Yoga For Diabetes: Q and A with Rachel Zinman

Earlier this month, I had the pleasure of finally meeting Rachel Zinman of Yoga For Diabetes at Abbott’s Diabetes Exchange in Melbourne. Rachel and I both began blogging in early 2015, and we first connected during Diabetes Blog Week. Rachel lives and breathes Yoga, and since her diagnosis with LADA, is passionate about helping others to realise the power of yoga in managing diabetes. She spends half the year based in northern NSW, and the other half of the year in South Africa teaching Yoga. Later this year, she will also be kicking off a tour across the US to launch her book, Yoga For Diabetes.

 

 

Rachel is one of the most generous and enthusiastic people I’ve come across in the Diabetes Online Community, with a great respect for other’s opinions and ideas. For some crazy reason she is one of my biggest fans, and I’ve greatly appreciated all of her support and encouragement over the years.

Rachel is kicking off a 7 day online Yoga challenge on September 1, Better Diabetes Management in 7 Steps with Yoga, which you can learn more about here. Today, she joins me here at Type 1 Writes to answer a few questions about the challenge.

Frank: Yoga and diabetes. They’re not two things that I would automatically put together in my head. You’ve obviously been practicing yoga well before diabetes came along. Tell me a bit about how yoga has helped you to manage your diabetes?

Rachel: I started yoga in the the early 80’s. Back then yoga wasn’t trendy at all. I did it because I had a lot of pain in my lower back from being a professional dancer and my chiropractor told me it could help me. I noticed the calming and healing aspects straight away. I felt more energised after a class, my mind was calm, my digestion improved and I found myself letting go of unhealthy habits and being more positive.

When I was diagnosed I focussed on bringing additional energy into the body through strong breathing exercises. I also practiced postures to tone the digestive organs including the pancreas. I worked with the sister science of yoga, Ayurveda, to find a practice that suited my physical type (I am very fiery) and the type of diabetes I have, LADA (Latent Autoimmune Diabetes in Adults).

I discovered:

  • Improved sleep.
  • Better and more stable blood glucose levels.
  • Increased insulin sensitivity.
  • Resilience in the face of stress.
  • Better digestion.
  • Stable weight.
  • A positive attitude.

Frank: Obviously, you’re kicking off a 7 day yoga challenge on September 1. Tell me a bit about the challenge, and what I would be doing every day if I signed up. How easy would it be to take up the challenge, and what sort of time commitment would I be looking at?

Rachel: The challenge is all about how to incorporate yoga into your life and your daily diabetes management plan. So each practice is between 3 and 10 minutes long and most can be done sitting in a chair or comfortably on the floor.

The practices are designed to reduce stress. A lot of people think yoga is a physical practice to increase flexibility. But there is so much more to yoga than that. There are a variety of tools we can implement to meet the demands of a life with diabetes.

The first step is to discover your Ayurvedic type. On the first day you’ll fill in a questionnaire and read a bit more about your type. Then we’ll explore a different practice each day to calm the nervous system.

Sound, visualization, hand gestures, breath, a simple yoga practice done lying down and on the hands and knees to improve circulation. You’ll also learn a traditional ayurvedic foot massage, which I think is the best part of the challenge.

Frank: The biggest draw card for me when looking at the yoga challenge is mindfulness. I often go to bed with a million thoughts on my mind, and don’t take a lot of time out. Tell me a bit about how taking up your yoga challenge could help there.

Rachel: As I mentioned each practice in the challenge is designed to reduce stress. The biggest stressor is our tendency to get carried away with our thoughts. So whether we are breathing or working with sound, or a visualization or even the physical practice, the guidance is to continually bring our minds back to the task at hand. The more we can bring our minds into a one pointed focus the easier it is to pull ourselves out of our habitual tendency to identify with thoughts.

It actually doesn’t take much to get the mind to be present. We just need to train it. I love that saying, “wherever the attention goes that’s where the energy flows.” So if we are getting caught up in our thoughts about diabetes or anything that stresses us out, that’s where the energy goes.

Bringing our minds to a sound, image or the breath etc. the mind is focused and calms down and energy flows effortlessly.

In my personal experience, these simple yoga practices are the first step in mind mastery and teach that it’s easier to master the mind then we think. We just need to set a few minutes aside and have the willingness to take that first step.

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Rachel blogs at Yoga For Diabetes, and you can find her on Facebook, Twitter and Instagram.

Her 7 day yoga challenge kicks off on September 1, and you can sign up here.

Prioritising Emotional Wellbeing in Diabetes Care

How many healthcare professionals ask you “how are you going” during an appointment?

Not how are your numbers going.

Or how your diet is going.

Or, how are the number of hypos you are having each week going.

When I say ‘how are you going,’ I mean ‘how are YOU going?’

I must admit that I was surprised in hearing psychologist Lisa Robbins express confidence in the abilities of diabetes healthcare professionals to identify burnout triggers, during our live webcast at DX2Melbourne. It’s my view that the right healthcare professional would be able to identify those triggers.

