The best exercises to manage diabetes and lower blood sugar

From insider.com

The best exercises for diabetes include any type of moderate physical activity, such as walking, gardening, or playing tennis. 

If you have diabetes or may be at risk, it's important to get about 150 minutes of moderate exercise every week, as it can help lower blood sugar levels. 

Make sure you talk with your doctor to learn how to exercise safely with diabetes, especially if you have type 1, which may come with more health risks. 

This article was reviewed by Jason R. McKnight, MD, MS, a family-medicine physician and clinical assistant professor at Texas A&M College of Medicine

Exercise and physical activity are extremely beneficial for overall health. And if you have type 1 or type 2 diabetes, or may be at risk, the benefits are quite useful.
"Regular exercise is especially important for those living with diabetes," says Alex Li, MD, an internal medicine specialist in Los Angeles.

But exercise can also present some complications for people with diabetes. Here's how to create a safe, effective workout routine if you have diabetes.

Why exercise is important for people with diabetes 

The American College of Sports Medicine and the American Diabetes Association both agree that exercise is "critical for optimal health" in individuals with diabetes.

When you exercise, your body burns glucose, or blood sugar, for fuel. This helps lower your blood sugar levels. As you exercise more, this effect is amplified over time, which leads to a decrease in insulin resistance. It's important to reduce insulin resistance, as it is what causes type 2 diabetes.
Regular exercise can also help you build muscle and decrease fat, both of which boost your body's ability to use insulin. In general, people with both type 1 and type 2 diabetes benefit from becoming more sensitive to insulin.

"In the short term, it can lower blood sugar, and in the long term, it can improve insulin sensitivity," says Emory Hsu, MD, an endocrinologist with Santa Clara Valley Medical Centre in San Jose, California.

A 2019 scientific review published in Annals of Physical and Rehabilitation Medicine found evidence that structured exercises — like engaging in an eight-week exercise class — can reduce insulin resistance for people with type 2 diabetes. The average participant saw their blood sugars drop by 5.12 points after intervention. 

Moreover, a 2017 study published in the Journal of Jiroft University of Medical Sciences followed 28 women with type 2 diabetes for eight weeks. Fourteen participants did not exercise, while the other 14 did aerobic exercise (cardio) three times a week and resistance training twice a week. After eight weeks, the exercise group had lower blood sugar and less insulin resistance than the control group.

How much exercise you need

People with diabetes, just like all other American adults, should aim to get 150 minutes of moderate exercise per week, according to a 2016 position statement by the ADA.
"If you're not exercising already, don't let this number intimidate you," Hsu says. "Any exercise is better than none, and you can start more slowly and ramp up."

The ADA recommends that people with type 2 diabetes or who are at risk for the condition exercise daily and never let more than two days lapse without physical activity. Most types of physical activity can count as exercise, even gardening or walking.

"If you are walking, this means you should walk briskly enough to start breaking a sweat or start to feel like you need to breathe more rapidly," Hsu says.
Other types of moderate exercise include:

• Mowing the lawn
• Swimming
• Playing tennis
• Casual bike riding

All of these types of exercise can be beneficial. A 2019 scientific study published in The International Journal of Exercise Science followed 905 people with type 2 diabetes who were previously inactive. They did aerobic exercises, resistance training, or a combination of the two for 49 minutes three times per week.

The study found that all three types of training reduced A1C levels, which measure average blood glucose over time. Combination training had the biggest impact, followed by aerobic exercise and then resistance training.

Overall, making exercise a sustainable part of your daily and weekly routine is important. Try going for a walk on your lunch break, or using resistance bands after work. Whatever allows you to hit the targeted 150 minutes of exercise is the right plan for you, Li says.

How to exercise safely with diabetes

Exercise is recommended for all people with diabetes, though some may have to take extra precautions. For example, people with type 1 diabetes should be particularly careful.

"For type 1 diabetics, exercise can lower blood sugar more dramatically," Hsu says. Dangerously low blood sugar, or hypoglycaemia, can cause health complications including seizures and coma in severe cases.

People with type 1 diabetes should carefully plan their exercises around food intake and insulin dosage, according to the ADA. It's also important to measure your blood sugar levels before, during, and after exercise — or check your blood sugar with a continuous glucose monitor. 
Overall, it's best to work with your doctor to develop a routine if you have type 1 diabetes.

If you have diabetes and are starting an exercise routine, you should take the following steps:

• Speak with your doctor. Let them know if you've had any other health complications with diabetes, like eye problems, heart disease, or stroke. 
• Start slow. Familiarize yourself with how exercise affects your blood sugar by measuring your blood sugar before and after exercise, and monitoring any major changes. Your blood sugar should stay within the healthy range that you and your doctor have established. 
• Monitor your feet for ulcers or sores. Many diabetics have decreased sensation in their feet, Li says, so you might not notice pain from sores. Visual monitoring can help you spot them and prevent infection.   

Takeaways

Working your way up to at least 150 minutes of exercise per week can help you manage your diabetes and lower blood sugar. Exercising with diabetes — particularly type 1 diabetes — can take some extra planning, but the health benefits are well worth it, Li says.

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