aspartame which are Non-Nutritive & Non-Calorigenic
  • If & when Hypoglycaemia sets in, ingest Immediately 2 Tsp Sugar, or Glucose, Biscuits, Candy, Milk
  • Keep at hand Emergency Eatables at all times and Avoid Long Gaps

EXERCISE

  • The Aim is to Increase the Sensitivity in Action of Insulin so that Cells Use Glucose Easily
    • Brisk Walking, Running, Jogging, Bicycling, Tennis, Skipping, Swimming
  • Duration 10-20 Min, beginning Gradual & Slow, & Increase to Atleast One Hour Per Day
  • Before Starting Intensive, Ensure Diabetes is Adequately Controlled
  • Initial Fluctuations in Blood Glucose Level might require a Dose of Insulin / Pills
  • Go Easy at the Site Of Injection like the Arm, Abdomen, Thighs, & Buttocks, Before Planning any Exercise Regimen
  • Work the Leg Muscles with Running, Jogging, Cycling

INTEGRATIVE YOGIC THERAPY

At Annamaya level – Diet, Kriya, and Asana.

  • Sithilikarana Vyayama / Loosening Exercises help in the Reduction of Fat from different parts of the body like –
  • Jogging and jumping –> fat around Thighs
  • Forward and backward bending –> Abdomen and Buttocks
  • Side bending –> sides of the Waist
  • Twisting –> reduces Waistline
  • Asanas used for DM
  • Pavanamuktasana kriya, Dhanurasana swing
  • Ardhakati chakrasana, Padahastasana, Parivrtta Trikonasana, Vakrasana, Ardha Matsyendrasana, Bhujangasana, Dhanurasana, Sarvangasana, Matsyasana, Viparitakarani with wall support
  • Stretch, Compress, or Twist the Abdominal area so that one can bring Awareness to the Pancreatic area, Focus and then Defocus to give Deep Rest to the Pancreas.
  • Avoid Yoga Mudra and Salabhasana as studies show that it may raise the blood sugar level.
  • Kriyas help to attain Mastery over Basic Reflexes of the Digestive Tract like Vomiting, Gastric emptying, Peristaltic motility, which help to reduce the Intensity of Hunger.
  • Regular practice of Vamandhouti and Shakhaprakshaana in Type II Diabetes helps to learn to Consume food only Twice a day so that the pancreas gets enough rest to Regain its Vitality in the Gap between meals and also helps in the Weight reduction.
  • DM may lead to the development of numbness of feet or hands due to lack of blood flow in the minute arteries that supply blood to the fine sensory nerves of the limbs.
  • Regular practice of Kriya also helps to Prevent or Delay such complications of Autonomic Neuropathy (a condition that results from damage to peripheral nerves that assist in organ system functioning. This nerve damage disturbs signal processing of the autonomic nervous system)

At Pranamaya level – All Slow Breathing Practices are useful to Slow down the Mind, which in turn Reduces the Stress levels and Harmonizes the Internal Physiology.

Breathing exercise –

  • Hands in and out breathing
  • Ankle stretch breathing
  • Tiger stretch breathing
  • Straight leg raise breathing
  • Shashankasana breathing

At Manomaya level Dharana, Dhyana, Samadhi, and Bhakti

Dharana -> Ability to Concentrate – to Focus for a longer Duration on Single thought with Efforts (1st step)

Dhyana -> to maintain the same Intensity and Duration of Focusing on Single thought without any Effort (2nd step)

During Aum Meditation, alternating Dharana and Dhyana, which is Slow and Fast Repetition (Loud or Silent) of Aum Chanting, finally leads to Slowing down the Chanting Rate to enter into Dhyana, a state of Let go and Expansion. This Systematic Training is essential to get off the Speeded up Loop of Negative thoughts during Stress and to overcome Mental blocks.

Another way to train in Dharana and Dhyana is to Deepen the Effects of Asana practice.

While maintaining the Final posture of Ardhamatsyendrasana, bring the mind to Focus on the Painful, maximally Twisted and Stretched part of the Abdomen where the Pancreas is situated.

