Everything You Need to Know About Weightlifting and Diabetes

If you have diabetes — either type 1 or type 2 — you're probably all too familiar with the recommendation that you move more.

"Everyone should be exercising, with or without diabetes," Laurie A. Kane, MD, an endocrinologist at Providence Saint John's Health Center in Santa Monica, California, tells LIVESTRONG.com. And if you have diabetes, exercise should be part of your treatment plan, she says.

Any type of movement is beneficial. But if you have diabetes, experts recommend incorporating strength training into your exercise routine. Find out the benefits it delivers — along with some steps to take before you pick up weights.

A quick note on terminology: Consider weightlifting, strength training and resistance training to be synonymous. As the American Diabetes Association (ADA) noted in an October 2016 position paper on physical activity, these terms cover workouts that use:

• Free weights
• Weight machines
• Body-weight exercises
• Resistance bands

For adults who have diabetes, these resistance-training workouts should be done two to three times a week, nonconsecutively, per ADA guidelines. There's good reason for this ADA recommendation — strength training delivers many benefits for people with diabetes, including:

By lifting weights, you'll tend to improve your blood sugar control, Dr. Kane says.

Here's why: When you strength-train, your body uses the glycogen stored in your muscles for fuel, explains Sherry Roberts RDN, a certified diabetes care and education specialist. After tapping into the supply in the muscles, your body uses the glycogen from the liver and blood, she says.

"As this fuel is depleted, the blood sugars will decrease and also provide a place for future sugar to go when carbohydrates are consumed," Roberts says.

There's a connection between losing muscle mass and having type 2 diabetes, according to Harvard Health Publishing.

By lifting weight, you can upend that trend, and instead increase your muscle mass, per the ADA. Doing so "provides additional storage for consumed carbohydrates," Roberts says. That is, by increasing your muscle mass, you'll have more capacity to store glycogen, she says. "[This] in turn will lower blood sugars," Roberts says.

Weight and diabetes have a complicated relationship. What's clear: For people with type 2 diabetes, losing weight helps improve blood sugar, according to Johns Hopkins Medicine.

While it's often cardio that comes to mind when you're thinking about the best exercises for weight loss, strength training is a powerful weapon as well. By making weightlifting part of your workout routine, you'll lose fat but gain muscle. This affects your metabolism, so you burn more calories even after your workout is complete, according to the American Council on Exercise (ACE).

"Even as the body rests, the lean muscle will continue to burn calories," Roberts says.

Resistance training improves insulin resistance, per the ADA. Weightlifting reduces your visceral fat (that's the hard kind, that wraps around your organs) which "produces chemicals and hormones that keep the body from using insulin effectively," Roberts says.

So when you cut down on visceral fat, you improve insulin resistance, which in turn leads to improved blood sugar, she explains.

It's worth noting that resistance training delivers other benefits that can be particularly meaningful for diseases that often accompany diabetes. Take a look:

• ​Improvements to fatty liver disease:​ Not all people with diabetes have nonalcoholic fatty liver disease (NAFLD) — but it is a risk factor, according to the Mayo Clinic. And when clinicians look for it, NAFD is often discovered in patients who have diabetes, Dr. Kane says. Studies show that resistance exercises can improve fatty liver, she says.
• ​Improved heart health:​ Diabetes and heart disease often go hand in hand, according to the Centers for Disease Control and Prevention — not only is high blood sugar harmful to the heart, but diabetes is linked with other conditions, such as high blood pressure and high cholesterol, that are hard on the heart. Strength training may help boost HDL (aka "good" cholesterol) and lowers LDL (aka "bad" cholesterol), Roberts notes.
• ​Improved bone health:​ People with type 1 diabetes are more prone to fractures and poor bone quality, per the National Institutes of Health (NIH). Weight-bearing and resistance exercises strengthen bones, according to the NIH.
• ​Blood flow:​ Poor circulation is a frequent issue for people with diabetes, according to UCLA Health. "Certain complications of diabetes can result when blood flow is impaired, such as retinopathy and peripheral neuropathy," Roberts says. Exercise is beneficial to blood flow.

Many health complications can accompany diabetes, according to the Mayo Clinic. These complications can take some exercises off the table — but they do not at all mean that working out isn't doable.

"Diabetes is not a homogenous disease," Dr. Kane says. Whether you have type 1 or type 2, how long you've had diabetes, any complications and your blood sugar control history all should be taken into account before planning an exercise regimen.

Here, important considerations for conditions that often travel with diabetes, courtesy of the ADA:

• ​Heart disease:​ Be cautious about strenuous activities and heavy lifting. If you have a lot of cardiac risk factors, your doctor may recommend a stress test and echocardiogram to understand how your heart functions prior to you beginning an exercise program, Dr. Kane says.
• ​Blood pressure:​ This is important to monitor, Roberts says. "Heavy lifting and straining should be done with caution if you have retinopathy and high blood pressure," she notes.
• ​Retinopathy (eye damage):​ Diabetes can lead to damage to blood vessels in the eyes, per the Mayo Clinic. If you have this, resistance exercises or anything where you bear down is a no-go, because it increases bleeding risk from these fragile blood vessels, Dr. Kane says.
• ​Neuropathy (nerve damage):​ This can lead to damage occurring to a person's feet without feeling it, Dr. Kane says. Some exercises — including prolonged weight-bearing activities — should be done with caution, per the ADA. If you have neuropathy, examine your feet daily for ulcers or sores, Dr. Kane says. "Wear comfortable shoes that fit well and do not rub or cause blisters," Roberts suggests.

