It is mental health awareness month, so I thought that I would take the opportunity to talk about it as an essential pillar of diabetes success and what you can do to improve your mental health right now that you might not already be doing.
We all know how stressful the unpredictability of diabetes can be. What works one day, doesn’t the next. It seems like at times despite our best effort, we still get it wrong. There are so many moving parts to ‘stay in balance’ that our mind takes a beating. Life is stressful enough without diabetes but then you couple it with highs and lows, alarms, needles and annual deductibles suddenly you have got a great recipe for chronic stress.
If you live with diabetes like me, it is essential to prioritize your mental well-being. I want to share with you how I have been able to reduce my diabetes related anxiety for good with yoga therapy.
It is not news that yoga and meditation are an effective way of reducing stress and improving self-awareness. Given this fact it would be healthy to assume that the practice of yoga and meditation would be beneficial for reducing diabetes stress.
You may be practicing both yoga and meditation but what you might be forgetting to do is this one very simple thing: seated breathing.
It seems so simple, it is most often overlooked. But let me tell you it is the most important tool in your self-care toolkit.
The breath influences the mind just as the mind influences the breath. When you are shocked, you gasp for air, and when you are relaxed, you take a long sigh of relief. The feeling of the breath is indicative of the mental state.
Simply inhaling and exhaling in a comfortable way activates the parasympathetic nervous system eliciting a calm and relaxed feeling in the body and mind. Regular daily practice allows the mind to slow down so you can start to see the causes of your stress and do something about it.
I have been MIA the last few weeks because I was getting married and honeymooning in Belize. My husband and I had an amazing experience and I'm happy to say that thanks to my yoga therapy practice diabetes did not get in the way from the fun and adventure.
In preparation for the wedding this last March, I decided to take an extended pump break, the longest I have ever taken! Originally my intention was to prepare for the trip but soon realized that I needed a break from my routine. I needed a legitimate detox from being constantly plugged into diabetes and challenge myself to understand a new way of diabetes management for personal growth and development.
We are taught early on that diabetes is about consistency. We should have routine, plan for all unexpected circumstances and rely on the memory of what worked in the past. Just like all of life, however, nothing is constant. The moment we get stuck in a routine, we stop growing, fear, and anxiety of the unknown set into the mind. This can also happen with diabetes management.
Yoga is a process of personal growth and development. Through the practices of yoga, the individual can begin to awaken and shift their concept of reality. They harbor less anxiety and fear, become less stagnant and habituated in their patterns and beliefs. I genuinely believe that all of the challenges that we face with diabetes are mirrors onto the challenges of the human experience. Through diabetes, we have the opportunity to master life’s challenges and accelerate our growth, happiness, and wellbeing.
Changing up your diabetes routine can be a yoga practice onto itself. It requires you to look at your fears, habits and comforts. Before you begin, ask yourself "what is my intention?" Why do you want to make a change? What is not working? It can be as simple as mine: To take a break from perfect numbers, try something new, and have a digital detox.
This experience over the last two months taught me a lot about myself, diabetes, and the process of letting go.
Changing your routine is a process of adjustment and letting go. The first few weeks on break I was not jiving with the long-acting insulin. I listened to my intuition and changed to a different, more familiar brand and immediately my blood glucose improved. Although my cumulative numbers were not as stable as when I was on an insulin pump, the break allowed me to be less worried about perfect numbers. I was less stressed out by highs and experienced very few lows.
Every time I noticed that I was frustrated with shots and wanted to go back on my pump, I reminded myself of my intention. It is not about perfect numbers right now; it is about taking a break.
Being on shots has its own set of positive and negative qualities.
Here are my top + and - from MY personal experience. You might agree or disagree.
1. Freedom – I feel less of a billboard for diabetes when I do not wear an insulin pump
2. Comfortability – getting dressed is a much more enjoyable experience
3. Exercise—I did not need to eat as many carbs before and during exercise
4. Relaxed –without having a smart pump (and just Dexcom), I was able to sleep better and be less involved with ups and downs.
1. Flexibility – It was harder to mitigate high blood glucose readings, make impromptu decisions. More planning for exercise and food.
2. Shots –frankly, my skin was bruised and keeping on top of site rotation was challenging
3. Quality of insulin –despite using a Frio bag, and Myabetic thermometer, traveling with my insulin pens in varying temperatures caused me anxiety. I noticed that after a week or so, the insulin was less potent. I found myself taking way too much short-acting insulin and had to increase my long-acting insulin daily.
4. HbA1c – My average blood glucose numbers went from being about 90% in range to 70% in range on shots.
You might be on a pump and have no interest in changing. I get it. You might be on shots and absolutely love it. There were times over the last two months when I considered making the long term switch to shots. Everyone has got to find their way of living with diabetes that is not only authentic to your lifestyle but also in alignment with your insurance and pocketbook. If you do have the ability to experiment, I highly encourage it!
