The term “diabetes” originates from a Greek word meaning “to pass through,” referring to polyuria, or excessive urination, a common symptom. The word “mellitus,” meaning “sweet,” was later added to describe the presence of sugar in the urine, a sign of the body attempting to expel excess glucose through the kidneys.
Diabetes is a chronic condition where blood glucose (sugar) levels remain abnormally high. Normally, glucose from digested food provides energy to cells, with insulin – a hormone produced by the pancreas – facilitating its absorption. In diabetes, either the pancreas produces insufficient insulin, or the body’s cells become resistant to insulin’s effects, leading to glucose buildup in the blood.
Elevated blood glucose can lead to severe complications, such as heart disease, kidney failure, blindness and nerve damage. Diabetes affects millions globally and is a growing public health issue, with an increasing prevalence in the UK.
Understanding the Types of Diabetes
Type 1 Diabetes (DM1)
In DM1, the pancreas produces little to no insulin due to an autoimmune attack on insulin-producing cells. This type, primarily genetic, usually begins in childhood or adolescence and requires lifelong insulin therapy. Without sufficient insulin, glucose remains in the bloodstream, causing high blood sugar levels while cells are deprived of energy.
Type 2 Diabetes (DM2)
Once known as “adult-onset diabetes,” DM2 is now affecting younger populations due to rising obesity rates. In DM2, the pancreas produces insulin, but cells resist its effects, a condition called insulin resistance. The pancreas may try to compensate by producing more insulin, but this often fails, leading to hyperglycaemia (high blood sugar levels).
Insulin Resistance and Prediabetes
Insulin resistance occurs when cells respond poorly to insulin, causing elevated blood glucose levels. Prediabetes, a condition preceding DM2, can often be reversed through lifestyle changes, such as improving diet and increasing physical activity, which may prevent the progression to full diabetes.
Causes and Risk Factors for Type 2 Diabetes
The development of Type 2 diabetes (DM2) is influenced by a combination of genetic and environmental components. Key risk factors include:
- Excess weight, especially visceral (abdominal) fat
- Physical inactivity
- Family history of diabetes (which increases susceptibility but does not guarantee development)
- Ethnicity, with higher risk observed in certain groups (e.g. South Asian, African-Caribbean, and Black African descent in the UK)
- Age, with risk increasing for individuals over 40, or over 25 in some high-risk ethnic groups
- Health conditions, such as polycystic ovary syndrome (PCOS) and gestational diabetes (diabetes during pregnancy)
- Poor nutrition, which contributes to weight gain and metabolic issues
- Chronic stress, both psychological and biological, as it can affect glucose metabolism and insulin sensitivity
- Adverse Childhood Experiences (ACEs), which may lead to psychological and social stress
Overall, these factors collectively increase the likelihood of developing DM2, especially in individuals with a predisposition due to genetics or lifestyle influences.
The Finnish Diabetes Prevention Study linked a high-fat diet, especially high in saturated fat, to an increased risk of DM2. Similarly, a Yale University study found that fat accumulation within muscle and liver cells may contribute to insulin resistance, suggesting that reducing this fat build-up could lower DM2 risk.
The Role of Lifestyle in DM2
In the UK, DM2 accounts for about 90% of diabetes cases. Physical inactivity, poor diet, and obesity are primary factors, while other elements, such as insufficient sleep, chronic stress, depression, and smoking, further elevate risk. Studies indicate that lifestyle choices are responsible for at least 90% of new diabetes cases, highlighting the importance of preventative measures to reduce DM2 incidence.
Symptoms of Type 2 Diabetes
Type 2 diabetes may present with several common symptoms, including:
- Increased thirst and frequent urination
- Extreme hunger
- Fatigue and unexplained weight loss
- Blurred or sudden vision changes
- Tingling or numbness in the hands or feet
- Very dry skin
- Slow-healing sores or frequent infections
- Darkened patches of skin, often around the neck or armpits
It is important to note that some individuals may not experience noticeable symptoms initially, making early detection more challenging.
