Exercising with diabetes

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With nearly every chronic disease, exercise is usually recommended as a treatment method. This is because exercise can help prevent and manage many conditions, especially those that affect the cardiovascular system. Regardless of if you are healthy or not, it is recommended that you perform moderate-intensity aerobic exercise for at least 150 minutes a week. However, for people with diabetes, exercise is not just a recommendation but a first-line course of treatment.اضافة اعلان

Who benefits the most?

When discussing the impacts of exercise on diabetes, it will mostly be about type 2 diabetes mellitus (T2DM). This does not mean that type 1 diabetes mellitus (T1DM) patients do not benefit from exercise but simply that T2DM patients improve at a greater rate.

Additionally, T1DM patients should consult their doctor before exercising as it may worsen their condition due to the difference in how diabetes manifests depending on the type. T1DM is an autoimmune disease in which the cells in the pancreas that produce insulin (B-cells) are damaged by the body’s own immune system.
Regardless of if you are healthy or not, it is recommended that you perform moderate-intensity aerobic exercise for at least 150 minutes a week.
T2DM, on the other hand, is the result of the body becoming less sensitive to the effects of insulin — a hormone produced by the pancreas which is responsible for regulating the sugar (glucose) levels in the blood. Insulin does this by converting glucose into a different molecule that can be stored in the skeletal muscles and liver.

In T1DM, there is not enough insulin, but when it is introduced — usually in the form of injections — the body can effectively regulate glucose levels. In T2DM, there may be a normal amount of insulin available, but the body does not store glucose as well as it should.

In order to increase the body’s sensitivity to insulin, there are two main courses of treatment: exercise, and medication such as metformin.

Exercise’s impact on diabetes

Reports of exercise-induced improvements in insulin action date back to the 1920s. There is a consensus that exercise is integral in managing diabetes both in the short-term and long term.

There are five main targets that exercise improves the more regularly you work out: The liver, adipose tissue, skeletal muscle, the circulatory system, and the pancreas.

• Liver

The liver plays many important roles in the body, one of which is assisting the pancreas in regulating blood glucose levels. Your liver acts as a storage site for processed glucose but can also produce glucose in a process known as gluconeogenesis. When trying to manage glucose levels in the blood, it is important to be able to suppress gluconeogenesis.

By exercising, the liver becomes more sensitive to insulin, thus allowing more glucose to be stored while suppressing the formation of new glucose via gluconeogenesis. Exercising also helps reduce the accumulation of triglycerides in the liver.

• Adipose tissue

Adipose tissue, more commonly known as body fat, also contributes to insulin insensitivity. By exercising, you can reduce the amount of fat mass and, in turn, improve insulin sensitivity in the body.

Additionally, adipose tissue plays a role in inflammation for those with diabetes. Despite the inflammation being low-grade, if it is chronic, it increases the risk of cardiovascular disease.

Exercise helps reduce the molecules produced by adipose tissue responsible for the inflammatory response.

• Skeletal muscle

Skeletal muscles are the primary site for glucose storage, and roughly 80 percent of stored glucose is deposited in the muscles. This is achieved by the use of insulin-dependent and insulin-independent mechanisms. Since diabetes results in insulin insensitivity, the body must rely on insulin-independent mechanisms.

A 2008 study found that a single bout of exercise can improve the muscle’s glucose uptake via insulin-independent mechanisms by up to five times.

As exercising becomes more regular, insulin sensitivity improves, allowing the muscles to utilize insulin-dependent mechanisms. Over time, these two mechanisms work in conjunction to greatly improve diabetes management.

• Circulatory system

Diabetes is known for causing complications to the cardiovascular system.

The cardiovascular system can be divided into microvascular complications and macrovascular complications. Macrovascular complications of diabetes include coronary artery disease, peripheral arterial disease, and strokes. Microvascular complications of diabetes include nephropathy (kidney damage), neuropathy (nerve damage), and retinopathy (eye damage).

Exercise helps reduce and control lipids and blood pressure, which can greatly increase the risk for micro and macrovascular complications if left uncontrolled. Furthermore, exercise helps lower blood glucose as well as HbA1c.

• Pancreas

In the early stages of T2DM, the pancreas tries to compensate for the lack of response from the body by increasing the amount of insulin produced.

Eventually, the pancreas can no longer sustain itself, and there is a marked decline in B-cell function. A 2004 study found that just three months of aerobic exercise could improve B-cell function.

This regained function allows the pancreas to produce more insulin, improving glucose control far more than the improved sensitivity.


The sooner you start exercising, the better. Diabetes is a progressive disease that continually gets worse with time. neither exercise or medication cure diabetes, but instead slow its progression.

If diabetes remains uncontrolled for too long, it becomes harder to manage, which is why it is important to start as soon as possible.
Diabetes is a progressive disease that continually gets worse with time. Both exercise and medication do not cure diabetes but instead slow its progression.

• Frequency

The World Health Organization recommends that all adults over 18 exercise for 150 minutes per week with moderate intensity or 75 minutes per week with vigorous intensity.

Practically speaking, this equates to 30 minutes a day, five days a week. For those with T2DM, it is recommended that aerobic exercise (exercise that increases heart and breathing rate) be performed at least three days a week and resistance training (weightlifting) be performed at least twice a week.

There should be no more than two days rest between exercises.

• Intensity

Intensity can be measured in several ways, but the simplest way is to put it in terms of your own physical capacity. Put your physical capacity on a scale between 0—10, where 0 is you at rest and 10 is maximum effort.

Moderate intensity would be considered a five or six on that scale, whereas vigorous intensity would be regarded as seven or eight. Aerobic activity should be moderate (like a brisk walk), but vigorous aerobic exercise can provide additional benefits.

Resistance training can be moderate or vigorous, depending on personal preference.

• Duration

Aerobic exercise should be 20-60 minutes per day and can be done continuously or intermittently. If done intermittently, each bout should be at least 10 minutes. Resistance training should consist of three sets of 8–10 repetitions that involve 8–10 different exercises that work for all the major muscle groups.

High-Intensity Interval Training (HIIT)

HIIT is a relatively new fitness regimen that has shown great promise for people with diabetes. HIIT generally consists of four to six repeated bouts of maximum effort for roughly 30 seconds with rest periods of 30-60 seconds in between.

A single session typically lasts 10 minutes and a trial that lasted at least two weeks showed a reduction of the Hemoglobin A1C (HbA1c) by 0.19 percent and 1.3kg of body weight lost.

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