Exercise and Diabetes
The importance of exercise when you have diabetes.
- Total Diabetes Wellness
- Updated on February 18, 2024
- Science Based
Benefits of Exercise for Diabetes | Exercise and Diabetes | The Importance of Movement | Types of Exercise – Aerobic vs. Anaerobic | A New Paradigm | How Do You Start an Exercise Program? | Establishing a Fitness Program | Exercise Equipment and Fitness Items | Recording Your Progress | A Well Rounded Exercise Program | Tips to Consider for Your Exercise Program | The Bottom Line
For many people, starting an exercise program is daunting. Even if you really want to exercise and be active, you may not know where to start or how to safely exercise with diabetes. You might have a sedentary job and feel like you don’t have enough time in the day to exercise. You may have tried an exercise program in the past, had a few good days, and ended up getting injured or extremely sore and given up.
Total Diabetes Wellness will provide you with information and a plan to help you get moving and on the road to living an active lifestyle. In doing so, you will see gains in your diabetes maintenance and your overall health and wellness. Learn the best strategies to get active while changing the way you view exercise.
Benefits of Exercise for Diabetes
Exercise has a positive impact on controlling and maintaining a healthy blood glucose level. Exercise is critical for creating and maintaining a healthy lifestyle. Benefits of exercise, specific to people with diabetes, include:
- Lower insulin resistance (the cause of type 2 diabetes)
- Lower blood sugar levels and more control of blood sugar levels
- Improved balance and reduced chance of injury
- Lower risk of heart disease
- Lower risk of nerve damage
Other benefits of exercise that benefit everyone are:
- Increased life expectancy
- Weight loss
- Maintained healthy body weight
- Better sleep
- Happier feelings
- Improved memory and mental health
- Lowered LDL (bad cholesterol) and raised HDL (good cholesterol)
- Help to quit smoking
- Reduced risk of some cancers
- Improved sexual health
According to the American Diabetes Association, “physical activity can lower your blood sugar up to 24 hours or more after your workout by making your body more sensitive to insulin.”
This article will educate you on the fundamentals of exercising with diabetes, specific cautions, and what to look for in an exercise program.
Our personal trainers and diabetes movement experts have developed exercise programs offered through Total Diabetes Wellness. Our exercise programs are a great place to get started working towards your fitness goals. Learn more about our exercise programs here.
Exercise and Diabetes
Exercising while having diabetes must be done with caution and preparation. Exercise can both raise and lower your blood sugar to dangerous levels (hypoglycemia and hyperglycemia).
Always discuss exercise with your doctor BEFORE starting any kind of exercise program. This is especially important if you are on medications. Full disclaimer here.
Although exercise can significantly improve your blood sugar maintenance, Total Diabetes Wellness recommends that you put exercise on hold until you meet these conditions:
- You have met with your doctor to discuss the possible risk and health implications of exercise.
- Your blood sugar is under 250 mg/dL (13.9 mmol/L) and over 100 mg/dL (5.6 mmol/L).
- You have created and implemented a diet and sleep schedule to help control your blood sugar levels. (See our guides on DIET and SLEEP to get started!)
- You have a good sense of balance (diabetes can cause nerve damage that affects balance).
- You are adequately prepared and have a plan.
If you experience any of these symptoms, stop exercising immediately:
- Shaky
- Weak
- Dizzy
- Confused
- Blood sugar of 70 mg/dL (3.9 mmol/L) or lower. According to Mayo Clinic, if this happens, consume 15 grams of fast-acting carbohydrates. Check your blood sugar every 15 minutes, and do not resume exercise until your blood sugar is over 70 mg/dL (3.9 mmol/L). Glucose tablets are an excellent option for fast-acting carbohydrates.
People with diabetes taking medication must be careful during exercise and closely monitor blood sugar levels while exercising.
A Plan to Start Exercising
Here is an outline we recommend you follow:
- Focus first on your diet and sleep schedule. Proper nutrition and sleep will help get your blood sugar levels in a safe range for exercise.
- Consult your doctor and let them know your intentions so they can provide you with appropriate accommodations if needed.