Diabetes in Context
Diabetes is a significant global health concern with high prevalence among adults and a rapidly increasing rate among children. Globally, over 10% of adults over 20 years old have diabetes, with the rate climbing to around 25% in those over 65. A large number of people are at risk, with research indicating that one in three adults is prediabetic. Unfortunately, around 90% of these individuals are unaware of their condition, often leading them to continue with unhealthy habits that raise the likelihood of progressing to full diabetes. Over the past two decades, Type 2 diabetes (DM2) has become more common in children, largely due to rising rates of childhood obesity and poor dietary habits.
In the United States, approximately 34.2 million adults have diabetes, with Type 1 diabetes accounting for about 5-10% of cases. Among U.S. cases, 29.1 million are diagnosed, leaving around 8.1 million people undiagnosed, representing nearly 28% of people with diabetes who may be unaware of their condition.
Diabetes has reached an alarming prevalence, impacting millions worldwide and becoming one of the most common and serious health issues. Countries like the UK and other parts of the world report a similar trend, with increasing numbers driven by lifestyle factors, ageing populations, and higher obesity rates. Most cases are Type 2, which can often be managed with lifestyle changes and medication.
Diabetes is a serious and often progressive disease that can lead to severe complications, including heart disease, kidney failure, vision loss, and limb amputations. In the UK, it is a major cause of preventable health complications and disabilities. The condition can develop insidiously, often going undetected for long periods, which increases the risk of severe consequences.
If poorly managed, diabetes affects nearly every organ system, with the following complications being especially common:
- Cardiovascular Disease: Adults with diabetes have a 2-3 times higher risk of heart attacks and strokes.
- Neuropathy (Nerve Damage): Reduced blood flow and nerve damage, especially in the feet, heightens the risk of foot ulcers, infections, and possible amputations.
- Retinopathy (Eye Damage): Long-term damage to small blood vessels in the retina leads to diabetic retinopathy, a leading cause of blindness globally, contributing to 2.6% of all cases of blindness.
- Nephropathy (Kidney Damage): Diabetes is one of the primary causes of kidney failure.
- Additional Health Risks: Diabetes is associated with various other complications, including skin conditions, hearing impairment, cognitive decline (including dementia), depression, obstructive sleep apnoea, fatty liver disease, cancer, fractures, and arthritis.
The COVID-19 pandemic underscored the increased vulnerability of people with chronic conditions, particularly diabetes. In 2020, approximately 40% of those who died from COVID-19 in the U.S. had diabetes, emphasising the heightened risk of severe outcomes in individuals with this condition.
Managing diabetes also imposes a significant psychological burden. Studies show that:
- 36% of people with diabetes experience diabetes-related distress, an emotional strain linked to managing a chronic illness.
- 63% report that fear of complications negatively affects their wellbeing.
- 28% struggle to remain positive about their condition.
This emotional toll, which often includes anxiety and fear of complications, highlights the importance of addressing mental health as part of diabetes care.
Approaches to Diabetes Management
Managing diabetes requires constant vigilance and resilience, which can significantly impact mental and emotional wellbeing. Many people, especially those with Type 1 diabetes, experience “diabetes burnout,” a state of emotional exhaustion resulting from the relentless demands of managing a chronic condition. This burnout is not due to a lack of care but rather the overwhelming stress associated with diabetes management. Symptoms of diabetes burnout often include:
- Strong negative emotions, such as frustration, anger, or feeling overwhelmed
- Feeling controlled by diabetes, leading to a sense of isolation
- Avoidance of management activities and decreased motivation to make positive changes
Addressing these emotional challenges is essential for effective diabetes care, requiring a holistic approach that goes beyond blood sugar control and includes support for emotional resilience.
Key Diabetes Management Strategies
Effective diabetes management relies on a balanced lifestyle combining regular monitoring, a nutritious diet, physical activity, weight management, and strong psychological and social support. Here are some key recommendations:
Blood Glucose Monitoring
Regular monitoring helps individuals understand how lifestyle changes and treatments impact blood glucose levels. Monitoring is especially crucial during and after exercise to detect fluctuations and prevent hypoglycaemia (low blood sugar) or hyperglycaemia (high blood sugar).
Healthy Diet
A balanced diet rich in whole foods, lean proteins, healthy fats, and fibre is foundational for stabilising blood glucose levels. Avoiding refined sugars and processed foods can further support blood sugar control. The Dean Ornish approach emphasises a holistic view – addressing diet, movement, stress, and social support to foster sustainable, healthful habits that nourish both body and mind.
