Type 2 Diabetes and Exercise

Type 2 Diabetes and Exercise

In this article Functional Health discusses Type 2 Diabetes and Exercise. At Functional Health, we like to discuss various topics through our social media and websites. We believe that providing our patients with information on health issues that may affect them is crucial to their well-being and helps us deliver a better Allied Health Service.

The problem:

Type 2 diabetes is one of the most prevalent conditions in Australia. According to Diabetes Australia, approximately 1.7 million Australians live with diabetes, with 170 new patients diagnosed daily (one every five minutes). Type 2 diabetes is a condition where our bodies do not respond to the hormone insulin as effectively as they used to. Insulin regulates the uptake of glucose we ingest to be stored and used as fuel for energy production. Without the actions of insulin, high levels of glucose exist in the blood, which can cause several health issues, including increased risk of heart disease, high blood pressure, and damage to nerves (particularly in the hands and feet), eyes, and kidneys.

The solution:

Type 2 diabetes can be effectively managed with medications that enhance the body’s ability to use insulin or by artificially supplementing the body with more insulin. However, at the cornerstone of type 2 diabetes management is lifestyle modification: increasing physical activity and eating a healthy diet.

Large studies of thousands of patients with impaired glucose tolerance (the precursor to diabetes; pre-diabetes) have shown that in patients who engaged in a physically active lifestyle (150-300 minutes per week of physical activity) and consumed a diet that promoted weight loss, the incidence of new cases of diabetes was reduced by over 50% .

The remarkable effectiveness of exercise and physical activity in preventing type 2 diabetes is due to the fact that exercise has a similar effect to insulin on skeletal muscle.

While a diabetic patient may not respond as efficiently to insulin to take up glucose into skeletal muscle, a muscle that has been exercised can take up glucose via a different pathway triggered by exercise. Additionally, the muscle becomes more sensitive to insulin, leading to increased glucose uptake following exercise that persists for several hours. This means that exercise should be completed regularly (e.g. walking 30 minutes each day) to ensure that glucose sensitivity is maintained.

A recent study in the Journal of the American Medical Association showed that in patients who were treated with medication and a lifestyle intervention (increased physical activity and dietary improvement), 73% had a reduction in their glucose-lowering medication compared to only 26% of those receiving just medication. This means that a healthy lifestyle can reduce the amount of glucose-lowering medications required to achieve adequate control based on the mechanisms of exercise on glucose uptake.

For more information about diabetes, visit Diabetes Australia or consult your GP.

The strategy:

Exercise and Sports Science Australia, the peak body for exercise guidelines in Australia, suggests that patients with diabetes aim for 210 minutes of moderate-intensity exercise (slightly out of breath but still able to hold a conversation) or 125 minutes of vigorous exercise (unable to maintain a conversation) per week.

This should ideally include both aerobic exercise (walking, jogging, or swimming) and resistance training (weight-based exercises). Resistance training can improve the amount of muscle we have, increasing the overall surface area that can take up glucose and improve control. For example, more parks are being built with resistance training equipment (e.g. chest press machines or step-ups) at various intervals along walking paths. This is a great way to engage in some resistance training during an aerobic session.

Given the effects of exercise on improving our sensitivity to insulin after each session, which can last up to 48 hours, there should be no more than two days of inactivity in a row, as this is when the effect will have worn off. However, before commencing an exercise programme, it is important to discuss with your GP, Exercise Physiologist, or Physiotherapist any medical issues that might impact your ability to exercise safely. In particular, it is important to measure your blood glucose after exercise to ensure it does not become too low.

Increasing your physical activity level is one of the most important components of managing type 2 diabetes. If you are looking to begin but need help getting started or have any questions, consider giving us a call at Functional Health to see how we can assist you.

Hordern MD et al., 2012. Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise and Sport Science Australia, Journal of Science and Medicine in Sport, 15 (2012), 25–31.
Johansen MY et al., 2017. Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial; The Journal of the American Medical Association, 318(7):637-646.