Managing your life partner is an art. A prolonged disharmony can wreck your whole life. This is the simple truth in our everyday life. This is also true in the management of diabetes which Dr. Ajgaonkar (who conducted the seven days camp for the diabetics) termed as "your life long companion", while giving an introductory talk to the campers on the first day.

When you enter into an alliance with diabetes, it is a life-long relationship. You cannot get a divorce from a court of law easily from the tentacles of your sticky partner. If your relationship is sore, it can lead to a lot of problems. The whole body can be a victim as the disease affects all the tissues and organs from head to toe. It strikes the vital organs - heart, brain, liver, kidneys, eyes, arteries and nerves. It makes one vulnerable to infections especially tuberculosis.

Unfortunately, it remains symptomless for many years and often goes unnoticed until a complication like a heart attack stroke or retinal haemorrhage, strikes the unfortunate victim. There would be fewer cases of heart attack, stroke, kidney failure and retinal haemorrhage, if diabetes is recognised early and properly treated.

Unless you are able to know the whims and fancies of your companion thoroughly, your marriage can go to the rocks. Like -wise if you are not able to understand the techniques of coping with your disease, there might be problems. The seven day camp gave tips to cope with the disease smoothly.

Diabetes is a condition in which the body cannot use the sugar and starches properly in the diet because the pancreas is not producing enough of the hormone insulin. The severity of the insulin deficiency determines the severity of the diabetes. As a result, sugar, which would normally be used up as energy or else, stored in the body as fat, accumulates in the blood and is then passed into the urine.

Excess of passing urine can cause a fairly rapid degree of dehydration, which then results in a dry mouth and unquenchable thirst - symptoms well know to a diabetic. Prolonged high blood sugar levels are associated with insufficient glucose being used for energy production and therefore the diabetic feels tired and week. At the same time, there is a breakdown of fat and protein in the body in an attempt to find other sources of energy. This result in weight loss and further weakness. If there is a severe and acute deficiency of insulin, there is complete burning of fats which causes ketone production. This, along with high blood sugar levels, causes excess sugar and ketones in the urine. Because of such high concentration of these substances in the urine, excessive water is taken out of the body in the form of urine leading to severe and excess acid in the blood. Initially, there may be nausea, vomiting, abdominal upsets, shortness of breath and confusion. Furthermore, since the brain must have glucose for normal functioning, if the diabetic state gets bad enough, the brain may suffer from lack of energy and coma may ensue. This is a severe and fatal complication of diabetes if not treated immediately.

Alteration in blood sugar levels, such as are found in the uncontrolled diabetic state, can cause swelling and contraction of the lens of the eye, which can result in various degrees of blurring of vision. This can also happen to the balance apparatus in the inner ear, so that sometimes, the uncontrolled diabetic may suffer from intermittent dizziness and loss of balance.

Majority of the cases of the disease are spontaneous (also known as hereditary, idiopathic, primary or essential diabetes). It can be due to the damage to the insulin producing part of the pancreas, induced by certain toxins, alcohol, trauma or surgery. Certain viral infections, overproduction or administration of hormones antagonistic to insulin such as cortisone, growth hormone or adrenaline may cause diabetes.

If a faulty gene is the seed, overeating, lack of muscular work, stress, are supposed to be supporting factors on which this disease thrives. It is true that nothing can be done in case of a faulty gene, but much can be done on the side of attitudes, control of diet as well as regular exercise.

It is a well known fact that till today, unless a pancreatic transplant is done, diabetes cannot be cured, but it can be definitely controlled. In fact, due to the restrictions of diet, exercise, mode of recreation and relaxation, a diabetic has been found to live longer than the average so called non-diabetic person.

It is in this area that Yoga could help a diabetic with discipline in "Ahar" (food), "Achar" (relationships), "Vichar" (thought processes), "Vihar" (recreation). All types of diabetes can be controlled with diet, tables or insulin replacement provided the diabetic plays his part in helping himself and working with the doctor.

WHEN THE OLD ORDER CHANCES

The change was remarkable in RM a materials officer in a chemical industry, compared to the first day of the camp his improvement was dramatic. The fasting blood sugar level on July 22nd, the day of the camp started was 276mg and after lunch 300mg. On July 28th the last day of the camp, the fasting blood sugar was 177mg and after lunch it was 85mg. By the time he came for a follow up after a month, he could reduce his dosage of insulin from 30 units to 24 units. Tablet Glynase which he used to take twice a day was stopped completely.

