Managing Diabetes Through Targeted Exercise
Exercise plays a critical role in diabetes management and the prevention of type 2 diabetes. Diabetes is a condition characterized by the body’s inability to manage blood sugar levels properly. The body either does not produce enough insulin or does not respond normally to insulin, causing glucose levels in the blood to become too high. Exercise has numerous benefits for those with diabetes, including lowering excessively high blood sugar levels, improving a patient’s HbA1c, improving vascular health and blood pressure, lowering inflammation, and enhancing nerve function and joint health. Physical therapists can help diabetic patients improve their physical fitness and engage in exercise safely through a targeted exercise program.
Diabetes FAQ
Diabetes is a condition characterized by the body’s inability to manage blood sugar levels properly. The body either does not produce enough insulin or does not respond normally to insulin, causing glucose levels in the blood to become too high. Insulin allows glucose into cells where glucose is used for energy. Over thirty-seven million Americans (1 in 10) have diabetes and over 88 million Americans (more than 1 in 3) have pre-diabetes.
There are several different types of diabetes:
Type 1: Type 1 diabetes is more commonly diagnosed in children and young adults and is an autoimmune condition in which the immune system mistakenly attacks insulin-producing beta cells in the pancreas, which results in little to no insulin production.
Type 2: Type 2 diabetes is more common and most often affects adults. It occurs when the body becomes resistant to insulin or when the pancreas can’t produce enough insulin.
Gestational Diabetes: This type occurs during pregnancy and increases the risk of complications during pregnancy and delivery as well as increasing mom and baby’s risk of type 2 diabetes later in life. It is more common in overweight women, those with a history of diabetes, or in older pregnant women.
Common signs of type 1 and 2 diabetes include extreme thirst, frequent urination, severe hunger, sudden weight loss, fatigue, irritability, and blurry vision. Signs are more pronounced in those with Type 1 diabetes.
Risk factors for type 2 diabetes can include being overweight or obese (particularly visceral fat around the abdomen and vital organs), a sedentary lifestyle, aging, a family history of diabetes, and high blood pressure. Diabetes is a condition that can act as a comorbidity, meaning it can make other health conditions worse, such as increasing the risk of cardiovascular disease.
How Exercise Improves Glucose Disposal & Insulin Action
Exercise helps the body lower excessively high blood sugar levels because it triggers the uptake of glucose from the bloodstream into working muscles and organs. The contraction of muscles during exercise and the contraction-mediated skeletal muscle blood flow leads to glucose uptake.
Exercise can impact glucose homeostasis for up to 48 hours. Exercise increases skeletal muscle GLUT4 expression (which facilitates transport of glucose into the muscle). It also augments insulin receptor signaling and oxidative capacity, which optimizes insulin action and glucose oxidation and storage.
Benefits of Exercise for Diabetes Management
Exercise plays a critical role in diabetes management and the prevention of type 2 diabetes. In fact, the American Diabetes Association recommends that adults with diabetes participate in aerobic and resistance training weekly (150 minutes of moderate aerobic exercise per week, or 30 minutes a day, and at least two resistance training sessions each week).
Exercise has numerous benefits for those with diabetes:
Exercise lowers excessively high blood sugar because it triggers the uptake of glucose from the bloodstream into working muscles and organs.
Exercise builds muscle which helps in glucose regulation. After eating, up to 80% of the glucose in the body goes to the muscles. If we have low muscle mass, we have a lower capacity to clear glucose from the bloodstream. If we have greater muscle mass, we are better able to clear glucose from the bloodstream as our muscles have more insulin receptors.
Exercise helps maintain a healthy weight. If an individual has excess body weight, losing 5 to 10% of body weight can improve A1C, the three-month average of blood sugar levels. Obesity is a risk factor for developing diabetes, so maintaining a healthy weight can help prevent the development of diabetes.
Exercise reduces visceral fat, which is abdominal fat that plays a role in the development of insulin resistance and diabetes. Visceral fat stores energy and produces and releases chemicals and hormones that make it harder for the body to use insulin, worsening insulin resistance.
Exercise also decreases stress by completing the stress cycle fight or flight response, which in turn decreases blood sugar levels.
Exercise improves vascular health, improving the ability of blood vessels to move oxygen and nutrients throughout the body. This reduces the risk of neuropathy, vision loss, and heart issues associated with diabetes.
Exercise lowers inflammation in the body. Inflammation is thought to be a major cause of the progression of type 2 diabetes and related conditions like arthrosclerosis, cognitive decline, and joint deterioration.
Exercise improves blood pressure and cholesterol and strengthens the heart through improvements in blood flow, reductions in inflammation, and improvements in vascular health.
Exercise helps to restore nerve function, helping to reduce diabetes-related pain and neuropathy.
Exercise improves joint health and addresses joint mobility limitations like frozen shoulder.
Research has shown that exercise can prevent the development of diabetes and help patients with diabetes manage the condition effectively. In the Diabetes Prevention Program (DPP), those patients who achieved 150 minutes of moderate intensity exercise each week had a 46% reduction in diabetes incidence. Another study looked at the effect of exercise alone on reducing the incidence of diabetes and found that the group who engaged in diet-only interventions had a 33% reduction; the exercise-only group had a 47% reduction; and the diet and exercise intervention group had a 38% decrease.
Studies have also shown that when those with type 2 diabetes exercise, they have a decrease in HbA1c by 0.67%, regardless of the type of exercise (aerobic, resistance, or combined training). Resistance training and aerobic exercise are effective in lowering insulin resistance in sedentary older adults; researchers have found that combining resistance and aerobic training is even more beneficial for diabetes patients. Another study found that women with diabetes who spent at least four hours a week doing moderate or vigorous exercise had a 40% lower risk of developing heart disease than those that didn’t exercise.
A meta-analysis of 915 participants compared the glycemic benefits across aerobic, resistance, and combined training through reductions in HbA1c. Both aerobic and resistance training showed reductions in HbA1c; however, combined training showed the greatest reductions in HbA1c, fasting glucose, and triglycerides.
Physical therapists can help diabetic patients improve their physical fitness and engage in exercise safely. Physical therapists design a customized exercise program tailored to the patient’s abilities, allowing diabetic patients to learn how their body responds to exercise under the supervision of the therapist while building endurance, strength, and mobility. A physical therapy program for a diabetic patient can include a graded, progressive exercise program involving aerobic and resistance training, stretching and balance and coordination training, chronic pain treatment, and foot pain assessment and strengthening.
Are you interested in learning how to manage your diabetes using exercise? Work with a physical therapist to safely exercise and gain the many benefits of exercise for diabetes management!
