Diabetes exercise is a powerful therapy for diabetes type 2. However, among the many people who come to my Nutrition Courses in Montebello to learn how to eat to prevent or control diabetes, only about five percent of them practice some kind of physical activity.

Exercise and Diabetes: A Clinician's Guide to Prescribing Physical Activity
  • Amazon Kindle Edition
  • Colberg, Sheri R. (Author)
  • English (Publication Language)
  • 424 Pages - 05/30/2013 (Publication Date) - American Diabetes Association (Publisher)

It seems that after a diabetes diagnosis is made, they are advised by their doctors to lose weight and to avoid sugar but, I am afraid, not enough emphasis is being made on how much they can profit from being physically active.

Regular exercise is crucial for diabetics

In fact, regular exercise is so crucial, that for people with pre-diabetes it can very well mean reversing the condition instead of moving into full-blown type 2 diabetes. And for those patients with diabetes type 2, regular exercise can mean the difference between having mild insulin resistance and being dependent on heavy medication.

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If at some point you have asked yourself what is the best diabetes type 2 treatment you can get nowadays, the answer is …. exercise! Without any question, it is also the safest and the cheapest. When combined with an appropriate diabetes diet, the disease can have minimal impact on daily life.

I firmly believe that if doctors were as eager to write a prescription for exercise to their diabetic patients as they are to write a prescription for medication, many diabetes diseases would not happen.

What happens when you exercise?

Besides moving your legs, arms and the like, there are other mechanisms that move inside your body when you exercise. Let’s take a look at some of the ones that affect your level of sugar in the blood:

  1. When you start exercising, your muscles use the glucose (blood sugar) they have stored for these types of occasions. Glucose provides them the energy they need to perform the task. One of the first benefits we encounter here is that exercise helps your muscles use glucose more efficiently.
  2. As the muscles start running out of glucose, certain hormones send the liver a signal to release more glucose into the blood so the muscles have a supply available to them.
  3. If you keep exercising, eventually your muscles will run out of glucose and they will start breaking down the fat in your cells (triglycerides).
  4. As you have guessed by now, this results in less fat in your cells, which means you are losing weight.

The Digestion of Food

When we eat, food is converted into sugar (glucose) in the intestine. From there, glucose goes to the blood, increasing the level of blood sugar. The blood maintains a normal level of glucose in the blood of about 1 gram per liter of blood (gr/lt).

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When a person without diabetes eats, the blood sugar level raises up to 1.25 gr/lt. However, when a person with diabetes eats, the glucose in the blood can increase up to 1.80 gr/lt.

No matter how much the level of sugar goes up in the blood after a meal, a complex system of signals in your body tells the pancreas that there is more glucose than normal in the blood. When the pancreas receives this signal, right away sends insulin to help glucose enter the cells.

It is very important that this mechanism works well because, in order for us to have energy, glucose has to get inside the cells.

The problem people with diabetes have is that glucose cannot get inside their cells due to insulin resistance and remains circulating in the blood vessels. This predicament can create many complications such as eye and kidney damage, heart disease, wounds that not heal and many more.

How Glucose gets into your Cells

As insulin leaves the pancreas, it carries by the hand special molecules called GLUT-2 transporters. These molecules attach themselves to the glucose particles circulating in the blood and escort them to the outside of the cell, the membrane.

There, these transporters “knock” on the many doors of the membrane and ask the GLUT-4 transporters (a similar type of molecules but that live inside the cells) to come to the surface and take the glucose molecules into the cell, which they do.

This is the way it works in a healthy person. However, in people with diabetes, the mechanism not always works this efficiently because either there are not enough GLUT-2 to hold the glucose molecules and carry them to the cell membrane or there are not enough GLUT-4 transporters to usher glucose molecules inside the cell.

Exercise can make up for Lack of Insulin

Believe it or not, moderate exercise such as briskly walking appears to do the same job as GLUT-2 molecules do. Briskly walking knocks at the membrane cell doors and “asks” the GLUT-4 molecules to come to the surface, grab the glucose molecules from the blood, and get them inside the cell, thus clearing the glucose from the blood. Astonishing, isn’t it?