When he came to the camp, he was nervous and jittery. In fact, he wanted his wife to stay with him at the camp. No wonder he was jittery and nervous because he did not know the most important thing in managing the disease. He did not know how and where to administer insulin correctly. Sometimes the dose of insulin was too high and sometimes too low; so he suffered from fatigue, hunger and nervousness. So, the first thing the Institute did was to teach him not only how to draw insulin correctly from the vial but also how to rotate and administer it in different places.

He could identify irregularity is diet as one of the major causes contributing to diabetes not being controlled in his case. He never cared about the importance of breakfast and normally used to skip it. It is essential for a diabetic on insulin to eat three normal meals with regular snacks in between meals this does not meals this does not mean that the patient has to eat excessively. It can be a light snack from the foods allowed to a diabetic. Thus, at the camp, the participants were allowed to have fruits in between meals and also at bed time. If one allows many hours to lapse between meals the continuing action of insulin on the blood sugar will result in the blood sugar dropping too low and an insulin reaction will occur, called hypoglycaemia.

Because of pressures of day to day life and rushing to work, RM had developed the habit of eating once or twice, skipping lunch or breakfast. This was almost profusely and felt giddy, many a times because of this. He feels the asanas, diet control and other disciplines have helped him not only in controlling his disease, but also gave him will power to stop smoking. Even though, earlier, he had wanted to stop smoking, he seemed to lack the will power to do so. To stop smoking is essential for a diabetic because smoking increases the risk of a heart attack. Heart disease is very common in diabetics and often, the diagnosis of diabetes is only made when an elderly diabetic develops angina or a coronary thrombosis. The increased incidence of heart disease is probably at least in part, because of the abnormality in the fat metabolism in uncontrollable diabetes, with the tendency to elevated serum cholesterol and triglyceride levels which cause fat deposits on the walls of the blood vessels.

By the time RM left the camp he was a new man who was sure of what he was doing. The only doubt he had was whether he would be able to practise discipline when out of the camp. But in the follow up interview three months after the camp he was following most of the things learnt during the camp.

DIET DOES MAGIC

P J found out that his dietary habits were playing havoc with his life. Inspite of having diabetes from the age of twelve and a hereditary case, he was not at all bothered about a proper disciplined diet. It was as if he wanted to avoid the disease feeling that it would automatically vanish if he did not take care of it. Moreover, since he had a habit of pleasing everyone, he used to take a lot of tea while entertaining his clients. He was so involved in other activities that he did not have time for himself. His lack of a routine life aggravated his problem.

Since food is equivalent to medicine for a diabetic, much care was taken in the kind of diet in quality and quantity during the camp. On the first day itself, Dr. Ajgaonkar, stressed the value of food, and the correct choice for its nutritive value. Many of the patients who had not been eating certain food and also harbouring certain resentments were made to realise for the first time the "why" of the restrictions so that those foods could be eaten with a certain discipline and discrimination P.J. still remembers the question one of the campers asked, "Doctor, what should we do when we have a craving for ‘ladoos’ and ‘jalebis’ and we incessantly think of them?" The doctor interestingly replied, "You may think of them, but do not eat them." An element of restraint has to be there. Many diabetics have testified that if they stay away from the forbidden foods, it is much easier to carry forth instead of just indulging ‘that once’ and reviving the taste.

So, all refined carbohydrates, like candies, cookies, chocolates and honey are totally forbidden. They may only be used in the prevention or treatment of the insulin reaction "hypoglycaemia", and this privilege must not be abused.

The diabetic should also take care that the total calories taken and the proportion of carbohydrates, proteins and fats in each meal remains relatively constant because of the insulin level. If the caloric intake varies greatly from day to day, it becomes difficult to calculate a stable insulin dose to keep the blood sugar constant.

Many thought had gone into setting up the menu for the seven days with an eye to appetite appeal, caloric calculations and sattivic quality of foods from a yogic point of view. It is believed in yoga that food affects not only the body but also the mind. So for some of the participants there were further restrictions which when understood from the yogic point of view were accepted.

