Type 2 diabetes usually occurs later in life and is mostly a lifestyle disease that results from obesity and lack of exercise. Insulin may be insufficient or the cells that take up glucose may be resistant to the action of insulin. Ultimately, the result can be the same as in type 1 diabetes, that is, a complete failure of the beta cells and insulin supply.
Gestational diabetes occurs in pregnancy, and although potentially serious, it is usually a temporary event with full recovery after childbirth as long as weight is controlled. It could suggest susceptibility to diabetes later in life.
Pre-diabetes is a condition in which blood glucose is abnormally high but not high enough for a diagnosis of type 2 diabetes. Without attention to diet, weight loss and exercise, a progression to diabetes is often inevitable.
Lifestyle Approaches to Managing DiabetesThe Diabetes Prevention Program and similar trials showed that attention to lifestyle with nutrition and exercise, and a weight loss of 7% to 10% of body weight, can reverse pre-diabetes.
Other than weight loss, for people with diabetes and pre-diabetes, formal exercise programs help manage blood glucose by making insulin action more efficient and by using and enhancing the storage of blood glucose in muscle, thereby lowering abnormal blood glucose levels. This efficient function of insulin is described in the term “insulin sensitivity.”
Weight training can build extra muscle and therefore increase the storage capacity for glucose. Glucose is stored with water as “glycogen.” This aspect may be particularly important as we age and muscle mass has a tendency to decline.
How to Exercise for Diabetes and Pre-DiabetesThe first point to make is that if you have been diagnosed with diabetes or pre-diabetes, or you are overweight and sedentary and have other markers for possible pre-diabetes or metabolic syndrome such as high cholesterol and high blood pressure, you need to get your doctor’s approval for exercise.
If you use injectable insulin or drugs for lowering blood glucose, you also need to get good advice from your doctor or a diabetes specialist who has experience with exercise for diabetics. Some trial and error may be required because blood glucose can respond differently in individuals who exercise and use various medications or insulin.
While various forms of exercise have been suggested and evaluated for diabetics, neither weight training, aerobic exercise or more intensive interval type exercise has been shown to be clearly superior to any other. They all have their strengths. What is clear is that the exercise guidelines for health and weight loss from the American College of Sports Medicine is a good starting point.
A Comprehensive Training Program for Diabetes and Pre-DiabetesBelow is a weekly training program, with progression advice, that combines both aerobics and weight training. It does not assume much previous physical activity. A combination of aerobic exercise and strength training -- as for healthy people -- is likely to be the ideal combination of physical activity for diabetics but it should be followed under supervision for safety and best results.
Day 1. Aerobic exercise. Walk, jog, treadmill or outdoors for 30 minutes at moderate intensity. Moderate intensity means in the range 50% to 70% of maximum heart rate or at a pace at which you can still talk easily enough or recite a poem for example. Swimming and cycling are fine for aerobic conditioning, but you don’t get the advantage of bone building that you do with impact exercise. Generic, step and pump group aerobics classes are excellent.
Day 2. Weight training. Use the Basic Strength and Muscle program as a guide. You can do this at a gym or you can do most of the exercises at home with a home gym or even a set of dumbbells. The individual exercises are not that critical, but you need to work all of the major muscle groups including the upper and lower legs, arms, shoulders, back, chest, abdominals and buttocks. The reason for this is that the more muscle you exercise and build, the more depots for glucose disposal and storage you create.
Do 8 to 10 exercises including 3 sets of 8 to 12 repetitions in each set. Adjust the load so that you can get through a complete set and that the final repetition, say number 10, is getting a little harder to do. At the end of the third set of any exercise you should be working somewhat hard. Rest for two to five minutes before the next exercise.
When you’re starting out, it is important not to overdo things. Do fewer sets or repetitions and use less weight but do all exercises and progress to higher volumes and intensity. However, strength and muscle training needs to stress the muscles appropriately. Lifting light dumbbells for 20 repetitions, although not useless, is not what’s required here. Take it easy, but not too easy!
Day 3. Aerobic training as for day 1.
Day 4. Aerobic training as for day 1.
Day 5. Weight training as for day 2.
Day 6. Aerobic training as for day 1.
Day 7. Rest.