And if that weren’t enough, walking also increases the number of GLUT-4 transporters. So, the more you walk, the more GLUT-4 transporters your body makes; and the more GLUT-4 transporters you have inside your cells the more glucose can enter your cells, lowering your blood glucose level. Not a small reward for just walking!

I leave you to know. Again, print this diabetes type 2 document treatment, read and what is even more important, practice the advice I am giving you here.

Take a Stress Test

Although moderate exercise is one of the best and safest therapies for diabetics or anyone else for that matter, the first thing I would like you to do is to tell your doctor you want to have a stress test done.

This is a very simple procedure; your doctor will ask you to step on a treadmill or a stationary bicycle while an electrocardiograph (EKG) machine monitors the activity in your heart.

Your doctor, or the person conducting the test, will ask you to increase the level of your work little by little and as the heart rate increases, the EKG device detects any abnormalities that may be present when the heart is working too hard.

This test can detect if your arteries are blocked or if the heart has a tendency toward arrhythmia or skipped beats. Your doctor then can use the test results to advise you on how much and what type of exercise is appropriate for you and what your heart rate should be during your workouts.

Your Exercise Heart Rate

Health authorities have determined that we can achieve the most benefits from exercise when the heart reaches a certain rate. Below that, the heart is not working hard enough to get the benefits of exercise and above it, we may be putting ourselves at risk.

What Heart Rate should you aim at during Exercise?

If your doctor does not indicate to you your maximum heart rate (the safe upper limit) during exercise, you can figure it out by yourself. It is very easy: subtract your age from 220.
Example: since you are 45, your maximum heart rate at exercise is 220 minus 45, which equals 175. Another example: if a person is 55, his/her maximum heart rate is 165 (220 minus 55).

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Determine a training Heart Rate

Depending on your level of fitness, the suggested training rate is between 65 and 85% of your maximum heart rate.
As a precaution, don’t let your exercising pulse go above this rate. Beginners, such as in your case, should stay in the lower range; more fit individuals can go to the higher end.

Check your Pulse Rate

Since, in order to send more blood to your muscles, your heart has to beat faster when you exercise, your pulse rate also increases. While in the process of exercising, check your pulse rate at intervals to make sure your level of work is appropriate.

First, find your pulse by placing your middle and index fingers inside your wrist, below your thumb (An alternative pulse point is on the large artery on either side of your neck). Once you feel the pulse, count the number of beats for ten seconds and then multiply the number obtained by six. This tells you how many times your heart is beating per minute.

Try to make an appointment with your doctor at your earliest convenience. In the meantime, you can walk at a moderate pace. Walking is quite safe.

A Word of Warning for patients with Diabetes Type 1

Exercise, in and of itself, lowers blood glucose. Because of this, the pancreas stops or slows down the production of insulin, but if the diabetic person takes oral drugs or uses insulin, the level of blood glucose can go down too much, creating a dangerous situation.
If you have diabetes type 1, by all means, have a guideline from your doctor on what type of exercise you can do before starting a vigorous exercise program.

The 2 Kinds of Diabetes Exercise that Lower Blood Sugar the Most

Although it is true that any type of physical activity helps, I am going to recommend the two forms of exercise that help diabetics lower blood sugar levels the most. Let’s take a look.

Recommendation Nº 1 – Aerobic exercise

The primary type of exercise I recommend you include in your daily exercise routine is any aerobic exercise that elevates the heart rate and sustains that elevation for a minimum of 20 minutes, preferably more.

