Breathe lightly & slowly, through your nose, using your diaphragm
Breathe lightly & slowly
Diabetics have an overactive sympathetic nervous system (fight or flight) and an under-active parasympathetic nervous system (rest and digest). This makes sense given that our bodies are under the constant stress of fluctuating blood sugars. And, you have probably seen that when people are stressed they often take faster and bigger breaths. The chronic, low-level stress of diabetes also causes chronic overbreathing, leading to many negative consequences.
One of the most important is the loss of carbon dioxide (CO2). Carbon dioxide plays a key role in getting oxygen into our tissues and organs. Specifically, CO2 loosens the bond between hemoglobin and oxygen (known as the Bohr effect); therefore, in the presence of CO2, oxygen is more readily released from the hemoglobin into organs and tissues. I think of CO2 as being to oxygen what insulin is to glucose. You can eat all the sugar you want, but without insulin, that glucose will accumulate in the blood and will not reach the tissues and organs where it is needed. By overbreathing, we exhale too much CO2, and the oxygen we inhale cannot be released into the tissues and organs where it is needed.
It seems counterintuitive, but with breathing, less is more.
This is important for diabetics: chronic tissue hypoxia is a large contributor to all diabetic complications. For example, tissue hypoxia has been shown to cause insulin resistance. By purposefully breathing lightly and slowly, we alleviate tissue hypoxia and improve our insulin sensitivity. For these reasons, you might notice the need for less insulin simply from breathing less.
Getting back to the nervous system, it has been shown that diabetics spend more time in a sympathetic state. The stress hormones produced in this sympathetic state increase the body’s endogenous production of glucose. By breathing lightly and slowly, we shift from a sympathetic state to a parasympathetic state, which reduces the glucose that your body produces naturally. This, paired with the improved insulin sensitivity, is where the magic happens.
“Our study supports the view that the intervention in the form of deep diaphragmatic breathing practice would improve the glycemic control and also decrease the cardiac autonomic impairment in IHD patients with diabetes mellitus.” - Kulur et al. (2009)
Finally, slow breathing has been shown to increase autonomic function, arterial function, and blood oxygen saturation in type 1 diabetic patients.
Through your nose
The nose warms, humidifies, and filters the air you breathe. The nasal cavity is also a warehouse for nitric oxide, a potent vasodilator that facilitates easier transfer of oxygen from the lungs into the blood. Evidence is also accumulating that inhaled nitric oxide plays a critical role in oxygenating the entire body. Lastly, the nose adds resistance to your breathing, which helps you slow down and reduce the volume of each breath.
“Man should no more breathe through his mouth than he would attempt to take food though his nose.” - Yogi Mamacharaka in Science of Breath.
Using your diaphragm
The last portion of Principle 1 is to activate the diaphragm, i.e., take a deep breath. However, I purposefully avoid using the word “deep” because most people associate taking a deep breath with taking a big breath. But, when you take a deep breath, you actually need less air. A true deep breath simply brings air into the lower lungs where the largest concentration of blood is (due to gravity), allowing more oxygen to get into your body. And, because of this improved gas exchange in the lungs, you actually need less air.
Practice Principle 1
From the above description of Principle 1, you can see that it is pretty simple. In fact, the goal is to eventually make it your natural way of breathing 24/7. However, when starting, it is helpful to devote time to practice until it becomes natural. Here are some of my favorite exercises:
Breathe Light - Sit comfortably in a chair with a straight back, or lie down. Inhale and exhale through your nose, and focus on bringing the air into your belly. Begin to slow down your breathing. Now, purposefully take in less air than you need. Bring a slight feeling of air hunger. Make the air hunger tolerable, but enough so that you would like to take a bigger breath. Try to maintain this slight feeling of air hunger throughout the practice. Start with 2 minutes of this practice, and gradually build up to 10-15 minute sessions. I personally do this practice for 15 minutes every morning after waking up.
Coherent Breathing - This involves breathing at a specific pace, between 4-6 breaths per minute, with equal time for the inhale and exhale. You can count the length of your inhales and exhales, or you can use an app to guide you. I use a free app called “Breathing Zone” and usually set it to 4.5 breaths per minute. However, start somewhere comfortable (6, 7, 8 + breaths per minute) and work your way down to the 4-6 breaths per minute zone over time.
Relaxation Breathing - This technique has been shown to reduce the glycemic response to an oral glucose tolerance test. To practice, inhale for 2 seconds, exhale for 1 second, inhale for 2 seconds, exhale for 2 seconds, inhale for 2 seconds, exhale for 3 seconds, and so on, until your exhale reaches 10 seconds. Then start over. By keeping your inhale at 2 seconds while your exhale gets progressively longer, you retain more CO2 and will likely begin to feel air hunger starting around the 6 second exhale. I commonly practice this technique at night when I’m laying in bed to go to sleep. Sometimes I fall asleep before I even complete one cycle!