- Concentrate on movement first and exercise later. Movement includes your daily steps, not sitting or lying down for too long, and developing a more active lifestyle.
- Stay safe! Don’t take unnecessary risks. Focus on flexibility, stability (balance), and mobility. Your main goal is to avoid injury and to be safe.
- Small gains are the key. Most of us are not elite athletes, so there is no need to train like one. For example, it is better to do 1 push-up at 5 different times each day for a week (35 push-ups for the week) than to try and do 10 push-ups in a row, get injured, and not be able to do anymore for the rest of the week (10 push-ups for the week).
Overall, we recommend you figure out your diet and sleep schedule before exercising. Once those two items are part of your routine, we suggest you work on increasing your movement. Finally, focus your exercise program on becoming more flexible, stable, and mobile while emphasizing your daily steps. Once you develop good habits and have a solid base, we recommend adding some strength and cardio exercises to your fitness program. This approach will help prevent injury and allow you to make safe and consistent gains.
The Importance of Movement
We recommend focusing on movement before starting an exercise program.
Tracking your daily steps is one of the easiest ways to track your movement. We encourage you to get either a pedometer or a fitness watch to track steps. Some phone apps will also track steps but may require the phone to be in your pocket to do so.
Once you have your device, wear it for a few days without changing anything in your routine to figure out how many steps you’re currently getting. Your goal should be to increase your daily steps as much as possible, eventually up to around 10,000 steps a day. Don’t let this be a daunting goal; you don’t need to reach 10,000 steps tomorrow or even next week, or next month.
Spontaneous Physical Activity (SPA)
There are many other ways to increase your daily steps and movement aside from going for a walk. Spontaneous physical activity (SPA) is physical activity not motivated by a rewarding goal. Instead, SPA should be thought of as all physical activity behavior that emanates from an unconscious drive for movement. Examples of spontaneous physical activity include:
- Take the stairs instead of the elevator or escalator
- Pace or stand while talking on the phone instead of sitting
- Park at the far end of the parking lot
- Walk or bike instead of drive
- Wash your car by hand
- Work in the garden, rake leaves, outside yard work
- Housework and cleaning
- Walk the dog
- Play with your kids, grandkids, or pets
- Stand up and move around often
- When watching TV, get up and move during commercials. If there aren’t commercials, set an alarm on your phone for 20 minutes, and every time it dings, get up and move around for a couple of minutes.
- Limit your TV, home computer, phone, and gaming to 2 hours per day. If this is too big of a goal at first, start by lowering your screen time by 15 or 30-minute increments.
The goal for spontaneous physical activity should be to increase your movement all day long. Say, for example, you’re a runner, and your morning jog each gets you over 10,000 steps. It still wouldn’t be healthy for you to spend the rest of the day extremely sedentary even though you already hit your step goal.
Benefits of Movement
Movement all day long helps improve blood sugar and also helps boost your metabolism. Other health benefits of spontaneous physical activity are:
- Prevent or delay the effects of chronic disease
- Feel better mentally and physically
- Decrease stress, anxiety, and depression
- Help control weight
- Build and maintain healthy bones, muscles, and joints
- Improve strength
- Increase balance and reduce the risk of falling
- Improve sleep
As you can see, it’s not important how you’re moving to increase your daily steps. If your schedule is too busy to fit in a walk every day, focus instead on increasing your movement in smaller intervals. You’ll be pleasantly surprised to see how quickly movement through spontaneous physical activity adds up in your daily step count.
Once you have developed a more active lifestyle, exercise can safely become a part of your day.
There are two types of exercise: aerobic (with air) exercise and anaerobic (without air) exercise. As with anything in life, a healthy balance is the best approach since both types of exercise offer different and unique benefits.
Aerobic Exercise
Anaerobic Exercise
Anaerobic exercises typically involve exercises that last less than two minutes. Most people refer to this as burst workouts since they are usually done in short energy bursts with rest periods in between. The intensity is at a level where the body cannot produce enough oxygen to continue the exercise for more than two minutes. Examples include HIIT (high-intensity interval training), weight training, calisthenics, plyometrics, or sprinting. Anaerobic exercise is excellent for helping with weight loss, increasing power and strength, boosting metabolism, fighting depression, protecting joints, preventing injuries, boosting energy, and strengthening bones to help decrease your risk of osteoporosis.