Physical Activity and Exercise
Regular exercise is beneficial for people with diabetes, improving insulin sensitivity and helping muscles use glucose for energy, but it requires careful planning, especially for those on insulin.
Low-intensity cardio can sometimes lead to hypoglycaemia (low blood sugar), causing symptoms like reduced cognition, nausea, and muscle weakness. High-intensity exercise, on the other hand, can increase cortisol and adrenaline, which may elevate blood glucose levels. This effect is particularly challenging for people with Type 1 diabetes (DM1), who cannot regulate this blood sugar spike naturally.
Regular blood glucose monitoring before, during, and after exercise is essential for safety.
Key exercise recommendations include:
- Short Movement Breaks: Engage in light activity (e.g. walking, stretching) every 30 minutes to support blood sugar control.
- Aerobic and Resistance Training: Aim for 150 minutes of moderate aerobic exercise per week, along with resistance training, to enhance cardiovascular health and muscle strength.
- Consistency: Avoid going more than two consecutive days without exercise to maintain steady blood glucose levels.
- Flexibility and Balance Exercises: Practising activities like yoga 2-3 times per week, especially for older adults, to improve flexibility and reduce fall risk.
Weight Management
Maintaining a healthy weight is critical for managing diabetes, particularly Type 2 diabetes. A balanced diet and regular exercise help reduce insulin resistance, improve blood sugar control, and lower the risk of complications.
Medication Adherence
Medications, including insulin or other glucose-lowering drugs, are often necessary, especially for advanced diabetes or Type 1 diabetes. Medications should be taken as prescribed, with careful monitoring to avoid side effects like hypoglycaemia.
Psychological and Social Support
Emotional and social support are essential in diabetes management. Fear alone is not an effective motivator, but positive experiences, connection, and support can foster sustainable changes. Spending time with supportive family and friends, participating in enjoyable activities, and seeking community support can help individuals stay resilient in managing diabetes.
Reducing Sedentary Behaviour
For people with Type 2 diabetes, reducing sedentary behaviour is vital, as prolonged inactivity can worsen blood glucose levels. Incorporating light movement throughout the day, particularly during otherwise sedentary times, can yield significant health benefits.
Yoga Therapy and Multidisciplinary Care
Yoga can complement diabetes management by addressing physical, mental, and emotional needs. Active yoga poses may support glucose control, and mindfulness techniques can help individuals overcome challenges in behaviour change. Yoga therapists can collaborate with healthcare professionals to recommend and implement lifestyle changes, helping to educate the modern healthcare system on the value of yoga as a classical wellness practice. This is asserted by Anil Kaumar Pandeve and Asim Das in The Implication of Yoga in Noncommunicable Diseases:
“A wide variety of common diseases such as coronary heart disease, hypertension, and diabetes mellitus are now being documented to be a faulty lifestyle. Yoga is probably the best lifestyle ever devised in the history of humanity. It is a simple, devoted, compassionate way and view of life, upon which people across cultures and across countries have stumbled from time to time for centuries. Yoga is finding an increasing approval as a nonpharmacological intervention for the prevention and treatment of diseases. Therefore, all the doctors should be well informed about yoga and how it impacts human body system so that doctors may provide sensible answers to patients about the fundamentals of yoga and its impact on health and diseases.”
Research Findings
Research highlights the potential of yoga as a therapeutic intervention for diabetes management, showing promising results across various health markers. Key areas where yoga demonstrates positive effects include glycaemic control, insulin resistance, lipid profiles, body weight and composition, and blood pressure. Below is a summary of findings from various studies:
Glycaemic Control and Insulin Resistance
Yoga has been shown to promote clinically significant improvements in glycaemic control, including reductions in fasting and postprandial blood glucose levels and HbA1c. Randomised controlled trials (RCTs) with individuals with Type 2 diabetes suggest that yoga practice can reduce insulin resistance, making it a valuable tool in managing blood sugar levels and improving overall glucose tolerance.
Lipid Profiles and Cardiovascular Health
Yoga interventions have demonstrated benefits for lipid levels, including reductions in LDL cholesterol, triglycerides, and total cholesterol. Improvements in cardiac autonomic function and reductions in both systolic and diastolic blood pressure have also been observed, suggesting that yoga may lower the risk of cardiovascular complications associated with diabetes.
