Diabetes
There are two kinds of diabetes, with Diabetes Type I resulting from a lack of insulin and requiring its replacement, and Diabetes Type II, much more common, which is brought on by overweight, sedentary lifestyle, and a resulting resistance to the effects of insulin. Medical research shows that good stress management is an important part of diabetes management, and that relaxation and guided imagery can be very helpful. The benefits are largely through the effectiveness of guided imagery to reduce stress and help people change to healthier lifestyles, but there may also be some direct effect on blood sugar levels. Our "Guided Imagery for Self-Healing" book and 4 CD set will teach you all the fundamental skills of using guided imagery to help stimulate healing and lifestyle change from within. The book will explain the process, review the science behind it, and coach you through the common questions that people have, while the CD set guides you through the 9 essential guided imagery skills taught in the book. If you prefer to listen rather than read, you may want to start with "Self Healing with Guided Imagery", a 2 CD set featuring Dr. Andrew Weil. The first CD explains mind/body healing and guided imagery while the second teaches you three fundamental self-healing skills.
RESEARCH
GUIDED IMAGERY FOR DIABETES
JANUARY, 2006 Definition of the Problem
There are two major types of diabetes mellitus (DM); both affect how a person metabolizes glucose (“blood sugar”). Type I diabetes, also called Juvenile Diabetes, is thought to be an auto-immune condition in which the pancreas stops producing insulin. Someone with Type I is "insulin-dependent," meaning they need daily insulin replacement therapy to survive. Type I diabetics comprise only 5%-10% of the diabetic population (Votey, Peters, 2005a).
People with Type II diabetes are "insulin resistant," meaning that the pancreas may or may not be producing sufficient insulin, but the insulin receptor cells have become "resistant" to absorbing the insulin. Type II diabetes is primarily a lifestyle condition associated with being overweight, and leading a sedentary lifestyle; it occurs more frequently in persons of low economic levels, probably as a result of the consumption of a high-fat, high-calorie diet (Black, 2002; Bo, Menato, et al, 2002; Votey, Peters, 2005b). Stress is a major contributing factor, since stress raises blood glucose by stimulating the liver to release glucose. Additionally, people under stress often fail to follow doctors' recommendations (Surwit, van Tilburg, et al, 2002; Arsham and Lowe, 1997, p. 213-215).
Scope and Cost of the Problem
Diabetes is among the most prevalent, most expensive, and fastest growing chronic conditions in the U.S.A. and the world. In 2002, About 18.2 million Americans were estimated to have diabetes (Votey, Peters, 2005a). In 1998, their care involved 513,000 hospital admissions, averaging 5.2 days per stay (Hall, Popovic, 2000). For the year 2002, Direct medical expenditures for diabetes in 1997 totaled $44.1 billion – about $7.7 billion for glycemic care, and $36.4 billion for treatment of complications and excess prevalence of general medical conditions (Votey, Peters, 2005b). People visited doctor’s offices 21.4 million times in 1997 (Schappert, 1999).
According to the American Diabetes Association, indirect costs of diabetes (from premature mortality and disability) in 1997 totaled $54.1 billion. In 2002, medical expenditures incurred by people with diabetes totaled $13,243 per person, compared with $2,560 for people without diabetes (Votey, Peters, 2005b). ADA research also found that: “In the United States alone, diabetes accounted for a loss of nearly 88 million disability days in 1997" (Schappert, 1999).
Patient Compliance
Outcomes, quality of life, and use of medical resources depend almost entirely on patient compliance, including following prescribed diet, exercising, infection prevention, and adhering to medication and glucose monitoring regimens. Improvements in glucose testing technology and medications have made glucose control possible for a greater number of diabetics. Still, the physical and psychological demands can be difficult (Polonsky, 1999). Patient noncompliance is the single largest cause of common diabetic complications, such as kidney failure, blindness, amputation, and heart disease (Arsham, 280-290). Any program that improves patient attitude and compliance will be extremely valuable and cost-effective. The Diabetes Clinical Control Trial clearly illustrated that diabetics maintaining excellent glycemic control greatly lower their risk of kidney failure, retinopathy, or amputation.
