Exercising with Type 2 Diabetes

If your doctor has diagnosed you with Type 2 diabetes, then she or he has probably already told you about the importance of adding exercise to your treatment plan. Physical activity can help you improve your blood sugar control, lose weight and reduce your risk of heart disease, peripheral artery disease and nerve problems, which are often associated with diabetes. In many cases, the right combination of diet and exercise can even help eliminate the need for medication for people with Type 2 diabetes.

But before you get started, you need to understand how exercise influences blood glucose regulation, and how to avoid potential problems, minimize risks and recognize when you may need to get additional information or support from your health care provider. *The general information in this article is not a substitute for talking to your health care provider before you begin an exercise program, or if you experience any problems in connection with your exercise.

How Exercise Benefits People with Type 2 Diabetes

In addition to boosting your energy levels, mood and capacity to burn calories for weight loss, regular exercise can lead to the following benefits:

• Improved blood sugar control by enhancing insulin sensitivity. Exercising on a regular basis makes muscles use insulin better. When muscles are able to use insulin better, they are able to pull more glucose from the bloodstream to use for energy. The more vigorously you exercise, the more glucose you’ll use, and the longer the positive effects on your blood glucose levels will last.
• Increased insulin sensitivity. Type 2 diabetics who exercise regularly need less insulin to move glucose from the bloodstream and into the cells that need it.
• Reduced need for medication. Combined with a healthy eating plan, regular exercise can reduce—or even eliminate—the need for glucose-lowering medication in some people.
• Reduced cardiovascular risks. Diabetes has negative effects on heart health, increasing the risk of heart attack, stroke and other cardiovascular diseases. Exercise reduces these risks by increasing HDL (good) cholesterol, lowering LDL (bad) cholesterol and reducing triglycerides in the blood stream. Physical activity also improves blood flow, increases your heart’s pumping power and reduces blood pressure.

The Best Exercises for People with Type 2 Diabetes

Always discuss your exercise plan with your doctor before starting, especially if you’re taking medication or experiencing diabetes-related medical complications (discussed above and below).

Experts generally recommend that people with diabetes engage in moderate aerobic (cardio) exercise that lasts at least 30 minutes on four or more days of the week.

• Always warm up for at least five minutes before you exercise and cool down for at least five minutes afterwards before you stop moving.
• If it’s been a while since you’ve done much physical activity and 30 minutes at a time is too much right off the bat, you can start with 10 minutes (or even less) and gradually increase your workout duration as you become more fit.
• Moderately intense cardio should elevate your heart rate to a level that is challenging, but not so difficult that you can’t do it for 30 minutes.
• Examples of moderate-intensity exercise include brisk walking, bicycling, dancing, swimming, climbing stairs, cross-country hiking, aerobics classes, cardio machines such as the elliptical, skating, tennis and other sports.
• If you pick activities that you enjoy, you'll be more likely to stick with your exercise plan.
• Being active every day is better for you than doing more exercise on fewer days of the week, and scheduling your exercise at the same time of day can help with blood glucose control.

In addition, moderate strength training (except as noted below) and flexibility exercises are also highly beneficial. These exercises will help you better use your muscles without soreness and decrease your risk of injury.

The Risks of Exercise and How to Avoid Them

Many people with diabetes have special needs that should be addressed when planning an exercise program. Here are four of the most common problems that will affect your exercise plan:

1. Hypoglycemia (Low Blood Sugar): Exercise can cause your blood glucose levels to drop too much, especially if you take insulin or other glucose-lowering medications. Symptoms of hypoglycemia, or "low blood sugar," include feeling shaky, lightheaded, weak, confused, anxious, fatigued, irritable or hungry; headache; breaking out into a clammy sweat; or even fainting.

Hypoglycemia can happen during exercise, right after exercise, or even up to 24 hours after you finish exercising. Symptoms of hypoglycemia can be mild and gradual; but it is more common for symptoms to occur quickly with diabetes-related hypoglycemia. It is also important to note that, in rare cases, individuals may not experience any symptoms at all. By paying close attention to how you’re feeling and knowing how to treat low blood sugar symptoms correctly, you can prevent problems before they put you at risk of injury. To prevent exercise-related hypoglycemia:

• If you take insulin, do not inject insulin near the primary muscles that will be used during exercise (typically the thighs or back of the arms), because it will be absorbed too quickly.
• Check your blood glucose level before you exercise. Talk to your doctor about understanding any carbohydrate adjustments you should make before exercise, based on your glucose reading.
• Do not skip planned meals prior to exercise, or go too long without eating.
• Carry an easy-to-consume glucose source (such as juice, hard candy or glucose tablets) when you exercise
• Drink plenty of water before and during exercise—dehydration can affect glucose levels.

2. Poor Blood Sugar Control: In some cases, exercise can also cause blood sugar levels to rise (known as hyperglycemia). If you take insulin, or if your glucose levels aren’t well-controlled, you must discuss your exercise plan with your doctor before starting. To prevent exercise-related blood sugar problems:

• Do not exercise if your blood glucose is above 300 mg/dL, or your fasting blood glucose is above 250 mg/dL and you have ketones in your urine.
• Check your glucose level before and after exercise, to see how your exercise has affected it. Share this information with your doctor (especially if you take any oral medications for diabetes or insulin) to help you determine the best times of day for you to exercise, and how to adjust the timing or amount of your dosage before exercising.

3. Diabetic Retinopathy: If you have this condition (damaged blood vessels in the retina of the eye), exercise could damage your eyesight. Strenuous activities could lead to bleeding or retinal detachment, so you may need to avoid certain activities, such as weight lifting or jogging. Ask your doctor to recommend appropriate exercise activities for you.

4. Reduced Sensation or Pain in Extremities: Because diabetes can cause nerve damage as well as interfere with blood circulation, many people with diabetes can lose all or part of the sensation in their feet. To prevent exercise-related foot problems:

• Check your feet for cuts, blisters or signs of infection on a regular basis.
• Wear good shoes that properly fit your foot with ample cushioning and support.
• Wear synthetic or cotton-blend socks that minimize moisture problems.

If you experience pain in your legs (or other extremities) at any time during or after your exercise routine, contact your doctor right away. Exercise-induced pain can be a symptom of one or more diabetes-related complications that require medical attention. If numbness or pain becomes constant or severe, talk to your doctor about alternate forms of exercise that may be appropriate.

Exercise Checklist for People with Type 2 Diabetes

There’s no doubt about it—consistent, moderate exercise is one of the most important and effective weapons you can use to help manage your diabetes and your weight. To keep yourself safe, follow this checklist:

• Talk to your doctor about the right exercises for you.
• Always check your blood sugar level before and after exercising.
• Always wear diabetes identification. Everyone with diabetes should wear a comfortable necklace or bracelet that states they have diabetes.
• Check your feet for blisters or sores before and after exercising.
• Wear proper shoes and socks.
• Warm up before each exercise session, and cool down and stretch afterwards.
• Drink plenty of fluids before, during, and after exercising.
• Bring a fast-acting carbohydrate snack in case you experience symptoms of hypoglycemia.
• Report any recurring, exercise-related pain in your legs or extremities to your doctor right away.

For more specific information or help, talk to your health care provider. The American Diabetes Association's National Call Center also offers live advice from 8:30 a.m. to 8 p.m. EST, Monday through Friday at 1-800-DIABETES or 1-800-342-2383.

This article has been reviewed by Registered Dietitian, Becky Hand, and Amy Poetker, Registered Dietitian and Certified Diabetes Educator.