Here are some ways that you can try a new way of diabetes management:
1. Contact your doctor or diabetes educator, let them know that you want to take a pump break to see if they have insulin pen samples, and have them recommend something for you.
2. If you are on shots and want to try a pump, you can also contact your diabetes educator. Sometimes they have demos on hand. A few years ago, I wanted to try the Omnipod and purchased a used one and two boxes of pods on a diabetes community Facebook page for only $200.
3. Give yourself a specific timeframe. I gave myself two months. I do not think that anything less than a month is adequate.
Fast forward to today. I am now back in the States and on my pump. It took a second to get used to the tubes and size but I am happy to be back. It is what works best for me. Yet, I am not attached to it. I am sure that I will take another pump break because it always good to change up the routine.
If you want to learn more about how the practices of yoga therapy can help you awaken and shift your relationship to diabetes check out my RISE ABOVE T1D PROGRAM launching again soon! Just sign up for the waitlist and you will be the first to be notified when the program opens for registration.
Next week, I will share with you a special practice for overcoming the anxiety of change and uncertainty. Stay tuned!
I'll be honest with you. Even though I consider myself to be in optimal control over diabetes, I still have days where I do not understand why I am running high.
On those days I follow a process of deduction to figure out its cause. Once you can pinpoint the why you can focus on the how.
In order to live mindfully with diabetes, it is essential to have a process of deduction to nip your high’s in the butt to the best of your ability.
In this short video I'll walk you through my personal steps for bringing down highs more consciously.
We all want to improve our HbA1c. If you watched last week’s video on diabetes perfectionism, for some it can become an obsession and actually hinder your efforts.
This week is all about what you can do right now to improve your numbers without fail. Just by bringing down your average one hour extra a day you can significantly decrease your HbA1c.
You will learn:
How to consciously create a relationship to hyperglycemia management that is fun
My personal checklist of how to deduce cause of hyperglycemia
What to do once you have inferred the cause of the effect
That you already possess the ability to improve your health
Is Diabetes Perfectionism Hindering Your HbA1c and Controlling your Life?
In this yoga therapy inspired video, I will teach you my favorite mindful strategies for overcoming diabetes perfectionism and optimizing your mental wellbeing with type 1 diabetes and beyond.
I’ve been type 1 for over twenty years, so I remember a time when testing took over 30 seconds and insulin pumps were a rare and highly coveted item. Fast forward to 2019 and life for the person with type 1 diabetes has improved tremendously. We now have continuous glucose monitors which enable us to observe blood glucose readings in real time. Many systems integrate with an insulin pump which will self-adjust to the CGM reading. Parents can view their child’s glucose readings when they are at school. Long-acting insulin works so darn well. We can see the graphs and trends related to food, exercise, hormones and make more educated decisions. Thanks to these achievements we can live more meaningful and more courageous lives with diabetes.
Despite the advances the system is not perfect. I think we know this but still expect it to be. Diabetes TMI is part of the problem. We know too much. Alarms, social media impressions, images of arrows pointing every which way. It can be exhausting. The modern-day person with type 1 diabetes is always plugged in, turned on and eventually without recharging, can quickly burn out. Without self-awareness, CGM’s can turn even the most relaxed person into a perfectionist. This was, and sometimes still is, me. I have had to work hard on letting go of perfect numbers and allowing the imbalances to teach me more about myself and diabetes. Curing this habit with diabetes has helped me heal perfectionist tendencies in other areas of my life.
According to the American Diabetes Association, optimal diabetes management is maintaining an HbA1c under 7 and blood glucose reading of 70-130 mg/dL before meals and under 180 mg/dL two hours after meals. These are not unattainable goals, but they are not always the numbers we see during the day. Due to an intense desire to remain “within the lines” diabetes perfectionism can actually cause hypo and hyperglycemia episodes because you react rather than listen.
All of this measuring up and striving to fit into the lines leaves a subtle imprint in the psyche. Isn't there already enough pressure in this world to be perfect without diabetes? The mind holds on to negative thoughts and beliefs further perpetuating the inability to be satisfied. Perfectionism is a product of fear. It is the fear of being inadequate, of making mistakes, of being vulnerable. Many of us are successful at living with diabetes because we put on the face of being capable. I always told my parents, “I’ve got this. Please don’t worry about me.” But that attitude only gets us so far. We have got to have the courage to make mistakes, learn from them and grow.
Please share your experiences with diabetes perfectionism below. I'd love to hear them
Skip to min 3:15 to get directly into the practice
The key to master diabetes lies within the mind. Diabetes requires an enormous amount of mental fortitude when it comes to decision making. Strengthening your mind is like developing a muscle. Like any muscle, if you don't work on it, it will stay weak and eventually atrophy. Without willpower diabetes will always be the one in charge of your decisions and destiny.
