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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Focus on Fitness, More Focus on Fitness, More
 

Managing Diabetes Through Exercise


July 09, 2013

By Howard LeWine M.D.

Brigham and Women's Hospital

Diabetes Type 2
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Managing Diabetes Through Exercise
Managing Diabetes Through Exercise
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If you are living with diabetes and trying to manage your condition, there is one weapon in your arsenal you may not have considered — exercise.
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Harvard Medical School Commentary
2013-01-24

If you are living with diabetes and trying to manage your condition, there is one weapon in your arsenal you may not have considered — exercise.

Diabetes occurs when the body loses the ability to handle glucose. Glucose builds up in the blood, resulting in life-threatening complications. Diabetes is a major cause of death and disability in our country. Type 2 diabetes (also known as insulin-resistant diabetes) accounts for 90% to 95% of all diabetic cases in the United States.

While there is a strong genetic predisposition for type 2 diabetes, other risk factors are under your control, specifically physical inactivity and overeating. These lifestyle behaviors lead to obesity, which is another strong risk factor for type 2 diabetes, particularly if you resemble the Michelin Man with fat distributed mostly in your abdomen.

In the earliest stages of type 2 diabetes, your body produces extra insulin to help keep blood sugar close to the normal range. But the cells in your body are not as responsive to insulin as they should be — a state called insulin resistance. The usual course of events is that you begin to gain weight as your pancreas produces more and more insulin to overcome the resistance. Blood sugar levels rise.

High blood sugar and insulin levels are associated with damage to the blood vessels of the heart and contribute to clogged arteries. Twenty-five percent of all cases of blindness in America are related to damage to the small vessels of the eyes caused by diabetes.

Exercise helps to counter the effects of high insulin production and revitalizes the pancreas as well as the rest of the body. Most type 2 diabetics have a decrease in blood glucose after mild to moderate exercise. Exercise improves glucose uptake by the cells and decreases production of glucose by the liver. Also, exercise burns up energy that is stored in the muscle cells. This makes cells hungry for more glucose. Thus, glucose moves from the blood into cells, preventing the conversion of glucose to fat.

Starting an Exercise Program

If a person with diabetes is not exercising, a good way to start is to get 10 to 15 minutes of physical activity in three sessions during the day and build up to at least 30 minutes per session per day. Outdoor exercise in fresh air is more healthful than indoor exercise. Commune with the environment and combine your workout with a break for spiritual renewal. You can enjoy the gentle morning breeze, the bracing scent of lilacs in bloom, or the tingling cold air.

The Best Types of Exercise

Walking is certainly a great exercise and requires little equipment or preparation. To control diabetes, the ideal is to walk three to five miles, five to seven days a week. Gardening is also a great exercise because it exposes you to sunlight and fresh air. By gardening, I don’t mean just the casual pulling up of weeds, but the vigorous digging, hoeing, shoveling, kneeling, squatting, and stretching involved in maintaining or starting a garden.

What about people with diabetes who have trouble walking or pregnant diabetic women on strict bedrest due to pregnancy complications? An upper-arm exercise program can allow a person to engage in aerobic exercise without brisk walking. Pregnant women should be aware that certain exercises may be too strenuous and might induce uterine contractions, resulting in harm to the fetus.

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The Best Time To Exercise

Finding the right time of day is important. You need to consider your eating habits and medications you take to avoid exercise-related low blood sugars (hypoglycemia). Ideally, periodically check your blood sugar right before and after you exercise. Write down what you ate that day and what times you took your diabetes medications. If you don’t take any medications, it is very unlikely that exercise will cause your blood sugars to drop too low. When exercising, always keep a sugary substance or beverage with you in case you start to feel lightheaded.

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Nutritional Strategies

  • Reduce the consumption of refined grains such as white bread and refined pasta. Refined grains have little if any fiber. They are also more likely to have less trace minerals such as zinc, chromium, and manganese that help the body maintain normal blood sugar.
  • Eat more fiber-rich vegetables, nuts and beans.
  • Reduce intake of saturated fat and avoid trans fats altogether.

Exercise and a healthy diet can help you manage your diabetes and prevent its associated complications such as heart attack, stroke, blindness, dialysis and limb amputation.

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Howard LeWine, M.D. is chief editor of Internet publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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