This is mainly intended to health professionals & diabetic patients, requesting a change in view of 'seeing beyond insulin and insulin resistance' to treat diabetes. A MUST read!

1. An Alternate Approach To
Diabetes!!
Viewing Diabetes with fresh pair of
Eyes

2. YOGA - In treating Diabetes and its
Complications

3. Yoga helps in…
-
• Genetic
- X (No evidence available)
• Insulin Resistance √
• Insulin Production √
• Diabetic √
Complications
• Body weight √
• Stress √
• Lipid Profile √

4. Complications of Diabetes
& Yoga

5. Neuropathy
• Increase in Nerve conduction velocity
(Malhotra et al, 2002)
• In the control group, who were continuing
conventional medicine, the nerve conduction
velocity deteriorated.

6. Evoked Reaction Potential (ERP)
• Increase in the Cognitive brain function in
T2DM (Kyizom et al, 2010)
• ERP is a measure of the cognitive brain
function.
• Yoga seem to reverse the decline in cognition
in type 2 diabetes.

7. Drawbacks

8. Complex Nature & Flexibility
(Myth)
Source : Google Images

9. Age factor
• South Asian getting T2DM around 54.6 years
(DAWN Studies, 2005)
• And, united kingdom the mean age being 64.1
years (DAWN studies, 2005)

10. You can’t expect…
Source : Google Images

11. Other drawbacks...
• Lack of blinded randomised controlled trials
• Scoring very low in Jadad Score (Jadad, 1996)
• Which proved high level of Bias
• Bias of two extremes (Skoro-kondza et
al, 2009)

12. Mechanism

13. • Thus, Yoga proved efficacious in almost all the
factors associated with diabetes (Except
genetic factor)
But, instead of concluding that yoga is effective
for type 2 diabetes...

14. It is worth considering…
Mechanism/ the pathway through which yoga
acts
So that, we can design a much better and
holistic way to deal with diabetes, in the same
way as yoga is helping.

15. Manjunatha et al, 2004
• Tested the hypothesis of whether twisting
helps in Diabetes
He Found:
• Effects are not all about twisting and
squeezing insulin out of pancreas
• β cell sensitivity to glucose was increased after
doing yoga.
• In other words, yoga activated Glucose
Transporter 2 (GLUT2).

16. Questions
• Could the GLUT2 receptor activation in a more
effective way be the answer to treat, or even
CURE diabetes?!
• Are there any treatment modes or drugs that
specifically targets on GLUT2 ?!
• Has there been enough limelight on GLUT2
receptors or on increasing glucose sensitivity
in the β cells?
NO...

17. WHY…..?!
• Answer for this big question of WHY is….
-Because of our ‘narrow vision’

18. Narrow Vision
Insulin &
Insulin
Resistance
Seeing through the pipe
and seeing only ‘Insulin & Insulin resistance’

19. Evidence free zone
You are about to
enter the
‘Evidence- free’ zone

20. Other targets
Apart from Insulin, there are other hormones
that influence in Diabetes like…
Glucagon Like Peptide (GLP)
Gastric Inhibitory Polypeptide (GIP)
Dipeptidyl peptidase inhibitors (DPP-4)
Testosterone
Leptin
‘Glucagon (Hyperlink)

21. Other Targets…
Apart from Insulin resistance and
Pancreas, there are other organs to target…
 Pituitary & Hypothalamus- Bromocriptine
(sympatholytic & dopamine agonist)
 Liver – Main organ in carbohydrate
metabolism
 Kidney – Phlorizine (SGLT 1 & SGLT 2 inhibitor)

22. Other Hormones:
•Glucagon Like Peptide (GLP)
•Gastric Inhibitory Polypeptide
(GIP)
•Dipeptidyl peptidase inhibitors
Liver (DPP-4)
•Testosterone
•Leptin
•‘Glucagon’ ∞
Phlorizine
–SGLT1 &
SGLT2 inhibitor
Bromocriptine –
sympatholytic &
dopamine
agonist

23. Vitamin D and Diabetes Mellitus (DM)
• Some association found between Vitamin D
and DM
• Vitamin D was found less in Diabetes Mellitus
patients
• So, they concluded saying, Vitamin D is the
cause of DM (Mathieu et al, 2004)

24. If…
• Vitamin D is the cause of Type 2
diabetes, then South Asians having sunlight
almost 12 months a year should have at least
some advantage over type 2 Diabetes
• But, it is not the case.
• Because, it is not as simple as ‘sunlight hitting
skin & getting converted to vitamin D’

25. Actual process is
Vitamin D3 in
Skin(Prohormone)
25-hydroxy D3
(Liver)
1,25 – dihydroxy
D3 (Kidney)
Active Vitamin D

26. • It is a known fact that, in type 2 diabetes liver
& kidney are the main organs to be damaged.
• There are high chances that the affected
organs in the diabetes prone individual fail to
produce Vitamin D from sunlight

27. – So... Low levels of Vitamin D could not only be a
cause but also be a result of diabetes.

28. Glucagon
• Study done UT South western Medical centre
• Young Lee, the lead author of the paper concluded
saying, ‘This means that there is some other mechanism
than insulin that is working to let the sugar be absorbed into
the cells for use as fuel’. (so, insuin resistance has got nothing to do with
insulin?!)
• Researcher Roger Unger in the article concluded that this
result means Insulin may not be the preferred treatment for
type 1 diabetes in the future, as insulin injections are not an
accurate method for controlling blood sugar

29. It is time to...
Open our eyes
Wider

30. • 90 years after the discovery of Insulin by
Banting and Best
• More than 100 years since associating
pancreas with DM and
• With more and more new class and new
generation of drugs coming in and going out

31. Still...
DM can only be controlled and not cured?!!!
Of course,
With an excuse that Diabetes is not a disease
and so, it cannot be cured

32. • It cannot be cured not because it is a
metabolic disorder, but because.....
Insulin &
Insulin
Resistance

33. • Perhaps,
Its time to view ‘Diabetes Mellitus’ with fresh
pair of eyes!
It is time to think...

34. Diabetes Tree
• Are we busy cutting the branches, without bothering about the
roots...?!
• Or, in fact without even knowing what and where the roots
are.....?!

35. Conclusion
• Considering the valuable comment made by
the researchers Roger Unger and Young Lee...
• And, with a tint of uncertainty in the cause &
effect relations of major influential factors...
• And, if Insulin and treating insulin resistance
not being the only modes of treating
diabetes....
(Glucagon, GIP, GLP, DPP-4 inhibitor, SGLT inhibitors &
hypothalamus, kidneys being the other modes of treatment)

36. Then….
Insulin or the Insulin resistance
MIGHT only be the effect, and not the
cause of Diabetes mellitus(DM).

37. Thank you

38. Earth is not flat....!
- Pythagoras

39. Dr. V. VENUGOPAL
B.N.Y.S, F.C.R, MSc (DIABETES)
YOGA & NATUROPAHY COSULTANT
Diabetes Specialist &
PREVENTIVE CARDIOLOGIST