Type 2 Diabetes Basic Exercise Guide

Physical activity is one of the essential parts of type 2 diabetes management. It helps us prevent complications and reduces the risk factors of diabetes complications by strengthening the circulatory system. When performed regularly, exercise helps to prevent or delay a type 2 diagnosis in people diagnosed with pre-diabetes. Dedicating time to perform moderate-intensity exercises can help reduce your A1c.

If you’re at risk or are living with type 2 diabetes and want to become more active, this guide serves to help you break from the sedentary lifestyle and help you move more.

Before Beginning a New Workout Regimen 

It’s great that you’re excited to get moving—we’re excited for you! But before you start a new exercise regimen, see your doctor for a thorough physical exam to identify and address any cardiovascular, kidney, vision and orthopedic issues. To assess the risk of diabetes complications and other health risk factors, your doctor may conduct lab work to test your A1c and lipids, such as cholesterol and triglycerides, to ensure they’re within normal range.

Also, when you’re at the doctor’s office, consider taking a stress test, which measures how your heart works during physical activity, how healthy your heart is, and if there are any irregularities. If you have diabetes, a stress test may be conducted to check for coronary heart disease.

You should consider taking a stress test if:

• Have a family history of heart disease and other cardiovascular health issues
• Have experienced chest pain
• Experiencing shortness of breath
• Have a history of diabetes complications

How Exercise Helps Control Diabetes

Physical activity uses stored glucose, called glycogen, from your muscles. Once glycogen has been used, your liver uses fat to cover the increased energy demand. When a person with diabetes exercises, their glucose tolerance and insulin sensitivity improve due to the muscles’ improved reception of insulin.

After exercise, glycogen in the muscles has to be replaced. Depending on the intensity of the workout, the energy requirements may change, which can cause blood sugar to lower for as long as 12 to 24 hours as the body replaces glycogen.

Building Your Workout Plan

There are different ways to start working out today. You can become more active by daily activities such as chores or going for a walk each day. Track how often you’re moving by using a pedometer to measure your daily steps. Aim for workouts for a mix of resistance and aerobic training that use large muscle groups like your legs, back and core. However, we know not everyone wants to lift weights, so maybe walking or learning how to train as a runner may be more your style.

Certain exercises can also impact your glucose levels in different ways. Aerobic exercise, such as jogging, tends to drive blood glucose down. However, certain high-intensity or anaerobic exercises, such as weight lifting, can increase blood glucose. It’s important to listen to your body, check your blood glucose often and look for patterns to help you adjust routines.

Drink Water

During workouts, your body attempts to cool itself by sweating as your muscles generate a large amount of heat. As water leaves your body, replace it with more water. The lack of hydration can cause an increase in core body temperature will occur increasing the risk of heat exhaustion and heat stroke.

Here’s when you should drink water before, during and after physical activity according to the American Council on Exercise:

• Drink 17 to 20 ounces of water two to three hours before exercise.
• Drink 8 ounces of water 20 to 30 minutes before you start exercising or during your warm-up.
• Drink 7 to 10 ounces of water every 10 to 20 minutes during exercise.
• Drink 8 ounces of water no more than 30 minutes after exercise.

Before Your Workout

Allowing yourself time to fuel up with enough carbohydrates is hugely important to avoid hypoglycemia. You may find yourself increasing the number of finger pricks before exercising to ensure you’re in an optimal range. If you need, blood glucose can then be raised in the 30 minutes before exercise by eating carbohydrates, like fruit.

During Your Workout 

It’s important to pay close attention to your body so you can manage blood glucose changes quickly. Always have the following on hand:

• Diabetes supplies (glucose meter, insulin, syringes and spare pump supplies)
• Fast-acting sugar (sports drink/glucose tablets)
• Water
• Food 

After Your Workout

It’s important to replenish glycogen stores post-activity. The effects of exercise can be felt for upwards of 24 hours. Hydration is crucial. Consuming “slow” carbohydrates, those with fat and/or protein is also key.

