How Exercise Helps Prevent and Manage Type 2 Diabetes

Exercise is one of the most effective lifestyle tools for preventing, delaying, and managing prediabetes and type 2 diabetes.

“The long-term benefits of exercise on blood sugar and insulin health are unquestionable,” says Rasa Kazlauskaite, MD, director of the diabetes technology program and an associate professor at Rush University Medical Center in Chicago.

• Uses Excess Glucose When you move your body, your muscles pull sugar out of your bloodstream and use it for energy. This process works even without as much insulin, which is especially helpful if you have insulin resistance. That’s why a short walk after eating can help prevent blood sugar spikes and keep levels stable.

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• Builds Muscle Having muscle helps pull sugar out of your bloodstream and helps stabilize blood sugar levels. “After you eat, 70 to 80 percent of the glucose in your (bloodstream) goes to your muscles,” Dr. Kazlauskaite says.

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   “The lower our muscle mass is, the more we hinder our capacity to clear glucose from the bloodstream.”
• Helps Maintain Weight Loss Losing just 5 to 10 percent of your body weight can improve your A1C, which is the two- to three-month average of your blood sugar levels.

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   Exercising, especially doing strength training, helps preserve lean muscle while promoting greater fat loss. This supports metabolism, strength, and keeping weight off long-term.

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• Reduces Visceral Fat Abdominal fat, also called visceral fat, is a major player in the development of insulin resistance and type 2 diabetes. “These fat cells not only store energy, but they also can produce and release a host of chemicals and hormones that make it harder for the body to use insulin, worsening insulin resistance,” says Nick Occhipinti, CSCS, an exercise physiologist in Glen Gardner, New Jersey. Aerobic and resistance exercise can help you lose visceral fat, and combining the two may offer the broadest benefits.

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• Decreases Stress Exercising reduces the body’s fight-or-flight response to stress, which in turn decreases blood sugars.

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Beyond improving blood sugar, exercising can help reduce your risk of some diabetes-related complications and improve your quality of life. Some ways that getting physical activity can reduce that risk are:

• Improves Vascular Health When you exercise, your muscles release a host of compounds that help your vascular and circulatory health, Occhipinti says. That means more oxygen and nutrients can get where they need to go, reducing your risk of diabetes-related nerve, vision, and heart issues.

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   Improved blood flow also may aid in joint health, he says.
• Lowers Inflammation Chronic inflammation throughout your body can play a key role in the progression of type 2 diabetes and complications such as atherosclerosis (arterial plaque buildup). But getting routine exercise can help lower chronically high inflammation to ease its negative effects, Occhipinti says.

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• Improves Cholesterol and Blood Pressure Getting exercise also can lower blood pressure and unhealthy cholesterol levels, Occhipinti says. Both are leading contributors to progressive heart disease.

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• Improves Nerve Function About half of people with type 2 diabetes also have nerve damage.

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   Getting exercise may help improve neuropathic symptoms, physical function, and other elements of nerve health in people with diabetic neuropathy.

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• Addresses Joint Pain Mobility limitations such as frozen shoulder and joint pain are common diabetes complications, says Ankush Gupta, MBBS, a diabetes specialist based in Pune, India. Strength and mobility exercises through physical therapy can reduce pain while increasing range of motion.

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1. Get the go-ahead from your healthcare team. Talk to your doctor or endocrinologist before you start a workout program. This helps ensure that you choose a type of exercise that’s best-suited for any health conditions you may have, such as heart disease or diabetic neuropathy.

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2. Make a plan to ensure your blood sugar stays in a healthy range. “Exercise must be carefully planned with intake of food and insulin to prevent hyper- or hypoglycemia,” or high and low blood sugar, says Kristen Gasnick, DPT, a physical therapist in New Jersey. Again, talking to your medical team can be important, as is testing your blood sugar before and after exercise. When starting exercise for the first time, you may also need to test your blood sugar during your workout, she says. Consider the 15-15 rule: If your blood sugar is low, have 15 grams (g) of carbs, wait 15 minutes, and test. Repeat until your blood sugar is at 70 mg/dL.

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3. If you’re new to exercise, take baby steps. “If 150 minutes per week seems like a lot, start with a goal of 45 minutes of exercise for the week, then 60, then 75, and continue until you hit and maintain the goal of 150 minutes,” Occhipinti says. In addition to being one of the best ways to stay motivated to exercise when you have diabetes, this gradual approach to exercise will reduce the risk of exercise aches, pains, and injuries.
4. Think outside of structured workouts when considering movement. Doing everyday physical activities like walking while going on errands, taking out the trash, and cleaning your home helps you maintain functional strength and mobility. Breaking up sitting time with these short bouts of movement can help improve blood sugar and insulin levels.

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5. Start with low-impact exercise, especially if you have nerve damage. Stationary cycling, weight-bearing strength training, swimming, and other low- to no-impact workouts are gentle ways to ease into exercise. They’re especially beneficial for people exercising with diabetic neuropathy. “Those with diabetic peripheral neuropathy, associated nerve damage, and loss of sensation in the feet are at an increased risk of skin breakdown and ulceration,” Gasnick says.
6. Focus on large muscle groups for maximum benefits. When it comes to resistance training, multi-joint exercises such as squats, lunges, rows, and chest presses come with the greatest per-rep benefits for blood sugar management and the progression of related complications, Occhipinti says.

• Getting enough exercise can help you prevent, delay, and manage prediabetes and type 2 diabetes by lowering blood sugar (glucose) levels and improving your insulin sensitivity.
• Beyond improving blood sugar, getting exercise can help reduce your risk of diabetes-related complications such as nerve damage, vision problems, heart disease, and joint pain.
• Guidelines typically say to aim for at least 150 minutes of moderate exercise per week spread over at least three days. But it’s best to ask your healthcare team what exercise plan would work best for your situation.
• If you're new to exercise, start with small goals and slowly increase your activity. Test your blood sugar before and after workouts to prevent dangerous highs or lows.