As of 2015, 1.2 million Australians (roughly 6% of the population) suffer from Diabetes Mellitus (1), a condition which is characterised in brief by the inability of the body to produce insulin (type 1) or being insulin resistant (type 2). Diabetes Mellitus sub group type 1 is caused by auto-immune dysfunction and sub group type 2 is generally caused by poor lifestyle choices and weight management issues. Gestational (caused during pregnancy) can also occur but is far less prevalent compared to its compatriots. According to the Australian Institute of Health & Welfare, 1 million Australians were living with type 2 diabetes, which unlike type 1, is very much a preventable disease. It’s scary to think that a simple lifestyle choice, such as exercise, can play a huge role in the prevention of type 2 diabetes, with research suggesting that exercise reduced the occurrence by 58% (2).
Unfortunately, diabetes doesn’t come on its own in health concerns. Other co-morbidities such as peripheral neuropathy (nerve damage that causes pain in hands and or feet), retinopathy (damage to the blood vessels in the back of the eye) along with an increased risk of cardiovascular disease due to a poor cardio-metabolic profile are frequently associated with diabetes. This article is not aimed to alarm you, rather to get you thinking about other strategies you can implement to assist in the management process.
The benefits of exercise within the diabetic paradigm
There are numerous benefits to regular exercise for people living with diabetes. However, it is important to note that there are certain variables that need to be considered, working in tandem with your diabetes specialist and exercise physiologist, to help ensure you maximise the benefits of the exercise intervention, safely. The recent Lancet publication (3) provided a nice summary of the benefits exercise provides for diabetics that include:
- Improved HbA1c (glycated haemoglobin). Gives an idea of estimated blood sugar levels over a period of time.
- Better cardio-metabolic health profile, through improvements in blood pressure, weight management and lipid profiles .
- Reductions in retinopathy and microalbuminuria
- Improved insulin sensitivity.
- Improved strength and aerobic capacity.
So now you know the benefits of exercise on diabetes, but can you start exercising straight away?
For type 2 diabetics who have their blood glucose well controlled, then yes – it is safe and recommended you undertake an individualised strength & conditioning program. However, with Type 1 patients and those type 2 patients who have big fluctuations in their blood glucose for external reasons this is not the case. There will be exercise modifications to be addressed, and should be done so on an individual basis by your specialist and exercise professional before getting started.
As mentioned above, exercise can play a huge role in helping you manage your diabetic profile. However, due to the nature and complexity of each diabetic profile, some of the below points need to be considered. These include, but are not limited to:
- Monitoring and adjusting (if need be) insulin dosage pre, during and post exercise. This is vital to manage the potential risk of post exercise hypoglycaemia (drop in blood glucose post exercise) and nocturnal hypoglycaemia (drop in blood glucose at night).
- Ingestion of carbohydrates pre, during and post exercise for same reason as above.
- Time of day – The best time to exercise varies person to person and should be done in consultation with your diabetes specialist, as the above points will also play a role in this. As an example, the risk of nocturnal hypoglycaemia is increased if exercise is performed in the afternoon for type 1 diabetics.
- Type of exercise – If peripheral neuropathies are present then exercises such as running/jumping may lead to other issues beyond the scope of this article
- Cardiometabolic profile – Because of the increased risk of cardiovascular disease, a thorough examination of cardiac risk needs to be performed prior to commencing exercise.
- Steady state vs HIIT vs Strength – variations in pre-training insulin and blood glucose levels for type 1 diabetics will vary the type of appropriate training. Pre-exercise levels will dictate what exercise is currently safe and depending on training goals, will help guide pre-exercise insulin levels for future training sessions, as well as post exercise dietary planning.
To wrap it all up
Exercise has wonderful effects on helping improve your diabetic profile. In my opinion which is shared by most in the health industry, the benefits of undertaking a supervised exercise program, after the above variables have been considered, far outweigh the co-morbidity risks that can happen as a result of being sedentary within this population group. If all variables are considered, exercise can be safe and enjoyable for a life time. Whether it’s working out in the gym or going for a walk, regular exercise will not just improve your diabetic profile, but also enhance your quality of life, allowing you to control your diabetes, rather than it controlling you.
For more information on diabetes, please visit https://www.diabetesaustralia.com.au/
Written by Exercise Physiologist & Performance Coach Adam Luther
- AIHW 2017. Diabetes Compendium. Canberra: AIHW
- Diabetes prevention program research group (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine. Vol: 346, 393-403.
- Riddell MC et al. (2017). Exercise management in type 1 diabetes: a consensus statement. The Lancet Diabetes & Endocrinology. Vol: 5, 377-390