In my humble experience, I often felt a lack of emotional support from my endocrinologist and my doctor in my early days of type 1. I never felt that they had the time for me on a busy clinic day, and I didn’t really feel too important when there were younger children and families around who understandably required more attention.

It was often hard to open up and be honest with them for fear of judgement. My very first endocrinologist told me that I had very poor control, just weeks after my diagnosis. Meanwhile, my general practitioner often told me that “my sugar levels are too high” without actually offering anything more substantial or helpful.

For the record, I certainly don’t expect that an endocrinologist or general practitioner should have to fill the role of a counsellor. They are qualified professionals in high demand. No doubt they have far better things to do with their time than listen to me blubber on about my diabetes.

However, I do expect that health care professionals will listen to me. I do expect that health care professionals will make me feel comfortable to open up to them. I do expect that health care professionals will look beyond what’s written on the charts and talk to me about what’s going on. I expect that health care professionals will show some empathy during consultations. And I expect that healthcare professionals will offer support and encouragement.

This is not a big ask. This can be done. Even on a busy clinic day. Even when time is limited. Even if you’re meeting me for the first time. Even if you are a general practitioner who is not a diabetes expert. Nobody has to be qualified to be supportive and empathetic, in my opinion. Above all, prioritising emotional wellbeing will assist diabetes healthcare professionals to better address the need for any further psychological support.

Emotional wellbeing helps me to see value in my diabetes healthcare team. It encourages me to continue to manage my diabetes to the best of my ability. A good experience motivates me to keep in touch with my diabetes healthcare professionals and to ensure I have my regular checkups. Above all, emotional well being has helped me to prioritise my health. It’s the difference between walking out of the doc’s office holding back tears, or with the biggest grin that I can’t wipe off my face.

Obviously, my endocrinologist and general practitioner are only individual pieces of the “emotional” support puzzle in my diabetes care. I have my wonderful diabetes educator, who has my undivided attention during every 60 minute session I have with her. I have my family at home, whom I have learned to lean on a little. There’s the wonderful Oz Diabetes Online Community, who I can hang out with on Twitter every Tuesday night. I have my soapbox right here at Type 1 Writes, where I can vent about any topic of my choosing. I also have some amazing d-peeps who I am lucky enough to call friends.

Three years ago, I certainly felt very alone with my diabetes.

Finding emotional wellbeing has helped me to embrace it.

Type 1, Turning 18 and Finding Peer Support

I was lucky enough to be featured on the very awesome Diabetes Mine over the weekend, if you haven’t already caught up. I’d like to think my article also serves as a timely awareness piece for Australian National Diabetes Week, which kicked off yesterday.

So, is it somewhat easier being diagnosed with diabetes as an adult? Or would you rather be diagnosed at a younger age, where you won’t know life any differently? It’s one of the age old debates within the diabetes community.

I don’t subscribe to the notion that there is an easier option. Every diagnosis, at every stage of life, is uniquely challenging. While I’m certainly grateful for my adolescent years that were free from diabetes, receiving a type 1 diagnosis as a young adult presented it’s own set of challenges. Herein lies my story.

“I’m one of the privileged few who joined the “diagnosed-a-few-weeks-before-turning-18 club,” in terms of living with type 1. That was in 2010, and I was in the midst of a big transitional change in my life: had newfound independence, was midway into my first semester at university, was enthusiastically working my first real job, and driving around in my first car. There was a lot going on at the time, and when that T1 diagnosis came along, I don’t remember actually processing the meaning of my new illness all that much right away.

Needless to say, being diagnosed with T1D as a young adult presented a unique set of challenges.

For starters, nobody knew that I had diabetes. I didn’t grow up with it, didn’t go through school with it, and it wasn’t simply there for the world to see. I didn’t know life any other way, and went from carelessy eating potato crisps after school to having to think about what they would do to my blood sugar.”

You can check out the full article over at Diabetes Mine here, to help tide you through your Monday-itis. 

I know I’m going to need an extra coffee today…

T1 Talk: Managing the Unmanageable

Welcome back to T1 Talk, a series of conversations between myself and Bec of Sweet and Sour Diabetes. We’ve started these conversations with the aim of highlighting how type 1 diabetes impacts two people of a similar age, who were diagnosed at slightly different stages of life. You can learn more about us in our first post here.

This T1 Talk is titled Managing the Unmanageable, and tackles the more technical side of management – from diabetes healthcare professionals to pens, pumps, fingersticks and CGMs. There are two parts to this T1 Talk. The first part is here, and the second part follows over on Bec’s blog at Sweet and Sour Diabetes.

The Australian health system is split into public healthcare and private healthcare. What do you use and why?

Frank: I began seeing a diabetes educator privately last year because I needed someone who had more time for me. The public system pushed me towards self management as soon as I was able, and diabetes education is something I genuinely missed for a few years there in the middle. I wanted someone consistent, someone who I could get to know and who I was able to contact inbetween appointments. I didn’t feel like the diabetes education I received in the hospital was personalised to my needs towards the end.

I see my allied healthcare professionals privately too, simply because it’s more convenient than going to the hospital.

