By Jacquelin Deatcher, APRN, BC, CDE
Diabetes self-management has evolved over the past few decades from relatively simple instructions to “avoid sugar” and take one’s medicines on time to a much more comprehensive system that includes exercise, stress reduction, and meal plans as well as medicines. Current diabetes self-management guidelines, such as those of the American Diabetes Association, reflect a more holistic style that addresses the needs of the whole person rather than isolated parts. Holistic principles that promote a more complete approach to wellness could enhance diabetes self-care efforts significantly.
Holistic medicine is not a new concept. Socrates knew that it was important to treat the body as a whole when he wrote, “For the part can never be well unless the whole is well.” An old Indian saying states that the body is like a house with four rooms: a physical, a mental, an emotional, and a spiritual room. To be a whole person, one must spend at least a little bit of time in each of these four rooms every day. For example, food and rest satisfy our physical needs; learning about the world and using what we learn enriches our minds; and validating and coping with our feelings meets our emotional needs. Our spiritual needs must also be addressed.
Spirituality can be defined as experiencing the presence of a power or force and experiencing a closeness to that presence. Spirituality may mean being involved with organized religion, taking time to contemplate one’s place in the ultimate order of things, or focusing on the things that give life meaning, such as one’s family or social group. No matter what one’s personal motivation for seeking it, spirituality can be seen as part of the journey toward becoming whole.
Diabetes care is coming to address the four areas of needs in one’s life. Insulin and diabetes medicines help the body. Diabetes educators teach people about blood glucose monitoring, meal plans, and exercise. Ideally, the health-care team also teaches people to manage stress or to recognize warning signs of depression to maintain emotional health. Recently, organized medicine has begun to address the spiritual aspect of self-care as well. Addressing each of these areas of our lives helps us to move closer to a holistic form of diabetes self-management.
Holistic health care seeks in part to enhance the body’s natural healing ability. Much attention has been focused on developing sophisticated drugs and learning healthy life choices, but enhancing the body’s natural healing ability hasn’t been as rigorously studied.
Recent research in the field of mind/body medicine, or psycho-neuroimmunology, though, has shown that the mind can and does have a profound effect on the body. Techniques such as the Relaxation Response and other forms of meditation, guided imagery, positive outlook, humor, hope, and even one’s beliefs can all affect medical outcomes.
Perhaps it was the growing acceptance of involving the mind in the health process that made it easier for mainstream scientists to begin to take a serious look at spirituality and prayer. Prayer can be defined as communication with God, the creator of life, the collective unconscious, or one’s higher self. Some studies have suggested that prayer can have an effect on both individuals who pray for themselves as well as on those who are prayed for by others (even without their knowledge). For example, in a study of patients in a cardiac intensive care unit, those who were prayed for (unbeknownst to them) by a group of community volunteers had about 10% fewer complications than those who were not prayed for by the volunteers.
Research at Duke University’s Center for the Study of Religion/Spirituality and Health has looked at “intrinsic religiosity,” which is defined as one’s beliefs rather than participation in organized religious activities. Those with higher levels of intrinsic religiosity had better survival rates after severe illness, less depression in older age, less disability and mortality when faced with chronic disease, and possibly stronger immune systems. These and other studies raised interesting questions about the effect of prayer on both medical outcomes and general wellness.
One particular method of using prayer was developed by Dr. John F. Rossiter-Thornton, a psychiatrist in private practice in Toronto, Canada. He developed a tool he called the prayer wheel (not to be confused with the revolving prayer wheels of Tibet) for use with his psychotherapy patients. (See this illustration.) The wheel is based on several distinct components of prayer, including giving thanks, singing of love, requesting protection and guidance, asking forgiveness for oneself and others, asking for needs, asking for inspiration, and surrendering to divine will. The suggested use of the wheel takes 40 minutes to allow at least five minutes for each component, including a “listen” segment in which one is encouraged to be receptive to any thoughts, images, or impressions that come to mind and to record them in a notebook. Use of the prayer wheel produced intriguing results for Dr. Rossiter-Thornton’s patients, including decreased anxiety, improved outlook, and improved family relationships.
One very small, unpublished study has looked at the possibility of enhancing diabetes self-management with the use of the prayer wheel. Nine study participants with Type 2 diabetes used the prayer wheel for three months in addition to their usual self-care. Glycosylated hemoglobin (HbA1c) values were measured both before and after this three-month period and compared with the HbA1c values of a similar group of nine people with Type 2 diabetes who were not involved in the study. Even though most of the participants reported that they used portions of the prayer wheel rather than the whole thing and that they used the prayer wheel anywhere from most days to occasionally but not every day, seven experienced a drop in HbA1c levels during the study period; this drop in HbA1c averaged 0.9%. The other two participants experienced an average increase of 0.4%. In the control group, five people experienced an average drop of 0.5% in HbA1c, and four people experienced an average increase in HbA1c of 0.8%. It should be noted that this study was conducted from October to January, a time of the year when common holiday behaviors often result in an increase in HbA1c values for many people. Although this study was very small, the results suggest that the use of prayer, when combined with other holistic approaches to diabetes self-management, may have beneficial effects on one’s HbA1c.
More research in the field of spirituality is necessary, of course. However, for those comfortable with incorporating prayer into the fabric of their daily lives, the use of prayer may be yet another resource to enhance diabetes self-management and therefore, general wellness.
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