The Role of Exercise in Diabetes Management

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes is a very prevalent chronic disease globally with millions of people of all ages being victims of this condition. One of the main ways to treat the disease is with the use of medications and diet; however, changes in lifestyle are also instrumental in keeping the condition under control. Of all of these, exercise works as a potent and yet natural measure to control blood sugar and help heart health as well as overall wellbeing. Knowledge of how exercise helps in the management of diabetes may help people to be more proactive in combating diabetes and minimizing complications of the disease.

Why Exercise Matters for People with Diabetes

Exercise is very important for people with diabetes because it helps control blood sugar levels and reduces the risk of severe health complications associated with diabetes. Here are the key reasons why exercise matters for people with diabetes:

• Enhances blood sugar regulation: Exercise aids muscles in utilizing blood sugar (glucose) more accurately, which increases insulin sensitivity and reduces blood sugar levels. It has been reported that regular exercise regimes can lower blood sugar to same extent as diabetes drugs. This is possible up to 2 days after exercising.
• Increases muscle mass and muscle energy use: The larger the muscle mass, the easier the body uses blood sugar as energy, thereby assisting with sugar management. Resistance regular exercise develops muscle and enhances insulin sensitivity which are especially useful in type 2 diabetes.
• Lowers Blood Pressure: The regularity of exercising lowers blood pressure by promoting a longer stroke volume which in turn increases blood flow. This shields individuals with diabetes against heart disease that is a standard complication.
• Aids in Weight Management: Exercise and particularly when added to healthy eating aids in weight loss and weight maintenance. This lowers insulin resistance and can even bring diabetics with type 2 diabetes to remission.
• Means to Enhance Overall Well-being: Exercise helps to boost energy, mood, sleep and mental well-being because it releases endorphins. It also aids flexibility of joints and stress reduction thus leading to higher quality of life.
• Various Kinds of Exercise Are Advantageous: Aerobic (e.g. walking, cycling, swimming) and resistance training (e.g. weightlifting, bodyweight exercises) are both beneficial. Combining both types has maximum benefits, but any regular exercise will be beneficial HIIT is effective as well.
• Considerations Regarding Safety: Patients with diabetes must measure their blood glucose before and after their workout to prevent hypoglycemia, especially when taking insulin or other blood sugar decreasing drugs.

Key Benefits of Exercise in Diabetes Management

Key benefits of exercise in diabetes management include:

• Enhances Blood Sugar Control: Exercise improves insulin sensitivity and uptake of glucose by muscles thus ensuring lower blood sugar levels and controlling glucose up to 24-48 hours after exercise. This is critical in controlling diabetes type 1 and diabetes type 2.
• Creates Insulin sensitivity: Exercise leads to insulin sensitivity, which is the fundamental issue in diabetes type 2 since it helps the body to respond positively to insulin.
• Reduces HbA1c: The interval average of blood glucose (HbA1c) level is reduced by about 0.67 percent through regular exercise, equating to some diabetes drugs.
• Facilitates Weight Control: Physical activity aids in weight loss and weight maintenance and decreases metabolic demands to provide greater control of diabetes. It also decreases central fat that is affiliated with metabolic risk.
• Enhances Vascular Health: Exercise reduces blood pressure, improves HDL and LDL cholesterol and blood triglyceride levels, and reduces the risk of cardiovascular disease, which is elevated in individuals with diabetes.
• Develops Muscle Mass and Strength: Weight based exercising increases the mass of muscles, which also has a positive outcome in insulin resistance as well as glucose metabolism.
• Boosts Mental Health and Well-being: Through the release of endorphins, exercise lessens stress levels, enhances mood, induces sleep, and diminishes signs of anxiety and depression.
• Aids in Prevention of Diabetes: In people who have pre-diabetes and those who are at risk, physical exercise is very effective in reducing the chances of developing diabetes type 2. Diets with regular exercise can help lower incidence by up to 74-46 percent in clinical trials.
• Varied Types of Exercise: It is best to combine aerobic work (walking, cycling, swimming), athletic training, and even dancing or walking sports. The routine is made sustainable by consistency and fun.

Overall, exercise is a cornerstone of diabetes management for its multifaceted benefits on glucose control, cardiovascular health, weight management, and overall quality of life.

Types of Exercise Recommended for Diabetes

The best exercises suggested to those with diabetes are a collection of aerobics, resistance, flexibility, and balance exercises. The most significant ones are the following categories and examples:

1. Aerobic Exercise
   • Walking (brisk walking is especially beneficial)
   • Cycling
   • Swimming and water aerobics (low impact on joints)
   • Running or jogging (if appropriate)
   • Aerobic dance or fitness classes (e.g., Zumba)
   • Team sports like basketball, soccer, tennis
     Aerobic exercises improve cardiovascular health, lower blood sugar, and help with weight management.
2. Resistance Training (Strength Training)
   • Weightlifting with free weights or machines
   • Resistance band exercises
   • Bodyweight exercises (push-ups, squats)
     Resistance training builds muscle mass, which improves glucose uptake and insulin sensitivity. It complements aerobic exercise in diabetes control.
3. Flexibility and Balance Exercises
   • Yoga
   • Tai Chi
   • Pilates
     These improve flexibility, balance, and stress reduction, helping especially older adults with diabetes avoid falls and better manage blood sugar.
4. Low-Impact and Seated Exercises
   • Aquatic exercises are good for joint issues or neuropathy
   • Specific calf muscle exercises (like soleus push-ups) can help lower blood sugar even when seated.
5. High-Intensity Interval Training (HIIT)
   • Alternating periods of high- and low-intensity exercise (e.g., sprinting and walking)
     HIIT can be effective in improving blood sugar and fitness in people with type 2 diabetes.