It is important to realize that someone cycling could be doing either aerobic or anaerobic exercise. The intensity determines in which category the activity falls, not the activity itself. Total Diabetes Wellness uses a combination of these two types of exercise methods to provide a balance for your health.
A New Paradigm
It’s Not What You Do, But Who You Are
Too many people focus on what to do instead of who to become. For example, suppose your goal is to run a ten-minute mile by the end of the calendar year. Make sure you frame your goal correctly. Don’t think of it as “I’m going out for a run.” In this mindset, you are focused on the act of going out for a run. Instead, frame your goal as, “Who do I want to become?” The answer is, of course, “I am a runner.” By changing the focus from “what” you are doing to “who” you want to become, you can break down some barriers that prevent you from achieving your goals. This mindset will also help keep you motivated and reduce or eliminate injury.
Exercise should not be a burden but rather something you look forward to each day. It is important to do things that you enjoy so that everything isn’t just another hard workout. For example, if you want to get in running shape but don’t like to run, you could do other aerobic exercises to help build stamina, such as cycling, swimming, rollerblading, etc. You could work some anaerobic exercise into your schedule, by getting some friends together to play soccer or ultimate frisbee.
If you want to get more steps in by walking, you could play a game such as frisbee golf. If you like to dance, pick up a dance class or play Just Dance on your gaming system. Perhaps you haven’t picked up a basketball in years. Get yourself an outdoor hoop and start shooting some hoops. Join a class so you have people to help motivate you and can enjoy interaction while working out if that’s something that gets you excited. Find something you enjoy doing that gets you outside or gets you moving, and incorporate that into your exercise program.
Work Smarter, Not Harder.
People who are efficient with their time are often very successful in most aspects of their lives. Exercise is no different. Many people have television shows they watch each day. Getting a stationary bike or treadmill so you can move while you watch your favorite programs is a great idea. If you want to work on body strength through resistance training, look at doing compound exercises to work out multiple muscle groups with just one exercise. It’s important that you look at this time as an opportunity to take care of yourself, rather than think of it as a burden or something that takes away from your day.
You Do You.
Here are some things to think about as you start to become a more active person:
- Be safe. You are no longer a high school or college athlete pushing yourself through fatigue. As an adult who may be out of shape, pushing yourself too hard will often lead to injury and have serious consequences.
- Expect to fail. Expect bad days. Focus on the gains you made for the day rather than what you didn’t get accomplished. Remember, it’s who you are becoming, not what you do.
- It is often better to exercise earlier in the day before you get too tired or other items become more important, and you run out of time throughout the day.
- Appreciate the challenge and enjoy the growth.
- Cut out the excuses by just getting started each day. Just lace up the shoes, push play on that workout video or get in the car and go to the rec center. Just start and do what you can, every day, every time.
- Have fun! Remember that the more you exercise, the easier it eventually becomes. Choose things you enjoy, so working out is something you look forward to doing.
How Do You Start an Exercise Program?
There are several things you need to consider before getting started. Let’s take a look at an example for someone who has type 2 diabetes.
Step 1: Schedule an Appointment With Your Doctor.
Step 2: Determine What Kind of Person You Would Like to Become.
Do this for you. Do you want to become a runner? Perhaps you want to become someone who works out several times a week and wants to improve your strength and mobility. Figure out what you want to do, and then start to look at your options to obtain that lifestyle. Make sure you don’t get injured or push yourself too hard.
Step 3: Determine Your Starting Fitness Level.
If you want to become a runner, what is your current level of being a runner? Can you run around the block? Can you run a mile? If so, what pace is your mile? Are you prone to injury? Are you overweight? What challenges will you face to become that person you want to become? These are all things you need to think about to either create your own appropriate plan or have someone help you make that plan.
