Got diabetes? Exercise Helps to Keep it in Check

By: Rukhsar Jabbar. M.Sc. Physiotherapy. Freelance Health Writer. Medical review by: The DLHA Team

Elderly black couple brisk walking.

Highlights 

• When your blood glucose, commonly known as blood sugar, is too high, you are said to have diabetes.

• One of the most essential treatment modalities for diabetes mellitus is exercise.

• All diabetes clinical guidelines emphasize that lifestyle changes, including diet and exercise, are the foundation of diabetes care.

• Exercise training promotes better glucose management by improving insulin sensitivity and promoting glucose utilization.

• Exercise for diabetic care, may take the form of resistance training, aerobic training, or both.

Introduction

High blood glucose or blood sugar is associated with the disorder called diabetes mellitus. Glucose is the primary energy source your body relies on. It is produced within your body and also derived from the food you eat. The hormone insulin, secreted by the pancreas, allows glucose to enter your cells and be used as fuel. However, in diabetes, your body either produces little or no insulin (as in Type 1 diabetes) or produces insufficient insulin and/or fails to use it effectively (as in Type 2 diabetes). This causes high levels of glucose to remain in your bloodstream instead of entering your cells. Diabetes can damage your kidneys, nerves, heart, and eyes. It is also linked to an increased risk of certain cancers. [1]

If you already have diabetes, managing your condition and making healthy lifestyle choices can reduce your risk of related complications. Controlling your blood pressure, cholesterol, and blood sugar is crucial to prevent further health problems. [1]

One of the most effective treatments for diabetes mellitus is exercise. Regular physical activity improves blood sugar control, aids in weight management, and reduces the risk of heart disease with diabetes. By enhancing the body’s sensitivity to insulin, exercise helps maintain better blood sugar levels. Additionally, healthcare professionals play an essential role in educating patients about these benefits and encouraging regular physical activity. [2]

This article aims to help readers, especially those in Africa, understand how staying active can benefit people with diabetes. It will explain how regular exercise helps control blood sugar, improves the body's use of insulin, and lowers the chances of complications. It will also share practical tips to help diabetes patients incorporate physical activity into their daily routines for better health.

Understanding Diabetes

• Type 1 diabetes

Type 1 diabetes is usually diagnosed in childhood or young adulthood, but it can develop at any age. In this condition, the body produces little to no insulin because the immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. To maintain normal blood glucose levels, people with type 1 diabetes must take insulin every day. [1]

Know more about type1 diabetes. 

• Type 2 diabetes

Type 2 diabetes is the most common form of the disease. It occurs either because the body's cells are not using insulin effectively or because the pancreas is not producing enough insulin to maintain normal blood glucose levels.

If you have a family history of type 2 diabetes or risk factors such as being overweight or obese, your chances of developing the condition increase. However, by understanding these risk factors and adopting healthy lifestyle habits, such as maintaining or losing weight, you can help delay or even prevent type 2 diabetes. [1]

Know more about type 2 diabetes

How Does Lifestyle, Particularly Diet and Exercise, Affect Diabetes?

All diabetes clinical guidelines emphasize that lifestyle changes, including diet and exercise, are the foundation of diabetes care. Exercise can help manage blood sugar levels by improving insulin sensitivity and promoting glucose utilization. [3]

Lifestyle plays a crucial role in managing diabetes. On the other hand, a sedentary lifestyle that is devoid of physical activity and proper diet raises the odds of developing diabetes and related health problems.

If you are overweight or obese, losing weight can help you control your blood sugar, blood pressure, and cholesterol levels. Your healthcare provider can assist you in setting weight loss goals. A common goal for someone who is overweight or obese is to reduce body weight by 5 to 10 percent. For example, if you weigh 240 pounds, losing 12 to 24 pounds would be a reasonable target. In some cases, significant weight loss can lead to normal blood sugar levels, a condition known as "diabetes remission," where you can maintain normal blood sugar without medication.

If you have had diabetes for less than six years and are not using insulin, your chances of achieving diabetes remission are higher. However, even modest weight loss can improve your health. Reducing your daily calorie intake can lower blood sugar levels even before you see a noticeable weight reduction.

The first steps in weight loss typically involve cutting calories and engaging in regular exercise. [4]

Types of Exercise Beneficial for Managing Diabetes

Various types of physical activities are beneficial for diabetic patients.

1. Aerobic Exercises: Examples like walking, jogging, swimming, and cycling.

On most days of the week, aim for 30 to 60 minutes of moderate-intensity aerobic exercise. Start with a 10-minute warm-up and stretching session. Then, engage in 15 to 20 minutes of your preferred aerobic activity, such as walking, running, swimming, dancing, cycling, or rowing. 

Consistency is key—try to exercise at least three to five times a week. It's important to align your workouts with your mealtimes and medication schedules. Gradually increase the duration and intensity of your workouts based on your tolerance.

Your goal should be to achieve a total of 150 minutes of moderate-intensity aerobic exercise each week. [2] 

Talk to your healthcare professional before adding any exercise schedule into your routine.

2. Strength Training: Importance of building muscle to improve metabolism.

Low muscle strength and rapid loss of muscle strength and function are independent risk factors associated with diabetes. Resistance training benefits everyone by improving physical and mental well-being, increasing muscle mass, enhancing body composition, and boosting strength. It also positively impacts blood pressure, cholesterol levels, bone density, and heart health.

