Dr. Shamanthakamani Narendran

M.D. (Pead), Ph.D. (Yoga Science)

PRAYER

AKHANDA MANDALÁKÁRAM

VYÁPTAM YÄNA CARÁCARAM

TATPADAM DARÙITAM YÄNA

TASMAI SRÈ GURAVÄ NAMAH

Name of the disease & terminologiesEtiologyPhysical examination, signs and symptoms InvestigationsModern medical treatmentAlternative therapies – Yoga managementDietBooks and journals for reference

Diabetes mellitus is a condition in which glucose level in the blood are much higher than normal and hence this condition is also commonly referred to as sugar disease.

The defect in this condition is that either the pancreas does not produce enough insulin or it produces sufficient insulin, but the cells of the body are unable to use the insulin properly.

INTRODUCTION

PANCREAS - BEHIND STOMACH

TAIL - “ISLET OF LANGER HANS”

Insulin is like a key which opens the

body cell doors to allow glucose to enter. In the absence of enough insulin, glucose cannot

enter the cells and remains in the blood stream in high amounts (hyperglycemia)

High blood sugar due to defective or deficient insulin action and the resulting associated problem is called diabetes.

Cells in the body needs glucose (sugar) for making energy required for daily life.

The food we eat turns into glucose after digestion.

What is Diabetes?

ALPHA CELLS -GLUCAGON

BETA CELLS - INSULIN

Glucose enters the blood stream to reach different body cells.

Insulin, a hormone produced by the pancreas is required for glucose to enter the blood cells.

Who are prone ...?

HEREDITY

CAUSES

HEREDITY

FOR INSULIN IDENTIFIED (CHROMOSOME 6)

GENE

GENERAL POPULATION 10% NIDDM - FAMILY HISTORY 40%

S.INDIA 80%IDENTICAL TWINS - IDDM 50%

NIDDM 100%

CAUSES

HEREDITY

3. URBANISATION

Migrant Indians in UK& USA very high

incidence

4. DIET - Rich, Refined foods

5. SEDENTARY LIFE STYLE

CAUSES TRIGGERS: contd...

CAUSES TRIGGERS: contd...

STRESS

ACUTE

DURING STROKE

HEART ATTACK

ACCIDENTS

PREGNANCY

INFECTION

CAUSES TRIGGERS: contd...

CHRONICSTRESSESSTRESSES

EXECUTIVE TENSION

UNFINISHED TARGETS

DEMANDING LIFE EVENTS

EMOTIONAL REACTIVITY

AGGRESSIONS

FRUSTRATIONS

COMPLICATIONS IN DIABETES

Eyes

Heart

Kidney

Neuropathy

Type 1 diabetes

Type 2 diabetes

Gestational diabetes

Classification of Diabetes

Other types of Diabetes Genetic Malnutrition related Drug induced

Age below 30 years Excessive urination Excessive hunger Excessive thirst

Symptoms of Type 1 Diabetes

Bed wetting in children Unexplained weight loss Dehydration Coma

MAY PRESENT WITH

• INFECTION

• COMA

• COMPLICATIONS

EXCESS HUNGEREXCESS THIRSTEXCESS URINE

IDDM

IDDM

EATS A LOT BUT DOES NOT GROW

LOSS OF WEIGHT

YOUNG

5 -35 Yrs

Frequent urination Always hungry Cave for extra liquids Sexual dysfunction Unexplained weight loss Family history

Symptoms of Type 2 Diabetes

Causes: Too much food, too little insulin or illness or stress.

Onset: Gradual, may progress to diabetic coma.

Symptoms: Extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, nausea

WHAT TO DO?: Test blood glucose test ketones. If over 250mg/dL for several tests CALL DOCTOR

High Blood Glucose / Hyperglycemia

Causes: Too little food, too much insulin or diabetes medicine or extra exercise.

Onset: Sudden, may progress to insulin shock. Symptoms: Shaking, fast heartbeat, sweating,

anxious, dizziness, hunger, impaired vision, weakness fatigue, headache, irritable

WHAT TO DO?: Drink ½ glass of orange juice/skim milk or eat several candies. Test blood glucose – if symptoms don’t stop, CALL DOCTOR. Within 30 min after symptoms go away, eat a light snack.

Low Blood Glucose / Hypoglycemia

FASTING BLOOD GLUCOSE

Normal 80-100 mg/dL

DM > 120 mg/dL

2 HOURS POST LUNCH

Normal 130-160 mg/dL

DM > 180 mg/dL

Diagnostic range of blood sugar level

Values are internationally accepted for plasma glucose Corresponding whole blood glucose values are lower

Diagnostic range of blood sugar (plasma glucose)

Normal glucose tolerance

Impaired glucose tolerance

Diabetes mellitus

Fasting plasma glucose (mg/dL)

<110 110-126 >126

Between 0-120 min (mg/dL) <200 <200 200 at least once

2 hours after glucose load (mg/dL)

<140 >140, but <200

>200

What are the consequences of untreated diabetes?

2 times higher risk of brain stroke

3-4 times higher risk of heart disease

Increase risk of high BP

Cause of leg amputations

Cause of loss of sensations in limbs & other nerve damage17 times of higher risk

of kidney failure – common cause in India

Affects the eye and vision3rd most common causeof blindness in India

Increase with duration of diabetes 50% retinopathy in 20 years of Type 1 diabetes 20% of retinopathy in 15 yrs of Type 2 In Type 2, retinopathy

may be present at diagnosis Leading cause of blindness

Diabetes & eye disease

Make sure to monitor blood sugar and undertake periodic test advised by doctor.

Take interest in own treatment and have to live with it for the rest of the life.

Checking of eye and vision Regular examination of feet Weight BP

What Can Be Done to Avoid Consequences of Diabetes

Diabetes can be kept under check by proper care and treatment

Once diabetes is established it cannot be cured, so stop running after magical cures!!.

Can Diabetes be Cured ???

Contrary to popular belief – diabetes is a serious condition – it is more than just high blood sugar!!!

High blood sugar due to untreated, diabetes damages many organs in the body.

When diabetes is well controlled such damage is avoided or minimized.

Why should diabetes be treated ?

Depends on the type of diabetes, condition of the person, age, weight and associated conditions.

Treatment includes – proper diet, exercise, regular monitoring and medications (oral and injections)

What Treatment is given?

DM - management

o DIET

o EXERCISE

o YOGA

o MEDICATION

INSULIN

ORAL ANTIDIABETICS

Proper diet is very important – Helps control blood sugar, blood cholesterol, and weight

Cut down on fat, oils, sugar, alcohol and red meat.

Eat vegetables daily. Avoid rich fried foods. Take lots of foods like cereals and pulses

Diabetic Diet Tips

Regular exercise is good for diabetes. Exercise improves sugar and weight control,

and increases a sense of well being

Diabetic Exercise Tips

Do’s Can participate in

active sports Keep sugar or other

carbohydrate source handy.

Don’ts Avoid exercise soon

after injecting insulin Do not exercise on

an empty stomach

Change daily into clean, soft socks or stockings which must neither be too big nor too small.

Keep the feet warm and dry. Preferably wear socks or stockings of cotton and leather shoes.

Never walk barefoot neither indoors nor outdoors.

Always wear shoes that fit. This applies also to sandals

Examine shoe everyday for cracks, pebbles, nails, and other irregularities which may irritate the skin.

Special Attention for Foot

Wash feet daily with lukewarm water and soap, just as wash hands.

Dry feet well, also between the toes. Cut nails straight across. Ingrown nails and

calluses should receive expert attention. Keep the skin supple with moisturizing lotion,

but do not apply it between the toes.

If not diabetic, but at high risk, require to take care of health.

Should watch weight in particular waist line. Exercise regularly. Eat healthy – cut out fat, reduce refined rich fried

food, avoid calorie dense sweets and red meat. Eat cereals and pulses, vegetables and fruits,

avoid or reduce alcohol intake and go for medical checkup regularly.

Avoid excessive psychological and physical stress.

Can Diabetes be prevented ?

All types of diabetes are serious and require full attention.

Insulin is given from outside when insulin producing cells do not produce enough insulin

High blood sugar is toxic to the insulin producing cells.

Improperly controlled diabetes worsens the condition and further damages the already stressed insulin producing cells.

Controlling diabetes is important irrespective of whether one is treated with/without insulin

Is Insulin requiring DM more serious ?

Problem: Choose a habit to change, write it down. Eg: Eat too much fried foods.

Overall Goal: Say why the change would be good. Eg: Low fat intake, may lose weight.

What: Choose a habit to change, write it down. Eg: Replace fried snacks with salads for a week.

Evaluate: Could you do it? Eg: I did it! Not too hard, try it for another week.

Reward: Celebrate success. Eg: Go to a movie with friends

The POWER within ...

SUGAR

SWEETS

NON-VEGETARIAN

DIET

INSULIN CANNOT BE RELEASED RAPIDLY TO COPE WITH QUICK RAISE OF BLOOD SUGAR

SWEETS

FATSCUT DOWN TO 50% NO BUTTER/MARGERINE/ GHEECUT DOWN TOTAL OIL INTAKE

• DELAY ABSORPTION OF GLUCOSE

• GUAR GUM ,VEGETABLES

• BITTERS - REDUCE APPETITE

FIBRES:

Guar gum is widely used as a thickening agent, stabilizer and texturant in many food

products

3 Kinds of Food3 Kinds of Food3 Kinds of Food3 Kinds of Food

1. Energy giving

2. Building and repairing

3. Protecting against infection

•TAMAS - GROSSEST, LETHARGIC

•RAJAS - DYNAMIC, RUSHY

•SATTVA - MATURE, COMPOSED

GUNAS:

THE TOOL FOR CLASSIFICATION

SATVIC FOOD

AYU SATVA BALAROGYA

SUKHA PREETHIR VIVARDHANAHA

RASYA SNIGDHAH STIRAH HRDYAH

AHARA SATVIKA PRIYA

SATTVIC FOOD

FRESH FOODS

VEGETABLES & FRUITS

GERMINATED GRAINS & PULSES

FIBRES (VITAMINS & MINERALS)

DAIRY PRODUCTS

LESS SPICY

YOGA FOOD

RAJASIC FOOD

KATVAMLA LAVANA TYUSNA

TIKSNA RUKSA VIDAHINAH

AHARA RAJASASYESTA

DUKHA SOKA MAYA PRADAH

BITTER SOUR

SALINE STEAMING HOT

PUNGENT DRY

RAJASIK FOOD

FOOD OF TAMASIC

YATAYAMAM GATARASAM

POOTI PARYUSITAM CA YAT

UCCISTAMAPI CAMEDHYAM

BHOJANAM TAMASAPRIYAM

1. OLD FOOD: CANNED or STORED

2. DEVOID OF TASTE

3. NONVEGETARIAN FOOD

4. FERMENTED DRINKS

5. STALE FOOD

6. LEFT OVER FOOD

7. IMPURE FOOD

TAMASIK FOOD

• EXERCISE BURNS CALORIES

• REDUCES WEIGHT

• INCREASES INSULIN SENSITIVITY

YOGA IN DIABETES - HOW?

MASTERY OVER MINDBETTER ADHERENCE TO DIET

BETTER MASTERY OVER APPETITE & SATISFACTION

MASTERY OVER CRAVINGS FOR JUNK FOOD & SWEET

APPETITE SATIETY

= MASTERY OVER MIND= MASTERY OVER MIND

HELPS

TO MAINTAIN REGULARITY OF EXERCISE BY BREAKING THE LIMITATION OF LAZINESS

YOGA IN DIABETES - HOW?

IMPROVES BLOOD FLOW TO PANCREAS BY INCREASING NEGATIVE SUCTION PRESSURE IN ABDOMINAL CAVITY

YOGA IN DIABETES - HOW?

NAULIAGNISÁRA

DEEP REST IMPROVES BETA CELL EFFICIENCY

ARDHA MATSYÄNDRA

MAYÜRÁSANA

STIMULATION & DEEP REST

DHANURÁSANA

YOGA IN DIABETES - HOW?

THYMUSB

T

YOGA IN DIABETES - HOW?

REDUCE AUTO IMMUNITYINSULIN ANTIBODY

YOGA IN DIABETES - HOW?

INCREASES SENSITIVITY OF CELL WALL INSULIN RECEPTORS

ALL CELLSC

LE

AN

SIN

GP

RÁ

NÁ

YÁ

MA

INTEGRATED YOGA MODULE FOR DIABETES MELLITUS

Breathing practices Hands in and out breathing Ankle stretch breathing Tiger breathing Straight leg raise breathing Instant relaxation

technique (IRT)

Loosening Exercises Jogging Forward and backward

bending Side bending Twisting Pavanamuktasana kriya Dhanurasana swing Quick relaxation

technique (QRT)

Yogasanas

Standing Ardhakati cakrasana Padahastasana Parivrutta Trikonasana

Sitting Vakrasana/ Ardha Matsyendrasana

Prone Bhujangasana Dhanurasana

Supine Sarvangasana Matsyasana Deep relaxation technique (DRT)

Pranayama Kapalabhati Vibhagiya pranayama (sectional breathing) Nadisuddi pranayama Sitkari pranayama Bhramari pranayama

Meditation Nadanusandhana OM Meditation

Vamanadhouti + DRT – Once a week

Sankhapraksalana + DRT – Once a month

Laghu Sankapraksalana + DRT – Daily

SPECIFIC PRACTICES Yoga can be an effective supplement to

diabetes treatment. It helps in controlling the blood sugar level by

helping the pancreas to produce more insulin. If diabetes is caused by lack of exercise or

stress, yoga eliminates the dependence on insulin treatment.

For daily practice: Bhastrika Pranayama Nadi Shodak Pranayama Ujjayi Pranayama

General considerations: People with diabetes should be treated and regularly checked by a medical doctor. The severity of diabetes may vary from mild forms requiring nothing more than diet to severe insulin dependent forms requiring systematic and long term medical treatment.

Contraindications: Patients with well treated diabetes without complications tolerate most yoga practices and benefit from them.

Recommendations: People with diabetes often benefit from asanas and relaxation. The blood sugar levels should be followed up to adjust the doses of insulin or other medicines to healthier yogic life style.

Recommended Asanas : Suryanamaskara (Sun salutation) - activates

almost all glands; due to reverse circulation of blood during this asan invigorates the facial tissues , the nervous system etc.

Bhujangasana (Cobra Pose) - activates whole of abdominal area.

Paschimotanasana (Head-knee forward Bend)- activates pancreas, thus regularising its functioning to secrete insulin in a normal way .

Vakrasana (Obtuse Pose)- affects the waist and abdominal area.

Matsyendrasana - has great effect on pancreas , adrenal, thyroid and sex glands.

Suptavajrasana - corrects disorders of stomach, intestine, liver, kidneys, spleen etc. ; enhances sexual potentiality.

Dhanurasana - affects pancreas, adrenal, thyroid, parathyroids, pituitary and sex glands; develops digestive power ; corrects menstrual problems in women.