The Role of Relaxation, Hypnosis, and Imagery
Stress reduction is a vital part of diabetes management program. This is especially true in Type II diabetes, where stress reduction appears to lower blood glucose directly (Feinglos, Hastedt, Surwit, 1987; Surwit, van Tillburg, et al., 2002). The advantages of guided imagery, relaxation, hypnosis, biofeedback and in Type I stem largely from improved behaviors and compliance, although there is also some evidence of a direct effect (McGrady, Gerstenmaier, 1990; Ratner, Gross et al, 1990). Depression and anxiety worsen glycemic control both directly, and indirectly through behavior (McGrady, Horner, 1999). Relaxation and self-hypnosis (guided imagery) can fat least partially relieve depression and anxiety (Davidson, Farnbach, Richardson, 1978; Stetter, Walter, et al, 1994). Guided imagery tapes have also been shown to be effective in improving several areas of diabetes' self-care behavior (Wichowski, Kubsch, 1999).
More recently, researches illustrated that both biofeedback and relaxation significantly lowered blood glucose, A1C, and muscle tension, depression and anxiety (McGinnis, McGrady, et al, 2005).
References:
American Diabetes Association. Economic Consequences of Diabetes Mellitus in the U.S. in 1997. Diabetes Care. 1998 Feb;21(2):296-309.
Arsham, G, and Lowe G. Diabetes: A Guide to Living Well, 3rd Edition. Chronimed Publications. 1997.
Black SA. Diabetes, diversity, and disparity: what do we do with the evidence? Am J Public Health, 2002 Apr;92(4):543-8.
Bo S, Menato G, Bardelli C, Lezo A, Signorile A, Repetti E, Massobrio M, Pagano G. Low socioeconomic status as a risk factor for gestational diabetes. Diabetes Metab, 2002 Apr; 28(2):139-40.
Davidson, GP, Farnbach RW, Richardson BA. Self-hypnosis training in anxiety reduction. Aust Fam Physician, 1978 Jul;7(7) :905-10. The Diabetes Control and Complications Trial Research Group no authors given] The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977-86.
Endocrinology Health Guide. Type I Diabetes. University of Maryland Medical Center. 2004. http://www.umm.edu/endocrin/diabmel.htm Accessed January, 2006.
Feinglos, M.N., Hastedt, P., Surwit, R.S. (1987). Effects of relaxation therapy on patients with type I diabetes mellitus. Diabetes Care, Jan-Feb;10(1):72-5.
Hall MJ and Popovic JR. 1998 Summary: National Hospital Discharge Survey. Advance data from vital and health statistics; no 316. Hyattsville, Maryland: National Center for Health Statistics. 2000.
McGrady A, Gerstenmaier L. Effect of biofeedback assisted relaxation training on blood glucose levels in a type I insulin dependent diabetic. A case report. J Behav Ther Exp Psychiatry, 1990 Mar;21(1):69-75.
McGrady A, Horner J. Role of mood in outcome of biofeedback assisted relaxation therapy in insulin dependent diabetes mellitus. Appl Psychophysiol Biofeedback, 1999 Mar;24(1):79-88.
Polonsky W. Diabetes Burnout. American Diabetes Association.1999.
Ratner H, Gross L, Casas J, Castells S. A hypnotherapeutic approach to the improvement of compliance in adolescent diabetics. Am J Clin Hypn, 1990 Jan;32(3):154-9.
Schappert SM. Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments: United States, 1997. Vital Health Stat 13. 1999 Nov;(143):i-iv, 1-39. Stetter F., Walter, G, Zimmermann A, Zahres S, Straube ER. Ambulatory short-term therapy of anxiety patients with autogenic training and hypnosis. Results of treatment and 3 month follow-up. Psychother Psychosom Med Psychol, 1994 Jul;44(7) :226-34.
Surwit RS, van Tilburg MA, Zucker N, McCaskill CC, Parekh P, Feinglos MN, Edwards CL, Williams P, Lane JD. Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care, 2002 Jan;25(1):30-4.
Wichowski HC, Kubsch SM. Increasing diabetic self-care through guided imagery. Complement Ther Nurs Midwifery, 1999 Dec;5(6):159-63.
Votey SR, Peters AL. Diabetes Millitus, Type 1 – A Review. 2005a. August 4. http://www.emedicine.com/emerg/topic133.htm Accessed January, 2006. Votey SR, Peters AL. Diabetes Millitus, Type 2 – A Review. 2005b July 14. http://www.emedicine.com/emerg/topic134.htm Accessed January, 2006.
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