When it comes to managing type 2 diabetes, exercise is one of the most potent options out there, according to a position statement from the American Diabetes Association (ADA).
How does exercise help diabetes? Moving more helps with blood sugar control, insulin sensitivity and weight maintenance — all important things to keep diabetes in check. It also just boosts your mood and helps keep you feeling healthy and strong. (OK, that's simplifying the benefits of exercise for type 2 diabetes quite a bit, but we'll dig into the full deets below.)
That said, diabetes and exercise do have a tricky relationship. And there are certain precautions all people with diabetes — gym veterans and newbies alike — need to take to get the biggest benefits from their workouts. Here's everything you need to know about exercise and diabetes.
3 Ways Exercise Helps Diabetes Management
1. Improves Insulin Health
The main way exercise helps control types 2 diabetes is by improving insulin health.
Insulin is a hormone secreted from the pancreas that helps carry glucose, or sugar, from the bloodstream into all of the body's cells, where it's used for energy, Caroline Apovian, MD, co-director of the Center for Weight Management and Wellness at Brigham and Women's Hospital, tells LIVESTRONG.com.
When the cells don't respond normally to insulin, blood sugar levels build up and the pancreas increases insulin production to try to compensate. Eventually, the pancreas can't keep up, and as blood sugar levels become chronically high, type 2 diabetes develops. (This is different from type 1 diabetes, which is an autoimmune condition in which the pancreas produces none or very little insulin.) As a result, people with type 2 diabetes need to take glucose-lowering medications to get the sugar levels in their bloodstream to a healthy level.
But research shows that exercise can improve the body's response to insulin and reduce blood sugar levels. One March 2020 research review in Mayo Clinic Proceedings found that regular exercise can reduce the need for glucose-lowering medications such as insulin.
And a 2017 review in Cardiovascular Diabetology found that aerobic exercise can significantly lower blood sugar and increase fitness levels in adults living with diabetes, with longer programs leading to greater decreases in blood sugar. Insulin resistance, fasting glucose and insulin levels also improve with exercise.
Strength training plays an important role, too. In a November 2016 position statement, the American Diabetes Association (ADA) confirmed that resistance training has numerous benefits for people with type 2 diabetes, including improvements in glycemic control, insulin resistance, fat mass, blood pressure, strength and lean body mass.
2. Eases Complications of Diabetes
Type 2 diabetes raises your risk of many health problems, but exercising for diabetes can help combat that.
Cardiovascular Disease: People with type 2 diabetes are at a higher risk of developing heart disease than the general population. According to the Centers for Disease Control and Prevention (CDC), people with diabetes are twice as likely to have heart disease or a stroke, and are more likely to have heart issues at a younger age. The longer you have diabetes, the more your risk increases.
Exercising regularly can improve heart health and reduce these risk factors, per the March 2020 Mayo Clinic Proceedings review.
Joint Conditions: Systemic inflammation is a hallmark of type 2 diabetes, and it is believed to play a role in many diabetes complications, including joint problems, Dr. Apovian says.
High blood sugar can contribute to high levels of inflammation in the body. Also, experts believe that high levels of fat around the abdomen and organs can secrete substances that cause inflammation, she says.
No matter where the inflammation originates, these inflammatory substances ultimately end up throughout the blood, leading to immune cell dysfunction. This inflammation also affects the joints and can cause pain and stiffness, she says.
Having a high body weight also places more pressure on the joints, potentially contributing to joint pain and osteoarthritis. Exercising can help support healthy joints by reducing inflammation and, if weight loss is a goal, reducing the amount of weight on the joints.
Neuropathy: About half of all people with diabetes develop diabetic neuropathy, or nerve damage from diabetes, according to the American Diabetes Association. The most common type is peripheral neuropathy, which often starts in the feet. Neuropathy can cause tingling, increased sensitivity, numbness and pain. "Improved glycemic control can improve neuropathy, but sometimes damage after long uncontrolled diabetes can become permanent," Dr. Ehrhardt says.
Exercise has been shown to help reduce neuropathy symptoms. A 2019 research review in the Journal of Pharmacy & Pharmaceutical Sciences found that, in people with peripheral neuropathy, low-intensity resistance exercise for diabetes improves sensation, reduces tingling and lessens pain.