General guidelines indicate that one should exercise at least 150 minutes weekly of moderate-intensity aerobics, performed on most days, and added two or three sessions of resistance training. Balance training and flexibility exercise are advised regularly, particularly those at old age.

You may also like to read: Importance of Carbohydrate Counting in Diabetes

Best Times to Exercise for Blood Sugar Control

The best times to exercise for blood sugar control in people with diabetes are generally:

• Afternoon and Evening: Afternoon or evening exercise has shown to provide greater benefit in insulin resistance and blood sugar regulation. In a study by Anderson, the work conducted moderately vigorous physical activity at noon to midnight cutting down insulin resistance and hepatic fat content significantly as compared to earlier in the day. Midday and evening exercise regimens performed better than a morning or all-day strategy at reducing insulin resistance with an 18 and 25 per cent lower rate of reduction respectively.
• Three to Dosto Hours After Eating (Post-Meal): This is an ideal time to work out as the glucose level is elevated and ready to be burnt. Exercise after meals may be able to reduce after-meal blood sugar spikes, as well as long-term cardiovascular risks. This schedule is viable in the control of glucose levels after a meal.
• Morning Exercise: This is not an advantage, but morning exercise may be appropriate to those who want to work out in the morning or must attend other activities in the daytime. It is reported that fast exercise in morning can enhance insulin sensitivity of a day, helping to manage weight and decrease food consumption. In the case of individuals with type 1 diabetes, training in the morning may enhance risks of hypoglycemia less than training later in the day.
• Timing Should Accommodate Personal Routine and Chronotype: A consistent time schedule is the most important thing to adhere to in long-term equivalents. The chronotype (being a morning or an evening person) also has an impact on exercise preference and metabolic reactions. Selecting a time that suits one better helps to sustain physical activity.
• Safety precautions: Insulin users or users of blood sugar-lowering drugs should measure their blood sugar before any exercise to avoid hypoglycemia, irrespective of the time of exercise.

Precautions and Safety Tips

Here are important precautions and safety tips for exercising with diabetes:

• Medical Approval: Seek doctor approval before commencing and changing an exercise regime especially when you have heart disease, neuropathy, retinopathy, kidney problems, or you use insulin or a drug that can cause hypoglycemia. Your physician can prescribe exercise advice and can modify the drugs.
• Start at Low Pace: When starting or after a hiatus, start at low and slow pace to prevent injury and over-fatigue yourself.
• Monitoring Blood Sugar: Monitor blood sugar levels before, during (long instance only), and after exercise especially in cases where you are taking insulin or other medications that reduce blood sugar as this could result in hypoglycemia. Use quick-energy carbohydrates to correct low blood sugar.
• Hydrate: Before, during and after physical activity, drink lots of water to avoid dehydration.
• Use Good Quality Footwear and Care: Wear proper shoes that fit your feet well and have good support. Wear socks made of moisture-absorbing materials to keep your feet and feet dry. Check feet daily, it you have neuropathy.
• Warm Up: Cool Down: 5-10 minutes warm up and cool down to gear up the muscles and minimize the chances of injury.
• Sporting in Safe Areas: Never sport in areas with extreme climate conditions, sport either indoors in the slightest weather extremes.
• Wear a medical ID bracelet or tag indicates you have diabetes in case of an emergency.
• Take Note of Your Body: Do not exercise when you are in pain, dizzy, lacking breath or weak. Remedy any strange symptoms with your doctor.
• Practice Constantly: The benefits will persist with regular physical activities over time and at the same time.

By taking these precautions, exercise becomes safe and effective in management of diabetes.

Would it also help to give some specific advice on how to manage blood sugar before/during/after what types of exercise? The key precautions and safety tips of exercising with diabetes are as follows:

• Check with your physician before undertaking or modifying an exercise program, particularly when you have heart disease, neuropathy, retinopathy, kidney problems, or are on insulin or some medications that may cause low blood sugar. Your doctor can recommend certain changes or exams
• To avoid injuries, start the exercise gradually in case you are new or returning after long absence. Start with activities such as walking that have low impact.
• Pre-check and post-check sugar levels to avoid hypoglycemia, especially during long exercise sessions in case of insulin or lowering of glucose medications. Respond to low blood sugar with carbohydrate snacks.
• Avoid dehydration before, during and after exercise.
• Use well-fitting shoes and socks that are moisture-wicking. Check your feet each day especially in case you have nerve damage (neuropathy).
• Before exercise, warm up properly and after exercise cool down to prepare your muscles to reduce injury.
• When the weather is too cold or hot, avoid exercising in extreme temperatures, consider an indoor exercise.
• Wear a medical ID bracelet or tag when you have diabetes to identify you in case of emergency.
• Stop exercising at any time when you feel any pain, dizziness, shortness of breath, or faintness. Check with your medical expert about unusual symptoms.
• It is best to have consistent exercise schedules to remain beneficial and safe.

Making these precautions will make exercise an effective and safe part of diabetes and complications management.

Bottom Line

Exercise is much more than a fitness workout it is a component of effective diabetes management. Exercise has many benefits, which include but are not limited to better control of blood sugar levels, increased insulin sensitivity, healthy cardiac functioning and robust mental health maintenance. The solution is to make it safe and fun and tailor exercise plans to health requirements. Regularly exercising will allow people to take more control of their condition and minimize their chances of developing complications and create a healthier future.