Exercise and Type 2 Diabetes: How Moving Your Body Helps Control Blood Sugar
If you or someone you love has ever been diagnosed with Type 2 Diabetes, you have probably heard this advice from your doctors again and again: clean your diet, do exercise and take your medication. But it really does feel like vague advice. What kind of exercise? How can I clean up my diet?
The truth is, regular movement might be one of the most powerful tools we have to manage blood sugar, and in this post I will break down why, using plain language.
Firstly, what is Type 2 Diabetes?
When you eat, your body breaks down food into its most basic molecules to be absorbed. Protein source foods are broken down into amino acids; fat source foods are broken down into fatty acids, and carbohydrates are broken down into glucose.
To absorb glucose, there is a hormone called insulin that acts as a bouncer at a pub. When glucose calls at the door, insulin calls to the cell and says, “Hey, there is someone at the door, let them in”, and so the cell lets glucose pass inside. When blood glucose levels are consistently high, cells can’t hear the call of insulin anymore to let glucose pass, and so glucose stays in your blood. This is called insulin resistance. This can lead to an excess of sugar in the blood, which can damage blood vessels, nerves and even organs if it is not managed well.
Why can exercise help in Type 2 Diabetes?
Exercise is a powerful tool to manage type 2 diabetes. When you work out your muscles, your muscle cells can take up glucose on their own. They don’t need insulin to work. This way, your body pulls glucose out of the bloodstream to burn it as an energy source, and so, the sugar level decreases (Amanat et al., 2020; Magkos et al., 2020).
This is when science makes things interesting. You would guess that that is wonderful, but what happens when I stop exercising? This will stop, and my blood sugar levels will increase again. Well, a consensus from the American College of Sports Medicine (ACSM) has confirmed that regular aerobic exercise (walking, jogging, swimming, cycling and others) improves long-term blood sugar management in people that has Type 2 Diabetes (Kanaley et al., 2022). Doctors track this with a test called HbA1c; it is like a “report card” for your sugar control that, instead of tracking it with a single-day snapshot, looks at it over the span of three months. In this study, patients who performed regular aerobic exercise decreased their blood sugar levels and lowered their blood pressure by 0.5 to 0.7 percentage points. An improvement that could match the results of some medications.
What kind of exercise works best to reduce sugar in blood?
A review from 32 different studies found that after regular exercise, almost all studies reported decreases in HbA1c, fasting blood glucose, body mass index and waist circumference (Shah et al., 2021). On average, the patients exercised for about 45 minutes per session, a little over three days per week, for around 22 weeks. This was a realistic and sustainable routine, not an extreme one.
It is easy to assume that exercise for Type 2 Diabetes could mean aerobic exercise or cardio alone, but that is far from the truth. According to the ACSM consensus statement, resistance training (lifting weights, using resistance bands or using your own body weight), resulted in 10 to 15% increase in strength, bone density and improvements in blood pressure, blood lipid levels (fats), muscle mass and insulin sensitivity (Kanaley et al., 2022). This means that by doing resistance training, the body was able to reduce this insulin resistance, allowing the cells to take up glucose again.
But what happens when both kinds of exercise are combined? In a randomised trial, it was found that a training program of combined aerobic and resistance exercise led to a bigger drop in HbA1c rather than just aerobic or resistance training alone (Syeda et al., 2023).
Small movements throughout the day add up
Different research papers reviewed by the ACSM found that interrupting prolonged sitting with light walking, or some simple resistance activities for just three minutes every half hour, reduced blood sugar and insulin resistance (Kanaley et al., 2022). Meaning that even if it is just a little, walking throughout the day or doing a small exercise while sitting at work can help you reduce your blood sugar. A very important feat for those of us who are very busy and sometimes don’t find the time to exercise.
How much exercise is recommended?