Step 4: Be Prepared.
If you are going to run or walk long distances, then you need supportive shoes. Do you need to be concerned about supination or pronation with your shoes? If you don’t know what these things are, then don’t worry. Total Diabetes Wellness will help you get the appropriate apparel and equipment to help you get into shape and reduce or eliminate injury. Perhaps you want to do some resistance training, and purchasing some resistance bands will be required for your workout. If you’re going to swim, make sure you have a pair of goggles and perhaps a swimming watch to track your progress.
Step 5: Take it Slow.
As a person with diabetes, there are some special considerations you should have in your plan. Some examples include flexibility, stability, and injury prevention. Total Diabetes Wellness recommends that you have a warm-up and a cool-down in each of your workout sessions. We also recommend that you have several movements in your workout routine. Include yoga poses, dynamic and static stretching, cardio and strength exercises, physical therapy exercises, compound movements for efficiency, and anything else you’re interested in trying. Being well-rounded is more important than being specialized since we aren’t training to compete in a specific sport or competition.
Step 6: Create Small and Achievable Goals.
Create small but important habits. Focus on all of these little things instead of the outcome. If you do the little things, then significant changes are bound to happen. Remember that these changes occur over time, and there is no rush. Most importantly, be safe!
Step 7: Not Sure Where to Start?
If you have no idea where to start, let Total Diabetes Wellness help you out. We will support you with a well-rounded workout program to support your needs.
Establishing a Fitness Program
What do You Want to Accomplish?
There are a couple of things you will want to think about as you prepare your fitness program. For example, who do you want to become, and what are the main goals you want to achieve? Think about the overall agenda before working on creating a specific plan. Use this to help determine how to tailor your program.
Parts of an Exercise Program
Make sure to incorporate an adequate warm-up and a cool-down in your program. Use compound exercises if you want to get the most out of your time. Make sure to include flexibility, mobility, and stability in your program to help avoid injuries. You can use dynamic stretching near the beginning to help you warm-up and static stretching near the end to cool down. Use your goals (weight loss, get in shape, gain muscle, etc.) to help determine what exercises to do and how to implement these exercises into your program. As you can see, many things need to come together in your program.
Find a Program to Meet Your Goals
Determine When You Will Exercise
Not only do you need to consider how to exercise and what you will do, but you should also think about when you want to exercise. If you are working out with someone, what time of the day works best for both of you? Or, if you are working out independently, think about what will provide you with the best chances of getting to your program each day. If having your exercise program scheduled for the evening is causing you to miss too many workouts due to something coming up at the end of the day, then think about moving it to the morning. Research shows that if you have an open schedule, people perform best (strength, flexibility, etc.) in the late afternoon. Late afternoon is the ideal time to exercise, but working out is more crucial than the time you work out.
What Equipment Will You Need?
As your program starts to come together, it is important to think about what equipment you will need to succeed. If tracking your steps is important, then think about getting a pedometer or watch that tracks that for you. You may want a watch or heart monitoring device if exercising with your heart rate at a certain level is important. If you are doing resistance training, then perhaps you need bands, dumbbells, or kettlebells. If you want to run or get a lot of steps in, then a sturdy pair of running shoes is important.
Where to Find Exercise Programs
If you struggle to find a program, consider using one of the programs Total Diabetes Wellness has put together. Our exercise programs are created by certified personal trainers specifically for people with diabetes. You can also hire a personal trainer at your local gym to put together a program for you. Learn more about our exercise programs and options here.
Exercise Equipment and Fitness Items
Equipment will depend on your interests and the type of program you want to follow. Here are some equipment items and what to consider in respect to each item:
Smartwatch or Fitness Tracker
Due to the importance of monitoring daily activity, Total Diabetes Wellness suggests considering a smartwatch/fitness tracker. Ranging from $40 to $400+, smartwatches are incredibly valuable as they can track steps, heart rate, sleep, stress, and activity alerts. These categories are instrumental in helping reduce blood sugar levels.