How to Monitor Your Progress

It is important that you monitor your blood glucose and blood pressure for the first few days when you start a workout session. It is recommended that you test your levels before, during and after exercise, to keep a record so your doctor and nutritionist can make the relevant changes in your medications and your nutritional program.

Tracking your progress can help you stay motivated and make any changes to your workout plan. You can do this with a smartwatch, smartphone and various apps to keep monitoring your progress. If you need extra help, consider asking your doctor to help you start a log or find a workout and accountability partner.

You should also look into footwear and sportswear. Shoe stores can help you get fitted for the correct size and may have orthopedic shoes specifically for people with diabetes. However, if you’re looking for a more personalized fit, especially if you’re at high-risk or experiencing foot complications and neuropathy, consider seeing a podiatrist or a perdorthist. For athletic clothes, wear breathable fabrics to prevent chafing and fungal infections.

Another component of exercise is to be aware of hypoglycemia and how to treat it. Monitor your blood glucose during your workout and carry a source of simple carbohydrates with you, such as a juice box, gel, or candy containing between 15-20 grams of carbs.

When You Shouldn’t Exercise

• If you suffer from acute infections or fever because can increase the risks of hyperglycemia.
• If there are ketones in your urine.
• If the baseline heart rate is above 100 beats per minute.
• If your blood glucose is equal to or greater than 13.9 mmol/L250 mg/dL. Why?
  • Insulin is the hormone that is responsible for transporting glucose where it is needed. If you are insulin deficient and exercise, other hormones called counterregulatory (epinephrine, norepinephrine, glucagon, growth hormone and cortisol) will release more glucose to meet the requirements of physical activity. This leads to higher blood sugar which could lead to metabolic ketoacidosis and diabetic coma. Therefore, you should wait until you’re within your target blood sugar range before exercising. However, consult with your diabetes care team for personalized advice on how to adjust any medication and exercise regimen in the event of high blood sugar levels.  

Working Out with Diabetes Complications

Neuropathy

The pain from neuropathy can interfere with one’s willingness to exercise. But, luckily, there are ways to get in a good workout that minimizes that pain.

People diagnosed with neuropathy should avoid weight-bearing exercises that are heavy on the feet, this includes jogging and walking and opt for exercises such as stationary biking and swimming. Other exercises include flexibility, balance and strength training exercises such as calf raises, hip extensions and calf extensions.

If you experience pain from neuropathy during your workout, do not push through the pain because it further damages and increases inflammation of your nerves. Check for blisters, sores and cuts on your feet and legs after each workout and treat accordingly. For more assistance, you may want to work with a physical therapist to manage the effects of neuropathy.

Retinopathy

Exercises by people diagnosed with retinopathy depend on its severity. People with advanced or severe retinopathy should avoid exercises such as heavy lifting, boxing, and the Valsalva maneuver during weightlifting.

Nephropathy

People with nephropathy should avoid exercises that are strenuous and other high-intensity workouts.

At the end of the day, choose the best workout plan that best suits your diabetes and health goals, will be fun for you and will keep you motivated. Also, as your needs change, your physical activity goals will as well. Remain adaptable and change your workout plan as necessary or as directed by your physician.

References

Manual ACSM para la valoración y prescripción del ejercicio (ACSM Manual for the assessment and prescription of the exercise), Ed Paidotribo, 3a Edición 2014 p. 232-237.

R Maughan, et all Actividad Física en el Calor: Termoregulación e Hidratación en América Latina (Physical Activity in the Heat: Thermoregulation and Hydration in Latin America), Journal Publice 1999.

Jorge J. Marquez A et al Revisión Actualidad en Ejercicio y Diabetes Tipo 2 (II) (Review Current Status in Exercise and Type 2 Diabetes), Vol XXVIII, Num 143, 2011 pg. 188-198.

Katja SC Röckl, Carol A Witczak and Laurie J Goodyear, Diabetes, mitocondrias y ejercicio (Diabetes, mitochondria and exercise). Esp Cardiol Supl Magazine, 2008, 8 27C-34C.

Jorge Roig.Entrenamiento aeróbico en la diabetes y la fuerza (Aerobic training in diabetes and strength?) December 2018.