Okay, so, we know now what exercise is best for Type 2 Diabetes. We know what are the benefits that come with it. Not just to reduce blood sugar, but also to reduce other conditions that some times come with Type 2 Diabetes, like hypertension (see our blog post on hypertension and exercise here) and other risk factors. Well, now lets take a look at how much exercise should we do. What is the sweet spot to reduce diabetes? The official guidelines summarised by the ACSM and the World Health Organisation (WHO) aim for 150 to 300 minutes of moderate-intensity exercise combining both aerobic and resistance training or 75 to 150 minutes of vigorous activity (Kanaley et al., 2022; Amanat et al., 2020). This may sound like a lot, but it is roughly 30 minutes per day for five days a week.
A few safety notes
Exercise is safe and beneficial for everyone who practises it, especially people with Type 2 Diabetes. But there are a few precautions that are worth knowing (Kanaley et al., 2022; Ambelu & Teferi, 2023):
First of all, and before starting to do any exercise, you should get a clearance from your GP or doctor. They know what is best for you, and they will know whether you can practice exercise or not.
Secondly, when using insulin or certain other diabetes medications combined with exercise, occasionally can cause the blood sugar to drop too low. It can cause dizziness, and it is worth discussing the dosage with your doctor if this happens, as it may need to get revalued.
Very important: if your blood sugar is very high before exercising (13.9 mmol/L or more) don’t exercise for the day, as it may be dangerous. Make sure you stay hydrated.
As you have seen, whether it is a brisk walk, a couple of strength sessions, or even just short burst of exercise throughout the day or week, the evidence is clear. Movement and exercise is one of the most effective and accessible tools to manage Type 2 Diabetes. It works alongside medication and also nutrition, not instead of them, unless recommended by the doctor or GP.
Sometimes, making this changes on your own can feel overwhelming. It is hard to figure out the right type of exercise and the amount required for oneself. That is exactly why I help clients at ROPE AU. If you want personalised guidance to get started safely and stick with it, book a 15-minute free consultation or send me a message on WhatsApp. I’d love to help you take the next step. And if you are not there yet, please download this free sample of an exercise routine especially crafted to tackle Type 2 Diabetes.
Bibliography
Amanat, S., Ghahri, S., Dianatinasab, A., Fararouei, M., & Dianatinasab, M. (2020). Exercise and Type 2 Diabetes. In Physical Exercise for Human Health (Advances in Experimental Medicine and Biology, Vol. 1228, pp. 91–105). Springer. https://link.springer.com/chapter/10.1007/978-981-15-1792-1_6
Kanaley, J. A., Colberg, S. R., Corcoran, M. H., Malin, S. K., Rodriguez, N. R., Crespo, C. J., Kirwan, J. P., & Zierath, J. R. (2022). Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine. Medicine & Science in Sports & Exercise, 54(2), 353–368. https://pmc.ncbi.nlm.nih.gov/articles/PMC8802999/
Syeda, U. S. A., Battillo, D., Visaria, A., & Malin, S. K. (2023). The importance of exercise for glycemic control in type 2 diabetes. American Journal of Medicine Open, 9, 100031. https://www.sciencedirect.com/science/article/pii/S2667036423000018
Magkos, F., Hjorth, M. F., & Astrup, A. (2020). Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nature Reviews Endocrinology, 16(10), 545–555. https://www.nature.com/articles/s41574-020-0381-5
Shah, S. Z. A., Karam, J. A., Zeb, A., Ullah, R., Shah, A., Ul Haq, I., Ali, I., Darain, H., & Chen, H. (2021). Movement is Improvement: The Therapeutic Effects of Exercise and General Physical Activity on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Therapy, 12(3), 707–732. https://link.springer.com/article/10.1007/s13300-021-01005-1
Ambelu, T., & Teferi, G. (2023). The impact of exercise modalities on blood glucose, blood pressure and body composition in patients with type 2 diabetes mellitus. BMC Sports Science, Medicine and Rehabilitation, 15, Article 153. https://link.springer.com/article/10.1186/s13102-023-00762-9
