Diabetes Mellitus

Yogic Management

• Circulatory system, heart and lungs
• Digestive system
• Renal system
• Nervous system and special senses
• Skin
• Role of pranayama

Yoga is ideally suited for both types of DM. In insulin dependent DM, asanas help prevent an increase in insulin requirement over the years. In NIDDM, asanas help normalise blood sugar due to the high intensity workout. Yogic exercises can either be high or low intensity, depending on the clinical condition. A young active diabetic can be made to practise very intense asanas in a dynamic manner, which will increase the cellular activity of the muscle which needs more sugar. The advanced asanas require a lot of energy and this helps normalise blood sugar. But, if the person is obese, asana practice is difficult and it is easier to reduce weight by other means and then take up yoga.

Yoga increases the practitioner's sensitivity to body movements and cellular changes. There is no pounding, flogging or forcible action in asana practice. The action on the cells is gentle and soothing and relieves the modified pathology by better blood perfusion, thus healing the area. Depending on the need the asanas can be modified. In yoga, it is possible to create a selective uptake of sugar depending on the group worked. Other exercises increase the general sugar uptake by the cells. Yoga selects the cells to absorb sugar. This is due to the wide variety of the geometric shapes of the asanas. The intensity of workout is total or regional.

The single advantage of the asana system is that the internal organs are directly affected by the geometric shape of the asana itself; in other exercises the results are indirect. The danger of hypoglycaemia in yoga is not so much as in other exercises because of the conscious control over the cellular systems. The advantage in the asana system is that even an elderly diabetic can practise it without any danger. Other systems might aggravate autonomic neuropathy and sudden death is possible. The emphasis in yoga is on controlling the autonomic dysfunction by means of pranayama. A prolonged observational follow-up of practitioners of yoga has shown that the incidence of DM is very low, if at all. This is so only if yoga has been practised from a very young age or very regularly. In fact, the incidence of most health disorders is very low in practitioners of yoga.

All the asanas are useful to prevent circulatory disease. Asanas impart strength to tissues, helping them resist cellular alteration in pathological states. Because of intra-arterial massage, the lining of the vessel wall is kept free of blocks. Moreover, the force of arterial flow can be increased and directed to any organ, which is of immense use in the diabetic state. In standing poses, the skeletal muscles increase their uptake of sugar. Hence, the tissues retain insulin sensitivity. Capillary changes are easily prevented by yoga as the action is on the vessel wall.

Foot injuries are avoided because of neural and soft tissue massage and retention of healthy blood flow along with fresh oxygen; the last is so vital to diabetic tissue in a particular area. For the patient with a diabetic foot lesion in the early stages, asanas do not harm the sensitivity of the foot as the practice is slow and reflective. Injuries are less likely to occur in comparison with other systems. In early cases, the situation of a diabetic foot can be reversed. Virasana is particularly useful for this purpose.

Peripheral blockage of arteries never happens if the patient is regular in asana practice. Hence vascular disease, which is so common in diabetics, can be prevented by instituting yoga as soon as the diagnosis has been made. Of course, the damage may have already occurred; yet, more can be controlled after proper assessment of peripheral flow by investigational procedures. The use of the foot rest for improving blood in the calf muscle area is very important. This prevents neuritic pain in the extremities. Peripheral neuritis is prevented and benefited by standing poses.

Back bends are very useful in averting blockage of coronary arteries. The maximum benefits are derived only with an early diagnosis and asana practice instituted as soon as possible, for atherosclerosis may have already progressed to a considerable extent. Angiographic evaluation of the quality of blood flow to the coronaries will provide baseline information of the status of the arteries. It is then possible to totally prevent future cardiac problems. As the autonomic systems are balanced, irregularities in heart rate and rhythm are controlled. Hence the chances of a sudden collapse of a diabetic patient due to a cardiac lesion are much less.

Asanas tone up the lungs also. Back bends, forward bends, standing poses, are all useful. Props may be needed for the elderly who have poor vital capacity. In this respect pranayama is highly useful. Oxygenation being better, tissue hypoxia never occurs.

Yoga is microcellular in its action. As the internal organs are massaged, sensitivity to insulin and uptake of sugar are enhanced. Gastric and intestinal activity is regulated and diarrhoea or constipation due to autonomic malfunction does not occur. As the villi are massaged, absorption is better and sugar uptake is regulated. Twisting poses squeeze the intestines and massage them. Hence, stagnation of colonic contents due to autonomic dysfunction cannot occur. Asanas also pressurise the pancreas in an effort to improve the secretory status. The massage of the pancreas by forward bends and twistings help release more insulin in response to food.