Shoes
Machines
If it is cold for a large part of the year where you live, then a treadmill, stationary bike, elliptical machine, or another larger item may make sense for you. For treadmills, make sure they support your weight and that you keep the belt lubricated. For a stationary bike, consider getting a bike with a seat rather than a bike seat to help avoid discomfort while pedaling. Consider where to place these machines. Perhaps you can exercise in front of the TV or in the basement, away from pets and children.
Workout Items
Consider items such as a yoga mat, resistance bands, lightweight dumbbells, a foam roller, yoga blocks/wheels, or an agility ladder if these items help improve your workout. Total Diabetes Wellness recommends that you only purchase what you know you will need based on the program. Materials needed are listed on all our fitness programs.
Monitors
Blood pressure and pulse oxygen may be something you need to track while working through your workout programs. Your doctor should let you know if any of these items will be helpful for you while implementing a new workout program.
Recording Your Progress
Weight and blood sugar are two things worth tracking. If numbers motivate you, then consider other measurements using a measuring tape. The main measurements are typically chest, hip, and waist, but other measurements to consider are the upper arm, thigh, and calf.
Many people like to record their weight and measurements in a small notebook. Some phone apps will track your data if you prefer to use your phone.
We recommend taking monthly photos of yourself for motivation. Often you’ll be able to see significant changes in your body composition, which may be more motivating than recording numbers. Consider wearing the same clothing each month for your photos to make comparisons easier.
A Well Rounded Exercise Program
The purpose of a warmup is to gradually get your body from a resting state to a state prepared to exercise. A good warmup should last 5 to 10 minutes and should be done immediately before the workout. The warmup depends on what the exercises are and the intensity of the workout. Warming up gets your body ready for your workout. The warmup should raise your body temperature, increase blood flow and oxygen in your muscles, and, most importantly, reduce muscle soreness and significantly reduce the risk of injury by improving your flexibility and other important aspects of exercising.
Balance
Balance is important for people with diabetes, stroke patients, and overweight adults, since they are at a higher risk of falls. Balance refers to the ability to hold a pose while in a fixed position, or to stay still while in a certain pose. Adding balance exercises to your fitness program helps improve posture and coordination, which helps reduce loss of balance and prevents falls.
Yoga poses are a great way to improve your balance. Beginning yoga poses such as tree, warrior, and mountain poses help strengthen your balance.
Stability exercises are critical for people with diabetes, especially those with severe nerve damage. Recall that both stability and balance refer to maintaining control of the body. The difference is that balance controls the body while in a still position, and stability controls the body while in motion.
Nerve damage is more likely to happen for people with type 1 diabetes but can also occur in people with type 2 diabetes. Nerve damage is due to irreversible damage in peripheral nerves with symptoms of pain, paresthesia, and sensory loss. Since people with diabetes are at a higher risk of falling, stability and balance exercises should be an important part of your exercise program.
As mentioned above, mobility is the ability to move or be moved freely or easily. When we think of how the body moves, we often think of body joints. Joint pain is one of the leading reasons that people see a physical therapist. Being able to move a joint through its full range of motion helps reduce injury.
Core
What exactly is your core, and why is it important? Your “core” is what most people think of, all of your abdominal muscles. You also have a minor core, which consists of your lats (back), glutes (butt), and traps (neck) muscles. These muscles help stabilize your spine and transfer force throughout your body. Doing so helps prevent pain and injuries to your back, hips, knee, and neck. If you suffer from chronic injuries, exercising your core should be an essential part of your exercise program.
Mindfulness
Mindfulness is a “mental state achieved by focusing one’s awareness on the present moment.” When you include mindfulness in your exercise program, you are fully present during your exercise and aware of your thoughts and feelings. Mindfulness helps reduce stress and improves overall mental health. Meditation or breathing sequences are a great way to include mindfulness in your fitness routine.
Cardio
Cardio is aerobic exercise and raises your heart rate. Activities such as brisk walking, running, biking, dancing, and swimming are all examples of cardio exercises. Cardio is important because it improves your stamina, helps reduce the risk of certain medical conditions such as heart disease and high blood pressure, strengthens your immune system, and improves your mental health and mood.
