Type 2 Diabetes: A Start Guide for Exercise

While dietary changes are typically the first lifestyle modification doctors recommend to people with diabetes, physical activity is also important. But how much physical activity should you do and what exercises are best? Here, experts answer those questions and offer guidance on how to exercise safely and effectively.

Most people know that exercise is good for them. But for people with type 2 diabetes, exercise has some unique benefits, including the following:

Lowers Blood Sugar Levels

“Any time you move, your muscles contract. When that happens, special doors on the surface of your cells open and help move sugar out of the bloodstream and into cells for energy, even when your cells are resistant to insulin,” says Samantha McKinney, RD, registered dietitian, certified personal trainer, and national manager of nutrition and weight loss at Life Time in the Minneapolis-St. Paul area.

Improves Insulin Sensitivity

Your pancreas naturally pumps out insulin — a hormone that regulates blood sugar. But, if you have type 2 diabetes, your body doesn’t respond to insulin as it should. Doctors call this insulin resistance. Physical activity, however, “improves your body’s sensitivity to insulin, which will help fight insulin resistance,” says Kimberly Gomer, RDN, a registered dietitian-nutrition in private practice in Florida.

Enhances Your Cardiovascular Health

Aids in Weight Management and May Aid in Weight Loss

Helps You Stick With Other Healthy Habits

Exercise releases feel-good endorphins, which can help you be more motivated — and mindful — of your day-to-day living with diabetes. “That can hold you personally accountable to other areas of your health,” says Akhil Shenoy, MD, endocrinologist and diabetes medical advisor at Aeroflow Diabetes in Houston. “For instance, regular exercise can help you avoid unhealthy eating choices.”

The two types of activities that people with diabetes should prioritize are aerobic (or “cardio”) exercise and resistance training. If time allows, flexibility and balance training can round out your fitness program.

Cardio and Aerobic Exercises

One of the most beneficial types of exercise for people with diabetes is aerobic, or cardiovascular, activity. With this type of activity, you’re elevating your heart rate for a certain length of time, perhaps even doing one high-intensity workout a week. Examples include swimming, walking, cycling, running, and hiking.

Which activities you choose is up to you, but the most important factor is that you enjoy them. “Consider activities you find fun so that you’ll stay engaged in regular exercise for life,” Dr. Shenoy says.

Strength Training

Building and maintaining muscle, the primary benefit of strength training (which some call resistance training), is crucial for everybody. “Think of your muscles like a currency of health,” McKinney says. “The more you have, the better. Not only does building muscle support your energy, it also reduces your risk of injury and falls, improves bone health, and can help manage your blood sugar.”

There are many strength training tools to help you build muscle, including resistance bands, free weights and weight machines. You can also use your own body weight, which is one of the easiest and most convenient ways to start strength training.

Flexibility and Balance Training

While more physical activity is a critical part of managing type 2 diabetes, there are precautions you should take to keep yourself safe, including:

• Consult with your healthcare provider: Light activities like walking are fine for most people with diabetes. But if you want to do something more demanding, or want to make sure exercise is okay for you, talk with your doctor to make sure there aren’t any exercises you should avoid.
• Monitor your blood sugar levels: “Exercise can dramatically drop blood sugar, so taking steps to monitor and regulate it is crucial with any exercise plan,” McKinney says. The ADA recommends checking your blood sugar before and after exercise.

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   For people who take insulin, the highest risk of developing hypoglycemia occurs 6 to 12 hours after exercising, according to Harvard Medical School.

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• Stay hydrated: “Dehydration can negatively affect blood glucose control,” McKinney says. While water can certainly keep you hydrated, you can also sip an electrolyte drink around the time of your workout, which she says can support hydration levels more efficiently than water alone. Look for options without sugars or artificial sweeteners.
• Eat before exercising: “Eating lower-fiber, easy-to digest carbohydrates paired with protein before you move can help slow blood sugar spikes and drops,” McKinney says. “For instance, try a rice cake with a thin layer of nut butter. She also recommends having a quick and reliable source of glucose on you during exercise in case your blood sugar dips. If so, consume 15 grams of fast-acting carbohydrates like a glucose tab or gel,” advises McKinney.
• Adjust medications if necessary: “Because exercise can lower your blood sugar, you may have to work with your doctor to adjust your medications, especially if you’re on insulin. If exercise is causing low blood sugar, consider lowering the dosage of medications rather than adding more carbohydrates to your diet,” Shenoy says.
• Wear medical identification: Wearing a medical bracelet noting that you have diabetes and whether you take insulin is critical if you experience hypoglycemia or a loss of consciousness.

Exercise and Diabetic Neuropathy

“With diabetic neuropathy comes tingling, numbness, and even pain. All of those symptoms, especially when they occur in your feet, can make exercising challenging. But that doesn’t mean you can’t exercise, as you’ll reap the same benefits as anybody with diabetes,” Shenoy says.

There are, though, risks with physical activity if you have neuropathy. “Most are related to potential injury from the impaired sensation,” McKinney says. That’s why she recommends reducing long walks or runs, as the repetitive nature combined with the weight-bearing nature may cause issues in your feet. Instead, choose lower-impact options like rowing, recumbent biking, swimming, or resistance training with machines.

“You should also check your feet daily for signs of swelling, wounds, or ulcers,” McKinney says. If you spot any of these, call your primary care physician.

Everybody is different, and what’s “enough” for one individual may be too much — or too little — for somebody else. That being said, though, there are guidelines for recommended amounts of physical activity if you have type 2 diabetes.

“Of course, doing that much is daunting for most individuals,” Gomer says. That’s why she recommends starting small with five minutes of walking and increasing by a minute at a time. Know, too, that daily activities like gardening and doing housework can count toward those moderate-intensity minutes.

• Getting more physically active through aerobic and resistance training exercises is crucial in managing type 2 diabetes and preventing further health issues.
• Although it can seem daunting to move more, start small — something is better than nothing, after all — and gradually build. You don’t even have to wait for the benefits because they occur as soon as you start moving, the biggest one being an increase in energy.