Body Weight and Composition
Studies indicate that yoga may help in weight management and improve body composition, both of which are critical factors in diabetes management. Increased mindfulness through yoga may support better dietary decisions and reduce emotional and external cue-based eating, contributing to weight loss and healthier eating habits.
Stress Reduction and Mental Wellbeing
Randomised Controlled Trials have shown that yoga has a significant impact on stress reduction, which is beneficial for individuals with diabetes, as stress is linked to poor dietary choices and emotional eating. Yoga participants often report reduced emotional distress, increased mindfulness, and improved self-care practices. Enhanced mindfulness, in turn, supports better coping strategies, improved mood, and greater resilience in managing diabetes.
Blood Pressure and Oxidative Stress
Yoga has shown a positive effect on blood pressure regulation and may lower oxidative stress, which contributes to diabetes complications. These findings are particularly promising for individuals with T2DM, as reduced oxidative stress and controlled blood pressure can decrease the progression of diabetes-related damage to the body.
Nervous System and Pulmonary Function
Yoga appears to reduce sympathetic nervous system activation and improve overall nervous system function. Some studies also suggest improvements in pulmonary performance, further contributing to enhanced physical health in individuals with diabetes.
Quality of Life and Sleep
Yoga participants have reported improvements in mood, sleep quality, and overall quality of life. Reduced diabetes-related concerns and enhanced mindfulness have also been associated with better diabetes management and a decrease in medication use.
Preventive Potential
For individuals with a family history of diabetes, yoga may reduce the risk of developing diabetes by improving insulin sensitivity and cardiac autonomic function.
Yoga Therapy for Diabetes Management:
A Holistic Approach
In the UK, diabetes is one of the most prevalent non-communicable diseases, alongside heart disease, cancer, and respiratory illnesses. Together, these conditions are the leading causes of death, diminish quality of life, and impose significant economic burdens. To address these issues, healthcare providers and wellness practitioners, including yoga therapists can help individuals adopt healthier lifestyles that can reduce the risk and impact of chronic diseases.
Yoga therapy offers a holistic approach to diabetes management, addressing physical, mental, and emotional wellbeing. By integrating movement, breath work, meditation, and lifestyle guidance, yoga therapy helps regulate blood glucose levels, improve insulin sensitivity, and support a balanced, healthful lifestyle. Key components of this approach include:
Asana (Physical Movement)
Physical movement through yoga poses can enhance the body’s response to insulin and aid in blood glucose regulation. Asanas focused on the upper and central abdomen -such as twists and dynamic vinyasa sequences like sun salutations – are especially beneficial. Rhythmic movement synchronised with breath encourages vitality, reduces stress, and balances the endocrine and nervous systems. By reducing cortisol and adrenaline (stress hormones that can raise glucose levels), yoga asana can help to regulate the autonomic nervous system, improve metabolic health, and support psychological wellbeing.
Pranayama (Breathing Exercises)
Breathing exercises in yoga help manage both chronic and acute stress by reducing sympathetic nervous system activity, often through practices focused on lengthening the exhale. These pranayama techniques stimulate the parasympathetic nervous system, promoting relaxation and alleviating stress. Managing stress through breath work can reduce tendencies toward emotional eating or other behaviours that may negatively impact blood glucose control.
Meditation
Meditation, including practices like breathing meditation and Yoga Nidra, helps calm the mind, reduce anxiety, and improve sleep – all factors that influence blood glucose levels. By activating the parasympathetic nervous system, meditation lowers stress levels and promotes emotional resilience, which can improve diabetes management outcomes.
Lifestyle (Vihara)
Yoga therapists guide clients in adopting lifestyle changes to improve insulin resistance, reduce stress, and support healthier habits. This may include encouraging a heart-healthy, Sattvic diet and integrating the philosophical teachings of yoga to nurture a mindset that promotes wellbeing. By addressing obstacles to change and focusing on mental and emotional health, yoga therapy helps individuals create sustainable habits and reduce fear surrounding diabetes management.