Initially there was a turmoil about not having tea but they were given an explanation that since tea was a stimulant it was being avoided. For the first one or two days many of the participants felt the withdrawal symptoms of a slight headache. This made them realize that tea was an addiction which they could avoid. Instead of tea a drink with tulsi leaves and lemon grass in milk was soon accepted.

So to make clear the validity of such a diet some of the recipes in the camp were discussed and were distributed. The basic food groups of carbohydrates, proteins and fat were discussed and how to calculate the calories not forgetting the importance of health giving vitamins and minerals.

Since most maturity onset diabetics are overweight, the most important factor in achieving and maintaining control of blood sugar is weight reduction. These dietary restrictions are not only for the camp period but for a lifetime. Tablets for a diabetic should be used for reducing the blood sugar if despite dieting and exercise the diabetes remains uncontrolled. There is no way for diet to be replaced by taking tablets and the fact that you may be taking tablets for diabetes does not exempt you from the correct diet.

P J who was greatly benefited by the camp by following the dietary habits and discipline is now keen on continuing the good lessons he had learnt at the camp. The remarkable decrease in his blood sugar level from 254mg (fasting) to 166 mg (fasting after the camp) and 354mg (after lunch) to 104 mg (after food after the camp) was truly encouraging.

The patients were also asked to test their urine sugar five times a day during the camp with a Diastix which is a strip of paper chemically treated to test the urine sugar levels the patients dip this in a sample of urine and compare the colour change on a colour chart provided on the bottle of the reagent stick. This test enables the patient to detect increase in urine sugar level before there is a major loss of diabetic control. The test is also easy and convenient as the patient can do it himself. Most important of all is that the test helps in disciplining and decision making for the treatment.

J.G. COOLS DOWN

J.G. working with the LIC felt that more than the diet, it was the other disciplines like Asanas, walking and relaxation which had helped him. His fasting blood sugar level which was 172 mg. Before the camp was 112mg. after the seven days. His post prandial blood sugar level before the camp was 299mg. Which decreased to 156mg. After the camp. In August during a further check up the readings were 102.3 mg. (fasting) and 129.8 mg. (post prandial). He felt that the change in attitudes had helped him to relax more. For the first time he said he came to know the concept of consciously relaxing. He became aware that if tension is prolonged it may result in disease.

Earlier he used to take up all the responsibilities in the house leaving no time for himself. Not only did he feel responsible for whatever was happening in the family but he used to get worked up about it. It was as if he was happy to indulge in worrying. He feels that his changed attitude has helped him to relax more. The karma yoga session which followed after breakfast had helped him to change his hard and fixed opinions. He had always wanting things to be his own way and had felt threatened by the environment. In a way the karma yoga concepts were treatment for his powerful ego. It was a tonic which overhauled the inbuilt structure of his personality. Many others like him, especially men who were not used to the type of work done at the camp, could very soon realize the spirit behind the work.

They learnt the concept of duty and dedicated service in a practical way amidst the companionship of fellow campers. If this lesson of activity without reaction could be learnt many of the problems of the diabetics could be solved. They also realized that if these valuable attitudes could be incorporated in everyday life a vast change could occur.

Smt. Hansa Jayadeva also presented some of the ancient truths in an interesting practical manner. The participants were encouraged to think of situations they themselves had faced in the past or were likely to face in the future. An approach to emotional planning was presented. This stressed the idea that one has not only to plan one’s spending of time, money and energy but also one’s reactions. This would make one more and more aware of one’s thoughts and reactions. The cardinal principle of not hurting oneself or others has to be incorporated.

The central theme of a balanced state of being would be that tension is disease and relaxation is health. For it is when the mind reaches a state of quietness and serenity that the diseased condition of the body is also minimized.

Stress in life causes certain physical changes. Any stressful condition leads to secretion of so-called stress hormones such as adrenaline. These hormones have anti-insulin action of raising the blood sugar levels by releasing sugar from the liver. To bring this increased level of sugar down to normal, there has to be increased production of insulin from the beta cells of the pancreas. Repeated stress (anxiety state) lead to exhaustion of week beta cells and cause deficiency of insulin.