‘Desha-bandhash chittasya dharana’ ||PYS.3.1||

Now to Let go the Effort – Dhyana

‘Prayatna-śaithilya-ananta-samāpatti-bhyām’ ||PYS.2.47||

Feel the Deep Internal Expansion, Slowness and Enjoy the Deep Rest. Thus using the Principle of Focusing and Defocusing while maintaining different Asanas provides very Deep Rest to the Pancreas and improves the Blood Supply, enabling the Natural Rejuvenating Processes to be activated by the Process of Letting go.

Bhakti helps to Transform suppressed or expressed Violent emotions (anger, fear, jealousy, hatred or depression trigger by external or internal demanding situations) into Soft emotions (pure love, compassion, pardon, peace, etc.)

Violent emotions contribute to poor control of blood sugar levels by secreting Stress Hormones. Bhakti, in turn, helps to soften the Reactions to different situations and helps to make our life Easy and Relaxed.

At Vijnanamaya level

“Taittiriya  Upanishad by Brahmananda Valli”

Happiness AnalysisA Systematic Analysis and Logic of the Mechanism of Happiness is given in this Upanishad.

Most of the time we feel Joy or Bliss or the ‘Aha’ effect in Doing something like eating, hearing, seeing, achieving something or meeting someone.

In Happiness Analysis, it is explained that the real Aha.. effect is in Between our Action, that is in the in-between Gap, in the Silence.

For example, when eating the favorite chocolate, at the first bite the taste buds are stimulated with that ‘Aha’ experience and there is craving for another bite. On keen observation of the speed or the craving of the mind, it can be realized that the ‘Aha’ effect is not in the chocolate but due to that Inner Silence Felt In Between The Bites.

This Analysis helps a Diabetic from the Cravings for food and in Weight reduction. This Understanding is also very essential to reduce Anxiety and Frustrations at the Workplace by Observing all the Moments of Happiness and Stresses of life. It gives Inner Contentment and Joy.

Frequent Dosage of insulin and oral tablets reduces as one is able to Manage the Food quantity and makes the diabetic more Efficient and Creative to meet the Targets.

At Anandamaya level – Karma yoga is the Practice in which one can be Blissful even during the Working time and not only during Moments of Joy or Meditation. Occupational Stressors are the major cause of stress in today’s busy life.

Few Corrections in Concepts help to Shift from Stress to Bliss, like ->

  • The Art of Working in Relaxation
  • Work with an Attitude of Yajna (offering to Divine)
  • Working without Worrying about the Results of action
  • Working with a Sense of Duty
  • Living in the Present Moment
  • Working in Tune with the Universal Principle
  • Recognize that real Swaroopa is Ananda
  • All the pain and suffering, losses and gain, name, fame, money including this physical body are all Transitory; that all come and go and “I AM” the Everlasting, Unchanging, Ever blissful, Imperishable Entity.

Thus the Yogic Lifestyle Change includes not only the High Fibre, Low Carbohydrate, Zero Fat, Vegetarian food but it goes into deepest Personality, Motivating to be Healthy and Blissful under all circumstances.

Let us understand DIABETES MELLITUS (DM)

  • The literal meaning is Sweet Urine
  • It is a Metabolic Disorder
  • It indicates an Increase in the Concentration of Glucose in the Blood
  • A case of Absolute or Relative Deficiency of Insulin
  • Wherein the Cells of the body is Unable to Use the Insulin Properly      
  • It comes about as a Major Killer among Non-Communicable Diseases

NIDDM- Non-Insulin Dependent Diabetes Mellitus

This is the Most Common Form of DM that occurs in Middle-aged & Elderly individuals who are 40 years or more; when there is an Inability of Cells to Utilize the Insulin owing to Impaired Functioning of Receptors -IR

INSULIN RESISTANCE

Excess Abdominal Fat and a Large Waistline indicates Central Abdominal Obesity and proves to be a High-Risk Form of Obesity prone to DM Type II; in which case Fat Cells Release Pro-Inflammatory Chemicals which makes the Body Less Sensitive to Insulin, that is they Disturb the Function of Insulin Responsive Cells affecting their Ability to Respond to Insulin

OBESITY & TYPE II DM

  • Thus Visceral Adiposity Escalates the problem of Insulin Response & DM Type 2
  • Excess Adipose Tissue leads to Chronic Increase in Circulating Fatty Acids which Reduces the Usage of Glucose, the Source of Cellular Energy
  • Excess Fatty Acid is due to Increased Deposition of Fat in the Muscles & the Liver and in effect Impede Cellular Insulin Signaling
  • Chronically Raised Lipid Levels Impair the Function of the Pancreas and acting in conjunction with Insulin Responsiveness lead to Aggravated HYPERGLYCAEMIA

