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Managing type 2 diabetes with exercise

If you’ve just been diagnosed with type 2 diabetes, chances are you’re probably in a state of shock. What happens next can vary quite dramatically. In some cases, newly diagnosed patients are simply given a prescription and told to get on with it.

However, these days, most people are given an introduction to what type 2 diabetes is and are advised to attend well-organised diabetes education courses.

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Early action will pay off in the long term

Although you might feel fine at the moment, type 2 diabetes is a serious disease that requires your attention immediately. In the early stages of the illness, most patients will be advised to lose some weight and increase their physical activity. Simply swapping a few items in your shopping basket for the low-fat version and going for the odd walk won’t quite cut it though.

Although it is a step in the right direction, the key thing to achieve here is some form of weight loss. Remember that food has a major impact on blood sugar (glucose) levels. Developing an understanding of the sugar, carbohydrate and calorie content of your food is key.

Losing even a small amount of weight (and keeping it off) will improve your blood glucose control. How you achieve that weight loss is ultimately down to you but remember you need to consume fewer calories than you burn in order to shift some pounds.

What’s the evidence?

When advised to eat less and exercise more, most people reply by saying: “I could have told you that!” The general piece of advice given to newly diagnosed patients is obvious to most of us.

But what does the research say? In one large-scale medical trial, nearly 600 patients with newly diagnosed type 2 diabetes were recruited and followed for one year. Participants were randomly assigned to one of three groups. The first group was provided with the usual care normally given by the health service. The second one followed an intensive diet intervention. Finally, the third group received the same diet intervention combined with an activity programme.

Unsurprisingly, when assessed at six months, glucose control had got worse in the control group but improved in both the diet and diet plus activity programme. Importantly, they also similarly reduced the risk of future cardiovascular incidents.

These differences persisted at 12 months, resulting in less diabetes medication being required. That’s good news, but what about exercise? Is it really providing extra health benefits that a diet alone can not offer?

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The power of a daily bout of exercise

In order to come up with the hard evidence that exercise does indeed provide health benefits, scientists had to come up with a new study that would prove just that.

In most cases, type 2 diabetes is the result of years of eating a little bit too much and not being physically active enough. A group of 26 healthy young men were asked to drastically change their habits for a week. All of them exercised regularly and none was obese.

For a week, they were asked to eat 50% more than usual and do less than 4,000 steps a day. Their diet wasn’t changed - they just had to consume more of everything! The other half of the group was asked to run on a treadmill for 45 minutes every day.

Crucially, every calorie burned on the treadmill was also added to their new diet (that group ate 75% more than usual). As a result, every participant experienced exactly the same energy surplus. All of them had their health assessed before starting the study and again a week later.

The results were striking.

After a week of no exercise and too much food, participants displayed a significant decline in their blood sugar control. Volunteers who had exercised once a day were just as sensitive as before to insulin and their blood sugar control was unaffected. This is despite all the extra food and the weight gain. Exercise seemed to completely cancel out the majority of changes induced by overfeeding and reduced activity.

Although most of us believe exercise does indeed improve health, this study did provide some much-needed proof that it was the case.

Getting active and staying active

Despite physical activity being key in the management and prevention of type 2 diabetes, many with this chronic disease do not become or remain regularly active. Exercise should be an important part of your treatment plan.

Regular participation in physical activity improves blood sugar (glucose) control. It will also help your body better use the insulin your body continues to make, and improve your cholesterol levels. Keeping your blood glucose levels within a healthy range will prevent long-term complications such as nerve pain and kidney disease.

Exercise has many benefits such as improving your mood and helping keep the weight off. By far, the most important one if you have type 2 diabetes is to help you control your blood sugar level.

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How does it help?

A result of type 2 diabetes is that sufferers have too much sugar (glucose) in their blood. The main reason is usually that their body doesn’t use insulin properly (insulin resistance), but not producing enough insulin also plays a part.

One of the benefits of exercise is that it makes your insulin more effective. That means your cells become better at using glucose and you become less insulin-resistant as a result of exercise.

Sadly, 80% of people with type 2 diabetes will develop long-term complications. Blocked arteries, which can lead to a heart attack, are a common issue. The good news is that exercise helps minimise the risk of these issues occurring. Unlike most prescription medicines, remember that exercise doesn’t come with detrimental side effects and is free!

Before you start exercising

The majority of patients who have been diagnosed with type 2 diabetes tend to be overweight/obese. As a result, starting a new exercise routine is particularly daunting.

But before you embark on a new exercise plan, you firstly need to talk to your doctor. It is important that your blood pressure is checked among other things. And remember to set yourself realistic goals. You will want to start slowly and build up progressively the intensity and duration of your sessions.

Being diagnosed with type 2 diabetes is life-changing but small changes to your routine will soon lead to improvements. Incorporating more physical activity in your day will pay off in the long run.

What if you're on medication?

A person without diabetes does not tend to suffer from low blood glucose (hypoglycaemia) during exercise. The body naturally decreases the amount of insulin released. But if you are on medication such as insulin or sulfonylureas, controlling your diabetes can be a balancing act.

You must keep an eye on your food intake, activity levels and medications. If you become more active than usual, your blood glucose level might drop too low causing hypoglycaemia. If you take regular medication and you know ahead of time that you will exercise that day, you might need to adjust your medication as a result. You might want to test your blood sugar levels before and after a certain type of exercise to see how it affects those.

If your blood glucose drops below 4 mmol/L you should stop exercising. You might need to take some form of sugar such as dextrose tablets. Monitor your blood sugar and wait for it to return to a safe range. While you are active, some form of carbohydrate every 30 to 60 minutes is recommended. Most importantly, take the time to see how your body responds to new forms of exercise and talk to your diabetes care team for help making decisions when it comes to your medications.

What type of exercise?

It's important that you find a way to exercise that you actually enjoy.

Exercise classes can be a good option or find a friend to go walking or running with. Having someone to exercise with will make you accountable and less likely to give up as a result. You should aim to be active on most days of the week. Walking to work or not using the lift are ways to make sure you are more active on a daily basis.

If you were inactive before, remember to start slowly. Making small changes over a long period of time is what you’re aiming for. But remember, the combination of reducing calories from your diet and increasing your physical activity will provide you with the best results.

Strength training is also a good addition on top of the regular aerobic exercise. Your muscles are the biggest consumer of glucose so it makes sense to develop those with some strength training.

But whatever you do, make regular exercise a priority. Remember that your health depends on it. There will be times where you will struggle to find the time or the motivation to exercise but keep at it! It will help you shift some of the excess weight (which is really the most important thing to achieve here) and make you more sensitive to insulin.

Article history

The information on this page is peer reviewed by qualified clinicians.

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