In already insulin deficient persons, repeated stress leads to increased stress hormones (anti-insulin in action) and cause persistent high blood sugar levels. Hence the reaction to stress plays an important role in diabetes. By yogic discipline it is possible to modify our reaction to stress and thereby reduce anti-insulin activity.

If the wrong attitude is there which is leading to mental stress, we must learn to identify feelings which are powerful. They influence us to behave and act in a contrary way. We must identify and use them positively, create good feelings and manage them. We must not let them overpower us. With growth in awareness, we can watch feelings rise, find the cause and see if they are justified. If we lose our balance and let our feelings overpower us we can be affected - at the physical, mental and emotional levels.

A G WAKES TO WALK

AG, a mechanical engineer, felt that walking which was incorporated in the routine of the camp had helped him to control his diabetes greatly. Now he is very regular in his walking routine. He had also identified tension as a cause of many of his problems. He fasting blood sugar reading before the camp was 156mg. Which became 96 mg. After the camp and his post prandial readings before were 177 mg. which came down to 124 mg.

Exercise is very important for a diabetic. Dr. Ajgaonkar said, "A diabetic on insulin will benefit even more from exercise than most people." If one is a diabetic on insulin, regular exercise will not only keep him physically fit and healthy but also help in keeping blood sugar levels down. The exercise not only reduces blood sugar levels but it is essential for weight reduction.

Patients were given special instructions to take care of their feet, because of impairment to the nerves, a diabetic may not be able to feel discomfort in his feet when injury strikes. Further because of poor circulation to the extremities so commonly found in diabetics small wounds on the feet often get infected and do not heal well. Therefore a diabetic is more liable to develop ulcers. Therefore a diabetic has to be very careful about minor injuries which if not attended to might lead to serious consequences even gangrene. Dr. Ajgaonkar said, "A diabetic should not only see his face in the mirror daily but put a mirror under his feet and examine them carefully to see that on injuries had been caused."

Many of the participants could ‘see’ themselves when Mr. R. J. Chinwalla an eminent psychoanalyst, gave an insight into the personality of diabetics. He said that many times diabetics seemed to have weak egos which were glossed over by bravado and assertiveness.

Many times they harboured apathy. If the cause of apathy or anxiety could be traced and recognised the real healing work on the diabetics could start. The patient could be guided to understand the emotional implications of the disease. Thus a patient may be on insulin but be indifferent to the correct dosage or the time of administration due apathy or indifference, thus harm could be caused. But once understanding dawns a change could come. Thus he reiterated the role of emotions and how to guide them correctly as an aid to control their disease.

Distiller (1980) has pinpointed three different coping patterns. Many according to him go through all three stages. These are rejection, obsession and finally an intelligent acceptance. Initially at the time of diagnosis there is a complete rejection. Sooner or latter when the diabetic realizes that the disease will not go away, he may become overly concerned about his health - the obsessive stage. With further understanding and insight most diabetics pass on to the third stage of acceptance. Problems exist in diabetics who do not evolve beyond stages one and two.

What yoga does for the patient is primarily to teach him how to accept the disease. Then an awareness is brought on how to correct faulty habits. Yoga also stresses on abhyasa which is putting into practice what has been learnt and not stopping till the goal is reached. This requires commitment on the part of the patients. If the patient does not want to play an active role and just wants the doctor to do something drugs become the only way out. But if the patient tries to take an active role in the care of his health, yoga can help.

BECAUSE OF ASHRAM?

According to Dr. Ajgaonkar, more than the diet or exercise it was the atmosphere of The Yoga Institute which had benefitted the participants. Here a person is guided to have an overall change in his attitude towards life. The serene and peaceful atmosphere of an ashram is different from a patient being in a hospital where he may be dumped in a ward. Here the campers were encouraged to take responsibility for their own health. The doctor is just a guide. The patient is the real ‘doctor’.

The participant is encouraged to feel one with society by participating in group activities and discussions. In the group the campers were encouraged to exchange their problems and find solutions. They were able to understand themselves and others better in this free flow of communication. Times are given when a patient could take stock of himself and reflect and bring about the necessary changes. Thus as a process of education and growth one is able to change one’s own fixed ideas.

The ‘sweet people’ had been given the necessary information and support in coping with their ‘life partner’. Now it is up to them to continue a favourable partnership.