The American College of Sports Medicine (ACSM) defines aerobic exercise as “any activity that uses large muscle groups, can be maintained continuously, and is rhythmic in nature.” Aerobic exercise includes: brisk walking, bicycling, swimming, jumping rope, stair climbing, running and aerobic dance

Recommendation Nº 2 – Strength training or muscle building exercise

The more muscle or lean body tissue you have, the better insulin can introduce glucose inside the cells, which means less glucose in the blood. Therefore, an exercise that builds up muscle tissue is highly therapeutic for people with type 2 diabetes. Types of muscle-building exercise include: weight lifting, push-ups, chin-ups, sit-ups

The Department of Health and Human Services recommends for most healthy adults:

  1. At least two hours and 30 minutes a week of moderate aerobic activity (brisk walking or swimming) or one hour and 15 minutes a week of vigorous aerobic activity (such as running) — preferably spread throughout the week.
  2. Strength training exercises at least twice a week


Regular walking is my favorite type of exercise (I never learned how to ride a bicycle) and is one that I often recommend in my consulting business because almost everyone can do it. Besides helping with insulin resistance, walking helps control high blood pressure, lowers LDL cholesterol level, increases HDL cholesterol, and helps you with overweight, all health conditions that are major risks for diabetics.

Choosing a type of exercise you enjoy doing is very important because otherwise, you would not stick to it. And as you know by now, being diabetic means you need to be physically active for the rest of your life. And the same goes for those reading this article that is not diabetic.

Is Walking Really Inexpensive?

I constantly hear people saying that walking doesn’t cost any money, and although it is true that it does not require high-tech equipment if you want to get good results from your walking outings, I suggest you get the following:

Shoes: Shoes are a walker’s most important piece of equipment so you need to choose shoes that are comfortable and that perspire; remember that your feet support your body weight so they need a good allied. You need to get shoes that offer adequate flexibility because, if not at the beginning, eventually you will want to move at a brisk pace. Test the flexibility of the sole by bending the shoe with your hands.

You will soon discover that some styles offer more movement in the ball of the foot than others. That’s important when you pick up the pace of walking and push off with the toes.
Look at the heel. Because walkers hit the ground with the heel first, you want a shoe with shock absorption in the heel and a stable landing surface. Choose a shoe that feels comfortable and gives you plenty of room around the toes.

Socks: Always use socks to avoid blisters. Synthetic blends fit the foot better than wool or all-cotton socks and prevent blisters.

Wristwatch: Get a simple digital watch from the drugstore with large, easy-to-read numbers; it will make it easier to take your pulse for ten seconds. You may want to choose a style that includes a stopwatch. Set it up when you start your 30-minute walk and you won’t have to remember when you started. You can also use the stopwatch to time how long it takes to walk a mile.

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Pedometer: Counting your steps with a pedometer can motivate you to keep walking. Get one that is easy to use and has a display with large numbers. All pedometers count steps but you may prefer a more advanced model that tells you the distance walked, the calories burned and your heart rate. A long term goal might be 10,000 steps a day but you may want to start with less and increase the number of steps every day.

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  1. Put your equipment to some use Start your adventure on the right foot physically by being conscious of posture and techniques that permit your body to move efficiently.
  2. Your abdomen and back have to be straight; this will guarantee you proper breathing.
  3. As you walk, look 2 or 3 yards in front of you with your head and chin straight.
  4. Move your arms forward and backward with your elbows close to your body.
  5. You can alternate the pace of your walking: you may walk fast during 10 minutes, slow down for other 10 minutes, and so forth.
  6. Take your steps always in this order: heel, sole, and toes. It will help you adopt a natural posture.
  7. Increase a little the distance you walk every day. If you walk one or two miles a day, increase it by 200 yards.
  8. Keep yourself hydrated. Remember to drink before you are thirsty.

Let’s not forget that diabetes and exercise should always go hand in hand. It doesn’t matter how healthy your diet is; if you are not doing some type of exercise, it would be very hard for you to achieve your main goal as a diabetic: to have a normal blood sugar level. Having a normal blood sugar level is crucial to prevent diabetes complications.


I am Andy Carpenter and I would start by saying that I have a Bachelor Degree in Nutrition Science conferred by California State University, Los Angeles and that I am certified as a Registered Dietitian.

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