DIABETES & ITS COMPLICATIONS:

Eye and DM: (Diabetic Retinopathy)

Diabetics with Retinopathy should avoid most of the Annamaya Kosha practices like –

  • Sithilikarana Vyayama (Loosening practices)
  • All Acute forward or backward Bending practices

In Diabetic Retinopathy, small bulges on the wall of the Retinal Artery occur. These areas are very thin and vulnerable to bleed. New capillaries that develop in the retina are also prone to rupture and bleed when the pressure inside the eyeball goes up. If these vessels bleed into the chamber of the eye, the chamber becomes opaque leading to blindness. Hence you should avoid all Vigorous Jerky Movements.

Heart and DM: Persons with Cardiac complications should follow the list of Practices Recommended for Heart problems first.

Kidney and DM: (Diabetic Nephropathy) Person with Renal complications of Diabetes are advised to practice Uddiyana Bandha, Agnisara Kriya, and Nauli, which can improve Blood Circulation to the kidney and thus improve Renal Filtration capacity.

Special practices that can help persons with complications of diabetes:

  • Trataka  -> to prevent Eye complications
  • Viparitakarani, Sarvangasana – Straight Leg Raise with Breathing -> to prevent Peripheral Neuropathy (numbness of feet)

DIABETIC KETOACIDOSIS-

-not diagnosed –not treated –life threatening diabetic coma –a metabolic state associated with high concentration of ketone bodies –formed by breakdown of fatty acids     

HOW STRESS INCREASES BLOOD GLUCOSE-

The body Demands Supply of Extra Energy when there is Highly Increased Muscle Work.

This Triggers the Endocrines & the Autonomic Nervous System to Regulate all Stress Adaptation Mechanisms-

  • Regulation of Blood Glucose Levels
  • Hormone Glucagon serves as the Glucometer to sense the Blood Glucose Level
  • Cortisol, Thyroid hormone, Growth hormone is released along with activation of Sympathetic Nervous System to produce Adrenaline and Noradrenaline

Thus with Emotional Stress, there is a rise in the Blood Glucose level which is common for Diabetics and Nondiabetics

An Insufficiency or Inefficiency to Manage this Supply on Sudden Demand to Release Insulin, in order to Cope with the Reactions of the Body to Function Better, leads to Glucose remaining High for a Long time even after the Short Duration of Emotional Upsurge.

BLOOD GLUCOSE CONTROL AND YOGA / EXERCISE – a good friend

Steady & Moderate Yoga & Exercise helps to Increase Insulin Sensitivity; the Available Insulin takes up the Glucose in the Blood During & After any activity

Greater the Gradient, the more the Concentration Difference in the Glucose levels in Blood & Muscle cells; Exercising helps to Move Glucose into the Cells slowly, which Reduces the Blood Glucose Level Without Extra Demand for Insulin

Glucose Transporter Type 4 –GLUT 4, is the Protein encoded in humans by GLUT 4 gene, which serves as an Insulin-Regulated Glucose Transporter; found in Adipose Tissues, Striated Muscles of the Skeletal and the Cardiac, it aids in the Transfer of Glucose from Blood to Cell Without the Need of Extra Insulin.

DIABETIC PILLS FOR NIDDM-

OHA ORAL HYPOGLYCAEMIC AGENTS

-effective –pancreas capable of producing insulin

TYPES:

SULFONYLUREAS- stimulate pancreas –secrete more insulin –Tab Daonil –produce skin rash itching –before 20-30 min of meal

BIGUANIDES- decrease absorption of glucose & nutrients from intestine –improve action of available insulin –no effect on pancreas –Tab Glycomet –gastrointestinal upsets loss of appetite skin rash itching –immediately after food –maintain regular schedule of tablets meals snacks physical activity –never skip meals after tablet

DIAGNOSES OF DM-

Fasting blood sugar test –done in the morning –blood glucose level

 -126 mg/dl or more after 8 hour fasting

–random any time of day 200 mg/dl or more

–ideal level   72-120 mg/dl

 –after meal -normal to rise –not beyond 180 mg

HYPERGLYCAEMIA -higher

HYPOGLYCAEMIA -70 or lower