Yoga & Diabetes
This page is intended to provide insight and information on documented and potential benefits of movement, breath, and meditation inquiries for the management of diabetes and its complications. While the focus is specifically on diabetes I believe the benefits of yoga described here apply to the management of many chronic conditions and life situations, as yoga, in contrast to allopathic medicine, offers neither diagnosis nor cure but a set of tools to bring the individual to greater awareness and inner healing.
I hope this page reaches diabetics interested in yoga, yoga teachers and therapists interested in providing classes to diabetic populations, and physicians and researchers curious about the potential that yoga has to help patients monitor their conditions. The organization of the information and specific topics I've chosen to cover are rooted in more than 30 years of living with Type 1 diabetes, what I have gained from yoga practice and study, and, where possible, scientific resources and research into both the benefits of yoga and the complications of diabetes. Please note that before beginning any exercise program a diabetic patient should discuss the potential impact on blood glucose management and medications with an appropriate medical professional.
General wellness benefits of yoga
Yoga classes can provide community, confidence, a sense of personal empowerment, greater body awareness, flexibility, balance, stress relief, and strength. While not all forms of yoga are aerobic, as with many types of exercise, yoga can potentially increase insulin sensitivity. Two recent books describe these overall benefits of yoga and detail breathing techniques, poses, sequences, and special considerations for diabetic populations:
Other resources on general benefits of yoga practice:
Potential Benefits for diabetic complications affecting the enteric nervous system and vagus nerve
Fluctuations in blood sugar over time can damage the vagus nerve, which serves as the parasympathetic communication channel from the enteric nervous system to the central nervous system (CNS), and eventually lead to gastroparesis, a disorder in which the stomach takes too long to empty, causing a variety of symptoms, including increased susceptibility to bacterial infection, nausea, bloating, abdominal discomfort, and weight loss. Gastroparesis affects approximately 20% of Type 1 diabetes patients. Decreased respiratory sinus arrhythmia (RSA), an indication of decreased vagal tone, is also found in diabetes patients not (yet) affected by gastroparesis. This decrease in vagal tone results in less ability to balance the sympathetic nervous system (SNS), associated with the well-known "fight-flight-freeze" response, with the parasympathetic nervous system (PNS). Deep abdominal breathing, breath-linked movements, meditation, and yoga nidra, all tools offered in yoga, can potentially strengthen vagal tone and, together with improved glucose control, help reverse this complication.
**About Diabetes, gastroparesis, & the vagus nerve:
**General information about the vagus nerve:
**About yoga and its effects on the vagus nerve:
Potential benefits for other forms of diabetic neuropathy
It is estimated that 60-70% of diabetics are affected by nerve damage, or neuropathy. The causes can include metabolic factors, vascular factors (including damage to the blood vessels that carry oxygen to the nerves), autoimmune factors, or mechanical injury to nerves (e.g. carpal tunnel syndrome). The most common type, peripheral neuropathy, is characterized by pain or loss of feeling in the toes, feet, legs, hands, and arms, or, alternatively, extreme sensitivity to even light touch. Lack of sensation in the feet places sufferers at risk for infection, as small abrasions may go unnoticed and spread to the bone, leading to amputation. Medications, including opioids, are sometimes prescribed to combat the pain. Yoga has been shown in studies to improve medial nerve conduction velocity in practicioners with peripheral neuropathy and improved grip strength and reduced pain in sufferers from carpal tunnel syndrome. It is my own personal belief that slow deliberate movements increasing awareness of breath and body could help strengthen damaged neural pathways or create new ones.
**About Diabetetic neuropathy:
**Review of studies on the therapeutic value of yoga:
**Reduction in oxidative stress in patients with Type 2 Diabetes:
Potential benefits for limited joint mobility
According to recently published literature review, "Musculoskeletal disorders such as Achilles tendon pathology, trigger finger, Dupuytren, limited joint mobility syndrome (LJMS), carpal tunnel syndrome, frozen shoulder and plantar fasciitis have been found to occur more often in subjects with diabetes compared to those without diabetes." Less attention has been paid to these complications, as they are less connected with mortality than complications such as heart disease and micro/macro-vascular complications, even though they significantly impact quality of life and are correlated with other complications of diabetes. An accepted hypothesis is that, "the joint tissue damage in diabetes is caused by an excess of advanced glycation end products (AGEs) that form at a slow but constant rate, accumulating over time in the normal body. However, their formation is markedly accelerated in diabetes because of the increased availability of glucose. A key characteristic of reactive AGEs is the formation of covalent cross-links within collagen fibers, altering their structure and functionality." A carefully constructed yoga program focusing on breath and body awareness is not only an excellent tool for managing the pain of these conditions, but can potentially improve antioxidant status to reverse damage from reactive AGEs.
**About limited joint mobility in diabetes mellitus:
**About the potential of yoga to improve antioxidant status:
Potential benefits of yoga for diabetes-related trauma
Diabetes is related to trauma in at least three distinct ways: (1) Episodes of hypoglycemia and daily stress over the management of blood sugar can cause trauma; (2) Diabetics develop more complications after trauma than do non-diabetic groups; (3) Some studies have suggested a causal connection between trauma and later development of diabetes. For all of these reasons, trauma-sensitive yoga, with its emphasis on experiencing the present moment, making choices, taking effective action, and creating rhythms, can be very healing for diabetics also struggling with trauma.
**About diabetes and trauma: