Yoga and Type-II Diabetes Mellitus

Diabetes Mellitus – Type II

HISTORY

• How many years
• Note the medicines
• Is the blood sugar controlled
• Latest report of BSL- F &PP
• Adv- GHb A1C
• What are the complaints?

Diabetes mellitus is defined as a state of chronic hyperglycemia with disturbances of carbohydrate, fat & protein metabolism due to insulin deficiency or its’ action.

Insulin

Is a polypeptide hormone, secreted by Beta cells of islets of Langerhans. It is released in the venous (portal) blood in response to blood glucose, amino acids, & gut hormones. 50% of Insulin is taken up by liver & remaining is circulated in the body. Other two main target organs for Insulin are muscles & adipose tissue. Its action is receptor mediated.

Actions of Insulin

1. It allows entry of Glucose inside the cell.
2. It activates the enzymes for utilization of (entered) glucose
3. It inhibits Neoglucogenesis, which is formation of glucose from amino acids, which occures in fasting state to maintain blood glucose level.
4. It allows entry of amino acid inside the cell & by stimulating RNA lead to synthesis of tissue proteins—thus it is an anabolic hormone

Types

It is studied under 2 types. Type I is due to total Beta cells damage causing absolute deficiency of Insulin, making Insulin treatment mandatory.

Type 2 is due to either insufficient Insulin or Insulin Resistance. Insulin resistance is a stage wherein target organs show less sensitivity to Insulin.It is often associated with high Insulin levels(suboptimal response of liver,muscles & adipose tissue to Insulin)which is due to high levels of glucose &fatty acids.

Pre-receptor level can be due to

1. Increased free fatty acid levels-These impair glucose uptake by muscles,promote glucose production by liver & impare insulin secretion by Beta cells.
2. Inflammatory markers produced by visceral fat like Leptin,Tumor necrosis factor)
3. Stress hormones.
4. This Insulin Resistance is functional & relative hence reverible.

Receptor Level may be due to less number of receptors

Post receptor level may be due to disturbances in intra cellular enzyme action.

Type II DM is caused by (1) Hereditary (2) Viral infections. (3) Obesity – mainly –central (4) Stress induced

• Hereditary predisposition may be from maternal or paternal side.
• Viral infections may cause pancreatic beta cell damage
• Obesity leads to more & more demand of Insulin, leading to high levels of Insulin, which causes Insulin Resistance. This increased demand ultimately leads to pancreatic fatigue. This causes low levels of Insulin, leading to DM.
• Stress induces high levels of Stress Hormones, which are Adrenaline, Nor-adrenaline & Cortisol. First two cause high levels of blood Glucose (Glycogenolysis) & high levels of free

fatly acids (Lipogenolysis). Cortisol mobilizes triglycerides & amino acids from their cellular stores.Formal for energy availability & later for synthesis of glucose.( Gluconeogenesis)

Insulin Resistance Syndromes

• Metabolic Syndrome-consists of constellation of Insulin Resistance,Hypertention,Dyslipedimia,Central or Visceral Adiposity,Endothelial dysfunction,Coronary artery disease.
• PCOD-is often associated with Insulin Resistance (Acne,Hirsutism,Obesity &Hyperandrogenism )

Complications-Diabetes Mellitus with uncontrolled  blood sugar leads to many complications.

• They are classified as micro-vascular- Nephropathy. Retinopathy & Neuropathy, leading to kidney failure, blindness or nerve pain.
• Other group is macro-vascular-Coronary artery disease, Cerebrovascular accident, Peripheral vascular disease which leads to heart attack, stroke, and death of any part of body These complications are not reversible, hence, they should be prevented by strict blood glucose control.

One can lead a normal life with Diabetes Mellitus, if we adhere to diet, exercise, medicines & Yoga therapy.

Type II DM is well managed by proper diet, moderate exercise, Medical Yogatherapy & Medicines. One can lead a normal life with a disciplined approach.

Proper diet suggested is 50-60 % of complex carbohydrates with low glycemic index, 15-20 % proteins, 10% fat which has minimum saturated fatty acids, rich in omega 3 fatty acids, in addition, food should have ample amount of fibers.

Glycemic Index is the degree of hyperglycemia, plotted against time, with reference to one fixed carbohydrate substance (white bread)

e.g. Potato/ Corn flex 80-90, White rice 70-80, Brown rice 60, Wheat, peas 50, Legumes, milk, peanuts 40

Transfatty acids leads to rapid synthesis of cholesterol (They are formed by reheating the oil again and again hence it should be avoided).

Selective vegetables which have lot of fibers lead to excessive bile secretion which leads to excretion of cholesterol.

• Exercise advised is brisk walking for 20-30min.

Medicines advised by physician should never be stoppe

Mode of action of MYT

1. Yogic Postures involve big muscles, which utilize blood glucose by aerobic oxidation to fulfill their energy needs. This reduces blood glucose level.
2. Kapalbhati helps reduce blood glucose by strong contractions of muscles of anterior abdominal wall. (These are four big muscles)
3. Standing, Sitting lying postures which involve twisting help in reduction in waist measurement. (Waist to hip ratio). This helps to reduce Insulin resistance.
4. Selective Yogic Postures are useful to maintain & increase the strength in postural muscles.
5. Study of Yogic Postures helps to improve mind control for adherence to dietary discipline and change in Lifestyle.
6. Conscious realaxation, cognitive corrections and emotional tranquility is obtained by Yogic Postures, Pranayam, Shavasan, Dharana & Dhyan. This reduces the level of stress hormones, reducing blood glucose levels

Benefits of MYT

1. Smooth & sustained control of blood Glucose.
2. Maintenance of strength & endurance in postural muscles.
3. Improvement in Insulin sensitivity.
4. Extremely useful in stress induced Diabetes Mellitus.