It may be better to tiptoe, rather than dive, into weightlifting. Here's what to keep in mind as you start your regimen:

Make this your first step.

"Diabetes does not cause any additional risks itself to beginning an exercise program," Roberts says. But, as noted above, complications from diabetes can make certain exercises off-limits or require a more cautious approach.

Every expert we consulted agrees: It's wise to use a certified personal trainer, even if it's just for a handful of sessions. Here are some of the reasons it's so key:

• ​Prevent injuries:​ Safety first! An expert will help make sure you have the correct form, which will prevent injuries, Roberts says.
• ​Get informed:​ If you're new to the gym, the machines, weights and barbells can appear more like weapons than instruments to improve your health. "[It] can be quite daunting for someone that's just getting started," Josh Honore, NASM-CPT, coach for Row House, tells LIVESTRONG.com. Having someone steer you eases the overwhelm.
• ​Increase efficiency:​ Instead of a grab-bag of random moves, a trainer can steer you to the most meaningful ones. "Usually a trainer's knowledge base will help us be more efficient in the gym," Honore notes. "So instead of doing a bunch of random exercises, we can focus on maybe two or three that are really going to have a deep impact on our goals," he notes.
• ​Add personalization and insight:​ There's no shortage of information online about weight training, Honore points out. But: "It's very challenging to consolidate all that into a program that works for us as individuals." Trainers can work with your goals and within your health and lifestyle to tailor an effective program, he says. Plus, a trainer can help you understand your body's cues, so you can know when you've hit a limit, and when to push through.

Hypoglycemia — aka low blood sugar — is the biggest risk of exercise for people who have diabetes, Roberts says. "It is important to monitor blood sugars before, during and after exercise," she says.

Before exercising, you'll want a Goldilocks-like level of blood sugar — neither too low, nor too high. Mayo Clinic guidelines for pre-exercise blood sugar levels are:

• ​Below 100 mg/dL:​ This is too low for a workout. Either skip it, or eat something, wait and then check your blood sugar again.
• ​100 to 250 mg/dL:​ This is the sweet spot. "A good general recommendation is to make sure blood sugar is over 100 mg/dL," Dr. Kane says. Higher than that is even better, so long as you remain under 250 mg/dL.
• ​250 mg/dL or above:​ This is high, and merits checking for ketones, Dr. Kane says. "If sugars are high, especially if there are ketones in the urine, then it's best to cancel the exercise session and address the high blood sugar," Dr. Kane says.

Get familiar with common signs of low blood sugar, Roberts recommends. They include:

• Dizziness
• Shakiness
• Cold sweats
• Heart palpitations
• Blurred vision
• Headache
• Confusion

"I strongly recommend that diabetes clients keep snacks on hand, and keep an eye on your blood sugar," Honore says. Appropriate snacks to address low blood sugar include glucose tablets or a small juice box, Roberts says.

A pre-exercise snack consisting of complex carbohydrates and a small bit of protein can help prevent low blood sugar during exercise, Roberts says. You may also want to plan ahead and have a post-exercise snack at the ready to prevent low blood sugar, she says.

It's a good idea to be consistent with your workout time, Dr. Kane says. It's also helpful to keep workouts at the same duration and intensity level, according to the University of Michigan Health. These tactics help keep blood sugar levels steady.

Keep mealtime and medications in mind when selecting a workout time, per the Mayo Clinic.

As you're thinking about your workout time, keep personal preferences in mind, too — some of us are larks, and others thrive in the afternoon or evening. Focus on frequency of workouts, rather than duration of time, Honore says. You don't need to put in an hour a day, seven days a week; committing to two to three workouts, at 30 to 40 minutes apiece, can be really effective, he says.

Take it easy when you first start strength training — collecting small wins early on helps to build momentum and consistency, Honore says.

Opting for heavy weight before you're ready can lead to injury, Roberts says.

Build in recovery time — that is, do not work out the same muscle groups on consecutive days, Roberts says.

Finally, "start with something that makes you feel good," Honore advises. You want to feel good about your workout — not exhausted or frustrated.

Working out big muscles — like the legs and back — helps create more of an insulin response, Honore says.

Plus, having strong legs and improving the leg and hip function helps you feel healthier overall, Honore says. "And it's an area where a lot of us are pretty tight, especially with a lot of us working at home and working from desks," he notes.

Working out the back helps improve posture, which gets rounded out by days hunched over a computer, he says. When "we push the back, we get a massive hormonal response," he says.

There's a certain complexity to working out if you have diabetes — you'll have considerations that people who don't have this disease won't have to consider.

But the benefits are considerable.

Roberts can attest to these wins: As well as being a nutrition expert and diabetes educator, she's had type 1 diabetes for nearly three decades. For the past 18 months, she's made strength training a consistent habit — it's led to improved blood sugar and using less insulin to keep her blood sugars in range. "Overall, my blood sugars are much more stable," she says. "I am also much more productive in my everyday activities. Strength training has literally changed my life for the better."