When combining resistance training and aerobic exercise in a single session, starting with resistance training tends to cause less hypoglycemia than starting with aerobic activity. For individuals with type 2 diabetes, resistance training offers significant benefits, including better blood pressure control, increased lean body mass, reduced fat mass, improved insulin sensitivity, and enhanced blood sugar management. [5]

3. Flexibility and Balance Exercises: Examples such as yoga and stretching, reduce the risk of falls and improve mobility.

Balance and flexibility exercises are especially important for older adults with diabetes. Limited joint mobility is common and can result from the buildup of advanced glycation end products, which are worsened by high blood sugar and occur naturally with aging. While stretching exercises improve flexibility and range of motion around joints, they have little effect on blood sugar control.

Balance training is beneficial even for those with peripheral neuropathy, as it can reduce the risk of falls by improving gait and balance. Group exercise programs, such as Tai Chi and resistance training, have been shown to decrease the likelihood of falls by 28% to 29%. 

Although the benefits of alternative exercises like yoga and Tai Chi are not as well-established, yoga may help people with type 2 diabetes by improving body composition, lipid levels, and blood sugar management. [5]

4. Daily Activities: Simple actions like taking the stairs, gardening, or dancing.

Frequent exercise has health benefits that go beyond increased cardiovascular fitness. These include decrease in low-grade inflammation, improved vascular function, weight loss, and improved blood lipids, insulin signaling, and glucose regulation. [6]

Tips for Incorporating Exercise into Yours Daily Life as a Diabetic

• You can take short walks in between periods of sitting, or you can do easy resistance training for three minutes every thirty minutes for eight hours.

• More than structured exercise, standing (2.5 h/day) and light-intensity walking (2.2 h/day) every 30 minutes can replace sitting time and improve 24-hour glucose levels.

• A good way to lower post-dinner glucose levels is to undertake stair climbing sessions.

• In individuals with impaired glucose tolerance, brief 5-minute breaks spaced out every hour for 12 hours substantially reduced glucose and insulin levels compared to one hour of continuous, moderate-intensity exercise at the start of the day.

• Moderate intermittent “doses" of physical activities reduce post-meal glucose and insulin levels, slightly more so than moderate continuous exercise. The effects are stronger in individuals with higher BMIs and insulin resistance. [7]

• For older persons with diabetes, flexibility and balance training should be done two to three times per week. Depending on personal preferences, incorporating yoga and tai chi can help improve flexibility, muscle strength, and balance.

• Supervised training is preferable to unsupervised training if you want to maximise the health advantages of physical exercise programs. [5]

Precautions and Safety Tips

General guidelines for exercise routines for individuals with diabetes mellitus:

• Drink plenty of water before, during, and after exercise

• Keep track of your blood sugar levels before, during, and following exercise

• If your blood sugar is less than 100 mg/dL then you should take an orange juice or glucose pills. The suggested amount of easily absorbed carbohydrates to consume 15 to 30 minutes before exercise is 15 to 30 grams. Blood glucose monitoring during exercise may indicate that more food consumption is necessary

• If you have a significantly high blood sugar level of more than 250 mg/dl, you should refrain from vigorous exercise

• People with type 2 diabetes who are not receiving insulin or oral hypoglycemics rarely experience hypoglycemia. It is not necessary to consume additional carbohydrates

• Use insulin 60 to 90 minutes before exercise, and inject it into a different site than the muscle you intend to work out, to avoid excessive insulin absorption. For instance, when exercising on a bicycle, inject into the arms; when exercising with both arms and legs, inject into the belly. [2]

Conclusion 

When a patient receives a type 2 diabetes diagnosis, exercise is usually one of the first recommended management techniques. Exercise is a crucial part of any diabetes and obesity prevention and lifestyle intervention program, along with food and behavior modification. Exercise training promotes better glucose management, whether it takes the form of resistance training, aerobic training, or both. In addition to being highly time-efficient, high-intensity interval training is also beneficial. The sustainability of exercise recommendations for patients remains elusive, although exercise is well-established to be effective, scalable, and affordable for the prevention and management of type 2 diabetes. [6]

 

References:

1. National Institute of Diabetes and Digestive and Kidney Diseases [Internet]. What is diabetes? Last reviewed 2023 April. [Cited 2024 Aug 19]. Available from here.

2. Borhade MB, Singh S. Diabetes and exercise. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [Last update 2022 Sept. 5]. Cited 2024 Aug 19. Available from here.

3. Zahalka SJ, Abushamat LA, Scalzo RL, et al. The Role of Exercise in Diabetes. [Updated 2023 Jan 6]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. [Cited 2024 Aug 19]. Available from here.

4. Delahanty LM. Type 2 Diabetes and Diet (Beyond the Basics). Uptodate [Internet]. Last update 2024 March 4. [Cited 2024 Aug 19]. Available from here.

5. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016 Nov;39(11):2065-2079. doi: 10.2337/dc16-1728. Available from here.  

6. Kirwan JP, Sacks J, Nieuwoudt S. The essential role of exercise in the management of type 2 diabetes. Cleve Clin J Med. 2017 Jul;84(7 Suppl 1):S15-S21. doi: 10.3949/ccjm.84.s1.03. Available from here.

7. Kanaley JA, Colberg SR, Corcoran MH, Malin SK, Rodriguez NR, Crespo CJ, Kirwan JP, Zierath JR. Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine. Med Sci Sports Exerc. 2022 Feb 1;54(2):353-368. doi: 10.1249/MSS.0000000000002800. Available from here.

Related:

Type 1 Diabetes Mellitus: An Explainer for Africans

Type 2 Diabetes: What Africans Need to Know

Management of type 2 diabetes in Nigeria

Does exercise promote general health?

Published: September 23, 2024

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