UPDATE: Due to an increasing prevalence of obesity and sedentary lifestyles, type 2 diabetes mellitus (T2DM) has become an epidemic. This common form of diabetes parallels with obesity (coined as ‘diabesity’) and has increased significantly over the past 30 years. The United States accounted for $198 billion spent on diabetes in 2010 which is 53% of total diabetes spending worldwide.

Exercising with Diabetes

Exercise has an acute and chronic effect on type 2 diabetes. Studies show that exercise is an effective prescription for managing this disease, whereas your risk of diabetes increases with sedentary behaviors (e.g., prolonged TV watching, sitting at work and other sitting like reading and eating meals).

Diabetes requires close monitoring of your glucose, insulin and diet. It’s necessary to be particularly diligent when you plan to exercise or engage in any physical activity. When you have diabetes, you’re unable to metabolize glucose normally.

Glucose (blood sugar) comes from the foods you eat and is your body’s most important source of energy and nutrients – especially during exercise. It’s needed by all your cells and organs, such as your brain and muscles.

Acute Effect of Exercise

  • Improves insulin sensitivity in your muscles
  • Lowers your blood glucose for 24 to 72 hours after exercise

Chronic Effect of Exercise

  • Improves your cardiovascular function
  • Improves your lipid profile, blood pressure, body mass, fat-free mass, body fat distribution, insulin sensitivity, glucose control (T2DM only), and metabolism
  • Can lower your daily blood glucose medications as a result of physiologic changes

The Battle with Blood Sugar

Diabetes is marked by high levels of glucose in your blood (hyperglycemia). This is because glucose is ‘locked out’ from getting into your cells and starts to build up in your blood. Blood sugar is a precious fuel for your body, but when it’s persistently high, glucose can damage nerves and vessels. Since glucose circulates throughout your entire body, high levels can cause damage anywhere.

Diabetes-related complications include:

  • Blood vessel damage that increases your risk of stroke and heart attack
  • Poor blood circulation
  • Nerve and vessel damage to your eyes (retinopathy), feet and kidneys

Types of Diabetes

The two most common forms of diabetes, known as Type 1 and Type 2, are distinctly different:

Type 1 diabetes mellitus: In T1DM, you DON’T PRODUCE INSULIN and can’t control the amount of sugar in your blood. This form of diabetes is an autoimmune disease where the body’s immune system attacks and destroys insulin-producing cells of your pancreas.

Type 2 diabetes mellitus: In T2DM, you DON’T USE INSULIN normally and can’t control the amount of sugar in your blood. 90% of diabetes cases are type 2. People who are overweight or obese, particularly with visceral fat (i.e., belly fat), are more likely to develop T2DM. (See videos: Beer Belly Anatomy 101 and Trimming Belly Fat.)  Therefore, weight loss is the primary goal in treating this form of diabetes.

In T2DM, your cells become resistant to insulin or your pancreas doesn’t produce enough insulin. High blood sugar levels can erode your cells’ ability to make insulin. Your pancreas will end up overcompensating and over time, it can become permanently damaged. T2DM is preventable whereas Type 1 is not.


Locked Out Cartoon
Glucose can’t get into your cells without insulin (the key).

Insulin is the hormone that’s needed for the glucose in your blood to enter your cells. Think of insulin as the ‘key’ that unlocks the cell door and lets glucose in. Without the ‘key’, your organs are starved of essential energy and can lead to cell death.

Glucose Monitoring During Exercise

Blood glucose levels can be monitored regularly using the following key methods – each having a different purpose. The HbA1c method has value overall in the treatment and monitoring of your disease, but is NOT helpful when participating in exercise.

Traditional Home Blood Sugar Monitoring: This method of testing gives you an instant reading of your blood sugar level and the results from this method are needed for exercise. Regular testing allows you to adjust the way you’re managing your insulin/meds, food intake and activity to stay within your target blood sugar levels. Doing so will help reduce your risk of long-term complications.

Glycohemoglobin (HbA1c): This blood test measures sugar (glucose) in the blood that is permanently bound to the hemoglobin in your red blood cells. Higher levels of circulating blood glucose will result in a higher percentage of HbA1c which is a reflection of how well you’re controlling your diabetes. Hemoglobin (Hb) is an iron-containing protein in your red blood cells that carries oxygen from your lungs to the rest of your body tissues.

When your diabetes is out of control, you increase your risk of diabetes-related complications. The HbA1c is generally performed three to four times a year. It measures your time-averaged blood glucose concentrations over the previous two to three months, assuming the average life span of the red blood cells is 100 to 120 days (the average in a healthy individual).

Consider your HbA1c number analogous to a baseball player’s season batting average. When you’re diabetic and exercising, you need to know your exact glucose level at that specific moment — not the average level over a few months time.  

RELATED: Safe Exercise Training with Diabesity (Follow the next post on Exercise Guidelines for the Diabetic, Blood Sugar Goals, Blood Sugar Changes During Exercise, and more…)

Karen Owoc

Karen Owoc is a certified Clinical Exercise Physiologist specializing in cardiopulmonary rehabilitation and lifestyle medicine. Her science-based approach to longevity, nutrition, and muscle health has made her the go-to source for health seekers and medical professionals alike. Karen's best-selling book on functional longevity, "Athletes in Aprons: The Nutrition Playbook to Break 100", and her transformative perspective have mended many minds, hearts, and spirits.

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