How people with Type 2 diabetes can get the benefits of exercise while reducing the risks

Researchers recommend three simple steps to start an exercise routine while reducing the risk of low blood sugar.

By planning ahead, choosing appropriate activities and setting achievable goals, people with Type 2 diabetes can improve their quality of life with exercise while reducing their risk of low blood sugar, say two U of A experts. Prodigy Diabetes Care photo

By Nicole Graham, University of Alberta November 18, 2019

Adults with Type 2 diabetes may have more to gain by participating in physical activity and exercise than healthy adults, but they may also have more to lose, according to University of Alberta exercise and diabetes physiology researchers.

“Exercise can improve one’s glucose levels, which can help slow the progression of diabetes and reduce the need for additional medications,” said U of A diabetes researcher Normand Boulé. “On the other hand, (people with Type 2 diabetes) have more risk factors for cardiovascular events with exercise and, depending on the medications they take, may be at greater risk for low blood sugar, which can result in a variety of harmful symptoms such as shakiness, or even loss of consciousness.”

According to the 2018 Clinical Practice Guidelines for Physical Activity and Diabetes— co-authored by Boulé, who is also the director of the Physical Activity and Diabetes Lab—at least 150 minutes per week of aerobic exercise and at least two sessions per week of resistance exercises are recommended for adults with Type 2 diabetes.

The guidelines also suggest reducing sedentary activities and recommend trying to interrupt sitting time by getting up every 20 to 30 minutes. Boulé noted that incorporating a healthy, appropriate diet with exercise can help further reduce glucose levels for people with Type 2 diabetes.

Striking a healthy balance

Jordan Rees, a PhD student in Boulé’s lab, said finding an achievable balance between exercise and diet requires planning.

“The overall health benefits of regular exercise and physical activity can help adults living with diabetes reach a variety of goals, such as increased fitness and energy levels, help with glycemic control, decreased insulin resistance, and reduction and maintenance of weight loss,” she said.

Boulé and Rees are recruiting subjects for a study to compare exercise in the morning, after an overnight fast, with the same activity performed after breakfast. In recent years, the importance of the timing of exercise has been a topic of debate and led to conflicting recommendations. The researchers hope the results can offer people with Type 2 diabetes simple strategies for more effective exercise.

Until then, Boulé and Rees encourage people to start a regular exercise program by following a few simple steps:

 Step 1: Have a conversation with your doctor  about the risks and benefits of exercise, and discuss what may be best for you as part of your current treatment plan.

 Step 2: Consider your past history  with sport, exercise and physical activity to help determine which activities you most enjoy and feel comfortable participating in.

 Step 3: Set achievable goals.  Rees suggests a walking program is a great place to begin, and simple strategies like walking with friends or family, or joining a walking club, can increase your likelihood of sticking with it over time

While incorporating a physical activity program is important for all adults, Boulé said everyone has preferences and barriers for physical activity and exercise, and setting achievable, realistic goals is an important part to help favour participation.

“For some people, exercise may not improve glucose levels as effectively as it does for others, or the rate of weight loss may not come as fast for some as it does for others,” he said. “What’s important to remember, however, is that for people with diabetes, exercise is not just about glucose or body weight; there are many other benefits such as improving your fitness, which substantially lowers mortality in people with diabetes and helps increase your quality of life.”

Source University of Alberta via Medical Xpress

  Further reading

Gender differences in the effect of diabetes mellitus and its treatment on osteoarthritic pain, Martha Cecilia Castano Betancourt, Carolina Larissa Morais, Monica Vannucci Nunes Lipay, Jordani Aragão, Marcelo de Azevedo e Souza Munhoz, Eduardo Gomes Machado, Evaldo Marchi. BMJ Open Diabetes Research and Care 2019;7:e000736. doi: 10.1136/bmjdrc-2019-000736. Full text

Diabetes Canada 2018 clinical practice guidelines: Key messages for family physicians caring for patients living with type 2 diabetes, Ivers NM, Jiang M, Alloo J, Singer A, Ngui D, Casey CG, Yu CH. Can Fam Physician. 2019 Jan;65(1):14-24. Review. Full text

Type 2 diabetes mellitus and osteoarthritis, Veronese N, Cooper C, Reginster JY, Hochberg M, Branco J, Bruyère O, Chapurlat R, Al-Daghri N, Dennison E, Herrero-Beaumont G, Kaux JF, Maheu E, Rizzoli R, Roth R, Rovati LC, Uebelhart D, Vlaskovska M, Scheen A. Semin Arthritis Rheum. 2019 Aug;49(1):9-19. doi: 10.1016/j.semarthrit.2019.01.005. Epub 2019 Jan 11. Review. Full text

Physical Activity and Diabetes, Diabetes Canada Clinical Practice Guidelines Expert Committee, Sigal RJ, Armstrong MJ, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, Riddell MC. Can J Diabetes. 2018 Apr;42 Suppl 1:S54-S63. doi: 10.1016/j.jcjd.2017.10.008. Full text

Type 2 diabetes and osteoarthritis: a systematic review and meta-analysis, Williams MF, London DA, Husni EM, Navaneethan S, Kashyap SR. J Diabetes Complications. 2016 Jul;30(5):944-50. doi: 10.1016/j.jdiacomp.2016.02.016. Epub 2016 Mar 2. Review.

Knee Osteoarthritis in Type 2 Diabetes Mellitus: Does Insulin Therapy Retard Osteophyte Formation? Al-Jarallah K, Shehab D, Abdella N, Al Mohamedy H, Abraham M. Med Princ Pract. 2016;25(1):12-7. doi: 10.1159/000441418. Epub 2015 Oct 31. Full text

Links between osteoarthritis and diabetes: implications for management from a physical activity perspective, Piva SR, Susko AM, Khoja SS, Josbeno DA, Fitzgerald GK, Toledo FG. Clin Geriatr Med. 2015 Feb;31(1):67-87, viii. doi: 10.1016/j.cger.2014.08.019. Epub 2014 Oct 7. Review. Full text

Also see
Men With T2D, Osteoarthritis Experience More Severe Joint Pain With Insulin Use Endocrinology Advisor
The exercise effect and prediabetes Medical Xpress

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