Backward bends, being very strenuous, help reduce blood sugar due to the intense work out given; yet in a different manner than that of aerobic exercises. Back bends improve blood supply to all abdominal and pelvic organs. This ensures healthy cellular integrity and due to the massage no deposits are formed. Forward bends increase the gastric fire and help healthy digestion of food. This prevents fluctuations of sugar levels in a diabetic. Hypoglycaemic reactions are suppressed. Burning up of excess sugar is promoted by the stimulation of gastric fire.

In renal disease, the increased systolic pressure in the renal artery and the protein load during aerobic exercises might further damage the kidney. Yoga makes arterial flow easier without an increase in systolic pressure. In yoga it is possible to control the velocity of blood flow to internal organs; in other exercises there is no control over the exercise process once it has begun.

In yoga there are asanas to shut off blood flow or promote flow without velocity if necessary. Intra-renal massage prevents deposits in the microcellular areas that damage renal tissues. Back bends are valuable tools against progression of renal lesions. They squeeze the kidneys and prevent stagnation of circulation and deposition of material that blocks blood flow to the cells. Hence, organ atrophy is prevented. In the early stages of a renal lesion, asanas can be very helpful. Even after a renal transplant, practice of asanas is very important to promote fresh blood supply to the donor kidney. If a diabetic patient who has no evidence of nephropathy practises yoga, he or she will never suffer the disorder. Passive back bends improve blood flow in the renal artery without increase in pressure, while active poses enhance pressure; thus both are needed.

Inverted asanas prevent blockage of cerebral arteries. Most important of all, they prevent the development and progression of retinopathy by enhancing microcellular perfusion of blood and oxygen into the retina without rise in systolic pressure. This also prevents further complications as oxygen supply to the tissues is maintained and enhanced. Forward bends soothe the nerves of the eye. They are preparatory to inverted poses. The retinal vessels are gently massaged and strengthened by forward bends. Standing inverted poses, like uttanasana with the head on the stool, dog pose, prasarita padottanasana and viparita karani, have to be done with a bandage on the eyes which acts like a pressure bandage, preventing rise in pressure in the retina. Half halasana is valuable to rest the retina. If the retinopathy is very advanced, much relief cannot be obtained. Competent guidance is essential to learn yoga if the patient has eye lesions.

If standing poses prevent peripheral neuropathy, back bends prevent central neuropathy; that is, afflictions of the autonomic plexuses and sympathetic and cranial nerves. If diabetic neuropathy exists (whether in the distal or proximal parts), practice of other exercises may be harmful as any injury to the tissues may go unnoticed by the patient. But yoga is very gentle in its action and the patient can restrain the intensity to any level. This prevents overstretching and injury. Moreover, the movements are very slow in comparison to other exercises.

In an early diabetic state, asanas prevent damage to the nerves. All asanas should be practised to prevent neuropathy. Standing poses, back and forward bends preserve the integrity of the spinal nerves and the plexuses. In a well established case of diabetic neuritis, it might be difficult to abolish the symptoms. This is why yoga should be started as soon as the diagnosis is made. Asanas prevent damage to the minute blood vessels which supply the nerves that normally get occluded due to the pathological state. As healthy micro-circulation and massage are provided by asanas, formation of new nerve sheaths are of a healthy nature.

The skin is massaged and blood supply preserved. As fresh blood flows through, resistance to infections is built up. The skin does not become waxy and -unhealthy as it would usually be in a diabetic. Elasticity is retained. Certain specific diabetic skin lesions are prevented if regular yogic practice is resorted to. Standing poses, virasana, padmasana, mula bandhasana, inverted poses, are all helpful in preventing diabetic foot lesions.

Pranayama is highly valuable for improving oxygen perfusion to the tissues. As it also removes stress on the system, progression of blockage is arrested. Oxygen delivery to the tissues is systematic and sure. Tissue hypoxia never occurs. Sympathetic and parasympathetic stabilisation prevent autonomic dysfunction. Even in an established situation of imbalance, depending on the individual merits of the case, relief can be provided. Prevention, relief or arrest of further progress of many forms of autonomic dysfunction can occur through pranayamic practice. It is very useful for all complications of the diabetic state, particularly cardiac autonomic dysfunction, retinopathy and peripheral arterial occlusive conditions.