3. Improves Overall Health
There are a host of health benefits to strength training, many of which can play an important role in diabetes management. Those benefits include:
Body composition: "When you build muscle mass, you raise your metabolism, which can help you manage your weight," Shahar says. Plus, higher levels of lean muscle mass can improve your overall health and day-to-day function.
Better balance: Building strength also improves balance, which can be a tough spot for some people with diabetes, particularly those who have related conditions like neuropathy, or numbness in their legs or feet. Indeed, in an April 2010 study in Diabetes Care by Colberg-Ochs and colleagues, older adults with type 2 diabetes who did resistance training for six weeks were significantly less likely to fall than those who didn't.
Stronger bones: This is important because people with type 2 diabetes are at higher risk for fractures due to weak bones and a high risk of falls, she says.
Mental health: Resistance training is associated with a significant reduction in depressive symptoms, according to a review of 33 studies in JAMA Psychiatry in June 2018. This is important for people with diabetes, who are more likely to experience depression, according to the Mayo Clinic.
Can Diabetes Be Reversed With Exercise?
While you can't ever completely cure type 2 diabetes, research suggests you can achieve remission — meaning you maintain healthy blood sugar levels without needing medication. Exercise can be a healthy part of that equation, but it usually can't cause remission on its own.
"Remission occurs when you lose weight," Dr. Apovian says. This is especially effective very early on in the course of the disease, before it progresses, she adds. The sooner you intervene, the better the chance of achieving remission.
The thing is, the amount of weight that many people with type 2 diabetes need to lose to achieve remission is a pretty large amount, Nicole Ehrhardt, MD, endocrinologist and assistant professor of medicine at the University of Washington, tells LIVESTRONG.com. "It is possible, but it requires 25 to 30 pounds on average," she says.
Exercise has so many wonderful benefits for people with diabetes, but it's not the end all be all of weight loss, Dr. Apovian says. Exercise burns calories, so it's not doing nothing, it's just that other factors, like diet, play a much bigger role in weight loss move the needle to a greater degree.
However, exercise seems to be pretty good at helping people keep the weight off once they do lose it. "There are probably many reasons for this, but we think it has to do with the way exercise promotes healthier hormone secretion," she says.
The 4 Best Types of Exercise for Diabetes
There's no ultimate best exercise for diabetes; rather, the best exercise is the kind you enjoy and will stick with, Dr. Ehrhardt says. However, certain types of exercise are particularly great for controlling type 2 diabetes and its potential complications.
If you haven’t been active and have diabetes-related complications such as high blood pressure, neuropathy or retinopathy, talk to your doctor before you start any sort of workout program.
1. Aerobic Exercise
How it helps: When you do aerobic exercise for diabetes, whether it's more moderate activity like walking or more vigorous like running or taking a cycling class, your muscles use glucose, the sugar in your bloodstream, to fuel your workout.
"This brings down your blood glucose levels, and it can last for hours after finishing a cardio activity," says Julia Iafrate, DO, assistant professor of rehabilitation and regenerative medicine at Columbia University Medical Center in New York City. It also helps your body better use insulin, per the ADA.
You don't have to run a marathon to see results, either. One July 2016 Diabetologia study found that when people with prediabetes (a precursor to type 2) did moderate-intensity exercise like walking briskly for 11.5 miles each week (that's a little over 1.5 miles a day), they improved glucose tolerance (how effectively the body responds to sugar) by 7 percent.
How to do it: The ADA recommends all adults with type 2 diabetes engage in at least 150 minutes of moderate- to vigorous-intensity activities like walking, running, swimming or cycling each week.
"You should spread it over at least three days a week, with no more than 48 hours without activity, since exercise's effects on insulin sensitivity only last for a day or two," says Sheri Colberg-Ochs, PhD, an exercise physiologist and professor emerita of exercise science at Old Dominion University.
Total beginner? Consider working with an exercise physiologist to come up with a program that's right for you, Dr. Iafrate says. (This is often covered by insurance companies.) It's fine to start slow, with just 5 to 10 minutes of moderate activity per day until you can slowly build up to 30 minutes most days of the week.
If you're no stranger to the gym and feel comfortable doing so, bring your workout up a notch by throwing in some interval training, says Jacqueline Shahar, MEd, a clinical exercise physiologist and diabetes care and education specialist at the Joslin Diabetes Center in Boston. This means doing spurts of high-intensity effort alternated with periods of recovery.