The purpose of a cool down, also called a recovery period, is to help return your body to a normal resting state after exercise. Doing exercises at a slower rate will help gradually bring your body back to its normal state. The cool down should reduce the potential risk for delayed onset muscle soreness (DOMS). It also helps remove lactic acid from your body and helps prevent dizziness or fainting. The cool down helps prepare you for your next workout.
Learn more about a well rounded fitness program:
Tips to Consider for Your Exercise Program
Severe diabetic complications can cause nerve damage to eyes, specifically the retinas. High-impact exercises can damage the retinas even further. Overweight, elderly, and injured people need to reduce impact while exercising to help avoid injury. Most exercise moves have modifications to help reduce or eliminate the impact on the body. If you are elderly, overweight, or concerned about your eyes, you must implement these modifications and avoid high-impact exercises. You can modify many common exercises to make them easier and lower impact.
It is only safe to exercise if your blood sugar is under 250 mg/dL (13.9 mmol/L) and over 100 mg/dL (5.6 mmol/L). It is also essential, especially for people with type 1 diabetes, to monitor your blood glucose levels frequently. Using a continuous glucose monitor (CGM) is especially helpful during exercise for quick readings without having to stop and manually check your blood sugar. Keep in mind that the type of exercise and the intensity of the exercise impact your blood sugar levels differently.
Feeling Dizzy, Light-Headed, or Nauseous
If you feel any of these symptoms while exercising, stop immediately. People with diabetes are at risk of being injured due to falls while working out, especially people with type 1 diabetes. It is important to make sure that you don’t push yourself through situations that could result in serious injury.
Bad Days
Be Prepared
Have backup plans in case something falls through for your exercise plans. Reasons to need a backup plan include poor weather, a partner who doesn’t show up, or an injury flares up on you. It is important that you still get a workout in even if something doesn’t go as planned. We recommend keeping a spare pair of workout clothes and shoes in your car. You might also consider keeping a basketball, frisbee, soccer ball, etc., in your vehicle to give yourself more options. If you become injured and cannot continue your planned exercise, make sure you are taking care of your injury. Physical therapy exercises and stretching can usually be done when injured and will often help you recover faster.
Technique
Proper technique is important. Whether running, swimming, strength training, or stretching, all of these activities are safer and easier when you have proper form. If you are just starting to exercise, then spend some time focusing first on technique. Doing 10 repetitions the wrong way is worse than doing 3 with good form the correct way. Focus on your inhales and exhales as you push through an exercise or sink deeper into a stretch. Proper breathing also helps provide your body with much needed oxygen.
Miscellaneous
Do this for you. Listen to music, podcasts, or motivational pieces while exercising. Don’t be afraid to spend a little extra money. For example, if you plan on running, then saving $30-$50 on a pair of running shoes that might not be supportive could end up costing you more on the back end with physical therapy appointments or injuries such as shin splints. It’s ok to start with what you are good at and comfortable with, but don’t be afraid to challenge yourself and try new things. Don’t obsess over numbers. Everyone makes gains at their own pace. Keep doing what you know is right, and eventually, those gains will start to accumulate and change.
Commit!
Commit for 60 days. Don’t worry if you can’t do everything. Do what you can each and every time. Remember, one day doesn’t define you or determine who you will be one year from now. Because several types of results you are looking for don’t take place for 6-8 weeks, it is important to focus on what you are doing rather than specific results. The results will come if you are doing the work.
Consider Outside Help
Consider finding a great physical therapist to help with any diabetes issues you may be experiencing. It may be important that you implement the recommended exercises and stretches into your workout program.
The Bottom Line
Remember, safety is priority number one. Always start your workout with safe blood glucose levels and monitor your blood sugar frequently during your exercise. Properly warming up and cooling down, having a well-balanced program, and modifying when needed are all methods to help reduce and eliminate injury. Make sure you talk to your doctor before starting any exercise program.
Lastly, focus on who you are becoming. This change in how you look at fitness will help motivate you to succeed with your fitness goals. Bad days happen, but they don’t define who we are or who we become.