I still see the endocrinologist publicly at the hospital. I feel like the endo is more strictly business. She refers me for all of my important check ups, reviews my hba1c and other pathology reports. I only tend to flag the more “medical” concerns with her. I’m happy seeing my endo publicly, and I don’t feel I could justify the cost of going private based on my experience here.

Bec: Your relationship with your CDE sounds brilliant!

When it comes to health system, I’ve sampled most of it. Currently my diabetes management primarily falls on two people, both private practitioners. My private endocrinologist is basically a whole healthcare team in one. She manages everything a diabetes educator would, as well as her usual endo role. This suits me really well and I feel very well supported in the private system. However, this was hard for me. I strongly believe in public health care being the best quality care. I believe you shouldn’t be able to pay more for better health care, it should just be a given. Unfortunately, the public system (whilst amazing as an early teen) was not the best fit for me as an adult. I see my allied health professionals in the public system, and everyone else privately.

Frank: Wow, the all in one sounds awesome. It sounds similar to endos I’ve read about in American blogs. It does sound expensive, though. 

Bec: It’s not too bad price wise considering it’s only once every 3 months. She’s very supportive by helping out between appointments via email, but I often feel guilty for asking for help when I’m not paying for it.

Describe the relationship you have with your Diabetes Educator and/or endocrinologist.

Frank: I see my diabetes educator once every three months. I’m pretty proactive with my management, so at the moment it’s more than enough. I’ve got her card and I know I’m welcome to call or email inbetween appointments if need be, which is comforting. It’s so good to have someone who dedicates that whole hour to you. She lets me steer the conversation, and I don’t feel pressured into anything I don’t agree with. I love that my educator also explores things like how I feel with my current level of management, or how I handle my diabetes around others. The price I pay is absolutely worth it.

Bec: I’ve always thought your educator sounded amazing. I remember mine at the kids hospital were brilliant. She sounds like she takes a real interest in your health overall, rather than focusing on just one part of diabetes.

My endocrinologist is quite business like and direct, but I like that about her. She understands my approach to my t1 and supports that, but she also tells me when to dial it back and give myself credit for what I AM doing for my management. She’s very contactable outside of the quarterly appointments via email which is very helpful for my management. I find that I’m not as self sufficient as you are Frank, and I need a bit of help working out what to do with my insulin rates. I think this might be because you’re not very self sufficient in the paediatric setting. I understand how everything works but still feel some hesitation making my own rate changes without confirming it with an endo. Plus, with work and uni and constant fluctuations in my sugars I need a helping hand to sort through the mess. So just like your educator, my endo is certainly worth paying for. I just don’t have the brain space to do it alone.

Frank: That’s fantastic. We’re under all this pressure as type 1s to constantly manage well, that along the way I think we lose sight of what an achievement this is in itself. So, I think it’s great that your endo gives you credit where it’s due. Basal rates are really tricky to work out, and obviously you need to allow time for them to kick in and sometimes it takes a lot of trial and error before you get them right. If you feel more comfortable making basal changes under the guidance of your endo, then I say good for you. I’m glad you feel supported in it.

What would you change about the system of healthcare in Australia?

Frank: Stop cutting resources in diabetes clinics! Stop pushing patients away! The number of patients in my diabetes clinic keeps growing, but over the years it seems the resources continue to be stretched thin. The wait time to see a diabetes educator is at least a month, and although I’m supposed to see the endo in 9 months, it will likely be closer to a year. Once upon a time, diabetes clinic was the only resource I relied upon to manage my diabetes. I couldn’t imagine where I would be today if I hadn’t diversified my investment chips into peers, websites, books, social media, private education and allied health professionals.

Bec: Excellent points there. So you see your endo less than once every 3 months? That makes sense considering the role your educator plays in your management. I agree that adult care needs to improve, which is something transition services such as Trapeze (a company I work for) is working toward. I left public health care because it just didn’t fit me or my needs.

The thing I would change is the idea that CGM is a luxury. It certainly is not. I can’t feel my hypos very much, and I tend to drop in my sleep. How anyone can consider an alarm system that keeps you alive a luxury is beyond me. Yes, it’s subsidised for those under 21 upon recommendation from their endo, but t1 has no age cut off. I’ve spent a lot of time contacting politicians to make a change. Just last week I sent a letter to my local member to bring the issue up again. Probably not effective, but at least I’m trying to do something about it.

Frank: I feel so guilty to whinge about CGM considering how lucky we are here in Australia, but yes I wish they were more accessible to me. While I’m so happy for the kids who will get one subsidised, I feel like our government has simply forgotten about the rest of us with type 1. I worry so much about going hypo unaware. I go through tonnes of test strips. I usually set an alarm midway through the night, just to make sure things are sitting steady. Good on you for doing something about it, I still haven’t gotten around to contacting my local MP.

Head on over to Bec’s blog at Sweet and Sour Diabetes to read the second part of this T1 Talk. We delve into pens versus pumps, fingersticks versus CGMs, and the challenges of making changes in our management. Catch you there!