A March 2017 study in the Scandinavian Journal of Medicine & Science in Sports found it can has major benefits. In the study, people with type 2 diabetes who did 4 to 6 30-second cycling sprints followed by 4-minute recoveries had better glucose metabolism in their muscles than those who just biked at a moderate intensity for 40 to 60 minutes.
If you're a novice to intervals, don't worry. They can be as simple as throwing some hills into your walk or run, or picking up the pace for 30 to 60 seconds followed by 4 minutes at a more moderate speed.
You may also need to stick with low-impact workouts, especially if you have arthritis or neuropathy in your feet. Dr. Ehrhardt recommends moving your resistance training to a pool, or using a cardio machine that's low-impact, like a climbing machine, stationary bike or elliptical instead of walking or running. "It's about being smart to protect yourself while still getting your heart rate up and figuring out the best exercise for you," she says.
Workouts to Try
2. Strength Training
How it helps: Even if you do cardio most days of the week, there's another crucial component your exercise regimen should include: resistance training. This is true for everyone, but especially those with diabetes.
"There are two places your body stores carbohydrates — your muscles and your liver," Colberg-Ochs explains. If you don't have much muscle mass, those carbs end up spilling out into your bloodstream, raising blood glucose levels, or being stored by your body as fat.
"Most of the time, the fat ends up in your central abdomen, which makes you even more insulin resistant," she adds. But if you do have muscle mass, these carbs can go into your muscles and then get used up through either aerobic or resistance-training exercises.
"People with diabetes are at risk for lower muscle strength," Colberg-Ochs says.
One March 2016 study in Diabetes Care, for example, found that people with type 2 diabetes had an increased amount of fat in their leg muscles, which actually lead to muscle weakness.
Resistance training builds muscle mass, which in turn enhances insulin sensitivity.
How to do it: The ADA recommends aiming for two to three strength-training sessions a week.
If you're a novice, consider working with an exercise physiologist or a trainer to come up with a plan that's right for you. "It's a good idea, at least at the beginning, to make sure you don't start out too aggressively, and that you're doing exercises correctly," explains Shahar.
When you're just beginning, it's best to just use your own body weight as resistance, with moves such as planks, lunges and modified push-ups, advises Colberg-Ochs. But if you can do eight to 12 reps without the muscle feeling fatigued, it's time to move it up a notch.
"You should be doing each exercise to the point where it's hard to do the last repetition without help," she says.
You can do this by using resistance bands, hand weights (like dumbbells), weight machines at the gym or even simple household items like full water bottles or soup cans.
"The heavier the weight, the more glycogen you use, which enhances your body's insulin action," explains Colberg-Ochs. Challenging yourself is also the most effective path to building muscle, which in turn helps improve insulin sensitivity.
Workouts to Try
How it helps: Regardless of your activity, it's a good idea to stretch after your workout, even if you just dedicate a few minutes to it. Colberg-Ochs also recommends stretching most days of the week, not just after your workouts.
It's important for everyone to help slow the rate at which they lose flexibility as they age, she says, but it's especially important for people with diabetes, who are at higher risk for joint problems: "The extra glucose in the bloodstream can end up sticky like sugar on joint surfaces, actually changing their structure over time," she explains.
As a result, joints and muscles become more brittle and less flexible, making you more likely to get overuse injuries.
How to do it: Stretching regularly is key for increasing flexibility. It's often easiest to stretch right after a workout: It's a great way to cool down, and makes it easier to remember to do it. It's also best to stretch when your muscles are warm and more limber.
Colberg-Ochs recommends stretching most days of the week, if you can. So even on days when you're not planning a full-on workout, take just a few minutes to run through some stretches and work on flexibility.
Need some ideas? This 3-minute stretching routine is a great one to do after any cardio or strength workout. You can also try these five great full-body stretches. Try this 20-minute routine if you have some time — it's especially great for anyone who spends most of their day sitting and needs to just get the blood flowing a bit.
How it helps: Mindfulness-based exercises such as yoga and tai chi have been shown to help people with type 2 diabetes.
A September 2018 review in Endocrinology and Metabolism concluded that yoga can be an effective tool when it comes to blood glucose control, and it also can help treat other, related conditions such as high blood pressure.