Just as important as it is to administer insulin, eat right and exercise, so too is developing your internal strength, willpower, and determination.
As a recently diagnosed person with diabetes, I remember how challenging it was for me to say no to certain foods. What were once everyday daily treats like pop-tarts and cereal were suddenly off-limits, and subsequently, I wanted them even more. I would pine at my brother’s cereal bowl every breakfast while I ate my less-than-exciting eggs.
To make matters worse, as a newly diagnosed diabetic, I could not control the impulse to overeat when I was low. My internal emergency alarm clock for low blood glucose was so loud that I could not separate my desire to eat cereal from the wisdom to know that I had enough. At one point, my mom had to padlock my brother's cereal so I would not eat it all. I lived for years a slave to my cravings on a physical and emotional rollercoaster. It wasn't until I began a regular yoga therapy practice involving breathing and meditation when my life turned around.
Inside the mind, we battle with our impulses, which are profoundly rooted in survival mechanisms. All day long, the mind waivers from distractions, desires, worries, cravings. When you have diabetes, the common internal disturbances are amplified. Externally the mind responds and relates to information received from our senses. For instance, if you see a disagreeable number on your CGM there is an emotional response, which is then internalized, triggering the heart rate to rise, the brain to release stress hormones, increasing insulin resistance, the mind spins, and you are caught up in the inner and outer drama of diabetes.
A primary tool for developing your willpower muscle is something you already have, something you are doing right now…breathing!
By consciously slowing down your breath you can:
In this short video, I’ll walk you through the steps to practice conscious breathing for developing your diabetes willpower muscle.
The steps are as follows:
1) Sit comfortably and close your eyes
2) Shape your breath slowly and continuously without pause
3) Relax at the beginning and end of each inhale and exhale
4) Allow the exhale to lengthen up to twice as long as inhale (purse your lips if you need)
5) Slow breath down as effortlessly as possible and maintain for several minutes
One of the most potent tools in your toolkit to live more mindfully with diabetes is the breath. Yoga defines breathing as pranayama as the expansion of life-force energy. As a person who lives with a condition that can be physically and mentally exhausting working with the breath is a simple and effective way that you can increase your energy, vitality and encourage your body’s natural ability to self-heal. Not only is the breath a tool of physical healing, but also it is the gateway into the mind. Diabetes stressful for many reasons. The breath helps reduce stress triggers by creating space between your thoughts and actions. By tapping into your breath on a regular basis you can change the way you think, feel, and relate to diabetes.
In this short video you will learn:
-What is the yogic breath
-Why it is essential for diabetes management
-How to breath properly
-Simple tools to begin a practice of mindful diabetes management
If you are short for time, go directly to marker 5:10 for the direct teaching on how to breathe more mindfully.
What can go wrong will go wrong when you have diabetes. I am not saying this to be negative. It is simply a fact of the matter. That is why it is extra important if you or someone that you love has diabetes that they are always prepared for an emergency. Here are the top 5 things that I keep in my purse or bring with me in a day pack. THIS IS NOT FOR MORE THAN A DAY TRIP so I am keeping in mind what is ESSENTIAL.
This active planning is considered a yoga practice because it is helping you to avoid all future suffering. If you are prepared for future problems, you can relax and enjoy the moment that you are in! That is what life is about.
It is no secret that living with Type 1 diabetes can be challenging for even the strongest of dispositions. Life is trying no matter if you have chronic illness or not but the added pressure of a variable like Type 1 diabetes makes life’s aggravations even more challenging to bear. Stress impacts the individual at every level (physically, cognitively and emotionally) and for the person with Type 1 diabetes, high levels of stress can be incredibly detrimental, not only making it harder to manage blood sugar levels but also rendering the individual sad, hopeless and overwhelmed. This article aims to inspire other people with Type 1 diabetes to work regularly on managing the symptoms of emotional distress through yoga therapy techniques, physical exercise and improved self-awareness. The goal is to be less affected by stress, become more conscious of stress triggers, and to detoxify the mind of its learned habitual reactivity with an ultimate aim to live healthy, happy and productive lives.
Depression: is it really clinical or an underlaying symptom of stress?
There are significant research studies correlating Type 1 diabetes to depression, claiming that T1Ds are nearly 50% more likely to be diagnosed with a form of depression than non-diabetics (Beyond Type 1). However in a recent UK study, this claim has been further examined and scientists are now suggesting that there is a distinction between emotional distress from managing chronic illness and an actual mental disorder. This emotional distress is known as “diabetes distress” (DD). If you live with Type 1 diabetes or any other form of chronic illness you understand exactly what the word “distress” feels like. At times it can be so overwhelming and the lingering aftermath so great, it can seem like there is no way out. It is this distress that is at the root of all suffering for those with Type 1, but also the entry point to eventually breaking the cycle of negativity and reactivity.