Ayurveda and Emotional Health
Ayurvedic principles emphasise the link between emotions – such as worry, anxiety, and anger – and disturbances in the pancreas, which can contribute to diabetes. Chronic stress and mental health challenges, such as anxiety and depression, are often associated with diabetes, complicating glucose regulation. By balancing the body’s doshas through yoga, diet, and lifestyle adjustments, individuals can better manage both the physical and emotional aspects of their health.
The Yoga Therapy Approach: Treating the Whole Person
Yoga therapy for diabetes and other chronic conditions is grounded in a whole-person approach, recognising the progressive nature of diabetes and the need for early, proactive lifestyle changes. Through yoga’s philosophical teachings, clients are encouraged to release attachments to behaviours that perpetuate the disease and embrace new, healthier habits. A yoga therapist’s role involves assessing the client’s current health, identifying risk behaviours, and addressing obstacles to change, both mentally and physically.
Key Components of Yoga Therapy:
- Assessing the condition from both medical and holistic perspectives.
- Identifying modifiable behaviours and areas for improvement.
- Collaborating with clients & other healthcare providers to select manageable lifestyle changes.
- Addressing obstacles that may hinder progress.
This partnership with clients aims to shift the trajectory of their health, reduce suffering, and support long-term management through a combination of yoga therapy and medical care. Yoga therapists educate clients on the fundamental principles of yoga therapy, including overcoming obstacles (Antarayas) such as doubt, procrastination, and a lack of perseverance.
The most effective yoga therapy is compassionate and tailored to the individual, as each person’s symptoms and challenges are unique. Yoga therapists customise practices to meet each client’s physical and emotional needs, ensuring personalised care for those managing any chronic condition.
Many individuals with diabetes feel a sense of betrayal by their bodies, which can lead to resistance to lifestyle changes. Yoga therapy focuses on cultivating a compassionate, non-judgmental relationship with the body. By reconnecting clients to their bodies through mindful movement and breath, yoga encourages self-love and reduces the adversarial mindset that can hinder positive change.
Physical and Mental Health Benefits of Yoga Therapy
Yoga therapy provides numerous physical and mental health benefits that support diabetes management:
- Stress Reduction: Yoga lowers stress, which helps control blood glucose levels.
- Improved Pancreatic Function: Enhanced blood flow and relaxation can benefit pancreatic health and reduce complications like neuropathy.
- Increased Body Awareness: Greater awareness often leads to healthier food choices, improved digestion, and better weight management.
- Enhanced Lung Function, Mood, and Sleep: Yoga supports lung capacity, mood stabilisation, and better sleep, all of which contribute to improved quality of life.
- Reduced Medication Dependence: Many clients experience a decrease in medication needs as they integrate yoga therapy into their lifestyle.
Overall, research suggests that yoga-based practices can offer substantial benefits for managing and potentially preventing Type 2 diabetes by positively affecting glycaemic control, insulin resistance, lipid profiles, body composition, blood pressure, and mental wellbeing. Yoga may also enhance pulmonary and nervous system function, reduce oxidative stress, and improve quality of life, making it a comprehensive and holistic tool for diabetes management.
As Evan Soroka suggests, qualities like forgiveness, adaptability, rest, and relaxation are essential for managing diabetes. Yoga helps individuals let go of past mistakes, depersonalise the condition, and access deeper layers of the subconscious for healing and growth. Through this holistic approach, yoga therapy can empower clients to live healthier, more fulfilling lives.
My deepest gratitude to my teacher Emily Smith whose wisdom and guidance have been invaluable, shaping my understanding and informing this writing in countless ways. Her insights and teachings are woven throughout, a testament to the profound impact she has had on my journey.
Sources & Resources
https://www.cdc.gov/diabetes/?CDC_AAref_Val=https://www.cdc.gov/diabetes/home/
https://www.diabeteseducator.org
Kaiser Permanente Food, Diabetes
Ornish, Dean. The Spectrum. Ballantine Books. 2008.
Smith, E. (2023) ‘Vihara as an Approach to YT and Diabetes’ (Lecture). YT303.03: Essential Sciences for the Yoga Therapist. 11 March.
Smith, E. (2022) ‘Introduction to Diabetes Pathology, Treatment and Yoga Therapy Principles’ (Lecture). YT203.09 Essential Sciences for the Yoga Therapist. 27 May.
Soroka, Evan. Yoga Therapy for Diabetes. Singing Dragon. 2021