Another meta-analysis, published July 2018 in the Journal of Diabetes Research, looked at 14 studies and found that regular tai chi yielded very similar effects.
There are a couple reasons why these types of workouts may be helpful: Besides promoting physical activity, they also help reduce stress, which has been shown to worsen type 2 diabetes, Dr. Iafrate says. They also emphasize flexibility, strength and balance at the same time, all three of which are recommended types of training for anyone with diabetes, adds Colberg-Ochs.
How to do it: While there are no official guidelines on mindfulness-based activities, the ADA recommends flexibility and balance training — which includes yoga and tai chi — two to three times a week. It doesn't matter which type of yoga, either, because there's no specific research showing one is more effective than another, she says.
Workouts to Try
5 Tips for Exercising Safely With Diabetes
1. Monitor Your Blood Sugar Before, During and After
Before your workout: The best time to exercise for type 2 diabetes is about an hour after you've had a small snack, Dr. Iafrate says. Then test your blood sugar about 15 minutes before exercising — it should ideally be over 1oo mg/dL.
During your workout: Check your blood sugar every 30 minutes. Follow what the ADA dubs the 15-15 rule: If your reading is under 100 mg/dL, have 15 to 20 grams of carbohydrate to raise your blood sugar (the equivalent of four glucose tablets, 4 ounces of juice or a tablespoon of honey).
Check your blood sugar again after 15 minutes. If it's still low, have another 15 grams of carbs. Repeat this every 15 minutes until your blood sugar is at least 100 mg/dL.
After your workout: Check your blood sugar again. If you're doing resistance training, keep in mind that your blood sugar may rise right after your workout. This is because strength training can raise stress hormones such as adrenaline for a short period of time, which tends to drive blood glucose levels up, explains Shahar. If yours is elevated, wait about 30 minutes, then check again before administering insulin or other medications.
2. Treat Your Feet Right
The biggest concern with foot neuropathy is that you can cut or otherwise injure your feet and not know it, due to lack of sensation, Dr. Ehrhardt points out. She recommends first working with a podiatrist to make sure you're cleared to do certain exercises. They can also help fit you for special shoes or other devices that might help make your feet more comfortable, she says.
On top of wearing properly fitting shoes, Colberg-Ochs recommends wearing socks made of sweat-wicking material to help keep the feet dry.
You should also check your feet daily to make sure there are no wounds or sores or other trauma. If there are, skip your workout and call your podiatrist or primary care provider. If your workouts are affecting your feet, you may need to do fewer weight-bearing activities, she says. Focusing on low-impact workouts may be necessary, too.
3. Account for Any Hand Issues
Lack of circulation and neuropathy in the hands can present a challenge during certain exercises, though it's not as common as foot problems. "This is less of an issue because most activities can be done without a major focus on the hands," Colberg-Ochs says. To avoid skin callusing and tearing, you can try wearing weightlifting gloves when doing any exercises that require gripping weights.
If you're concerned about your ability to grip a weight and hold it without dropping it, you should talk to your doctor and work with a fitness professional to learn how you can keep strength training safely.
4. Keep Any Other Health Conditions in Mind
It's important to also consider any other health conditions you have on top of diabetes — high blood pressure, cardiovascular disease and arthritis are all common comorbidities, and you may need to adjust your fitness routine for them. For example, you may need to keep your cardio workouts within a certain intensity level or duration of time to account for any heart-related issues, and there might be some exercises you need to avoid because of joint inflammation and pain.
Additionally, certain medications have a risk of low blood sugar, so you want to make sure you know that and know how to account for it when exercising, Dr. Ehrhardt says.
Exercising with diabetes only helps improve your health if you do it right and without hurting yourself, so you want to make sure you're looking at your entire health picture when choosing how to work out.
5. Talk to Your Doctor Before Starting Anything New
"Always important to talk to your healthcare provider if you are starting or changing your exercise," Dr. Ehrhardt says. They can tell you if there's anything you need to be cautious about, adjust your treatment if necessary and evaluate you once you've started exercising to help you decide next steps.
Generally, starting a walking routine is going to be helpful and safe for mostly everyone, Dr. Apovian says. But if you want to start to lift weights, run or do other types of high-intensity exercises with diabetes, always talk with your doctor first to make sure you're fully cleared.
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.