The mind at the root of suffering
Have you ever heard that you create your own reality? The mind is at the root of understanding and managing the stress response. Often it is the reaction to the stress that is more detrimental than the stressors themselves, especially if self-created. The mind is the filter to all of our experiences, past, present and future. If that filter is corroded or tainted due to negative past impressions then our present moment will reflect this tainted point of view and the future will be muddled by a cloud of self doubt and darkness. It’s like if you go to a restaurant and have a bad experience; it would probably take many more positive experiences at that same restaurant to get over the one bad experience. This is what it is like living with chronic illness except you can’t pick a better restaurant to go to. This is what is for dinner. So what are the options? You can choose to live with anger, resentment and reactivity or you can choose to do something about it.
How to begin …
The first step in the process of applying yoga therapy for those with Type 1 diabetes to transform how you feel in your body right now. It is no wonder that people with T1D are athletes. Movement can reduce physical tension associated with emotional tension. Physical activity such as yoga poses can increase insulin sensitivity and improve circulation. However, limiting the focus on the physical body to treat stress simply puts a band-aid on the origin of the stress itself. To truly create long lasting change, one must influence the mind.
So the second step is to strengthen the mind. The doorway to shift the mind is respiration. You cannot control every detail of Type 1 diabetes but your breath is something that you can control. The quality of the breath directly relates to the quality of the mind; i.e. tension and strain in breathing are often indicative of the same qualities in the mind. These tensions can be conscious or unconscious but with regular practice you begin to make the unconscious conscious.
This is a process known as viveka or clear seeing. Through the regulation of breath one can regulate the autonomic nervous system’s response to stress. When the nervous system is in balance you are less driven by your emotions, your behavior improves and you can link to sources of inspiration and joy. Breathing is a discipline onto itself which can be refined with breath-centric yoga movements, pranayama (lengthening inhale, exhale or both); with chanting, meditation and mantra one can develop his or her resiliency and adaptability to stress. The third step is putting the work into action. The sooner you recognize your mechanism of reactivity the less time it takes for you to return to a state of balance.
When your emotions are balanced you can observe the constant fluctuations of blood sugars and nagging alarms without getting caught up in the drama. The greatest example I have of this is encountering a severe hypoglycemic episode. Yoga teaches us to observe ourselves from outside ourselves. When you are suffering from a low blood sugar, the body goes into complete survival mode. All reason goes out the window and you would do just about anything to get that box of juice or handful of glucose tabs in your mouth. When I was younger and lacking discipline, I would reach for the box of cereal and one bowl would turn into four. Being utterly possessed by the primal instinct of survival, I could not limit myself to one bowl and wait until I felt better. Instead I would find myself at 400 ml/dl a few hours later. Now with practice and refinement, I can treat my low and abide in the uncomfortable 15 minutes of sensations and visceral survival mode without over reacting.
This example can be applied to so many instances of life with Type 1 diabetes, from staggering health insurance premiums, to uncomfortable insulin pumps, CGMs and needles, to communicating with non-T1Ds, to your own self-forgiveness for not bolusing correctly for your meal. Yoga therapy can be an effective and powerful tool for people with Type 1 diabetes to apply a positive influence over their unpredictable disease. Ultimately to treat Type 1 diabetes with yoga therapy, there is no specific posture or sequence. It depends on the individual and their current level of diabetic distress and coping mechanisms. With regular practice and dedication to yoga therapy, you can live a more balanced, spacious and joyful existence in relationship to your disease and the world around you.
There reason why you can't keep those goals and intentions you've set for yourself is because your mind is not stable, yet. When it is stable, calm and quiet you can perceive its self-luminous properties, i.e. the BEST qualities of your mind: joy, clarity, space, creativity and freedom!
In order to set better intentions we must first stabilize the mind. Without this preliminary step and regular practice we will go back to all of the old behaviors. When applying this for type 1 and type 2 diabetes it is important to recognize the patterns of our own behaviors. We often have lots of goals but cannot fulfill them because our behaviors are rooted deeply in habituation. This makes sense because so much of diabetes is routine!
Take 5 minutes with me. Practice balancing out the energetic channels of the mind. Regulate the right and left nostril dominance. This has a hugely powerful effect over the constantly moving mind.
Happy New Year!
Break through diabetes habits with yoga therapy
Join me for a 6-week online yoga therapy series for diabetics. We will work with the foundation to yoga therapy, breathing and meditatton practices, weekly intention-setting and self-care practices. Rise above the challenges of diabetes and use them as a source to your own self-mastery! Join now.