Exercise and Diabetes
Current guidelines for the management of both type 1 and type 2 diabetes recommend regular physical activity.8 Physical activity improves blood glucose management and insulin sensitivity so that the body’s insulin, or the insulin medication, is able to work better.8 Exercise also reduces body fat, and potentially reduces the long-term risk of macro-vascular (damage to large blood vessels) complications.9
Exercise can potentially lower or raise blood glucose.10 During exercise, blood glucose can lower due to the muscles using glucose as energy and the body can become more sensitive to insulin.10 However, sometimes blood glucose increases due to other factors, for example, the effect of other hormones that are also released during physical activity such as adrenaline.10
Everyone’s diabetes is different, and individuals react differently to exercise. It is important that people with diabetes understand how their blood glucose responds to exercise so they can manage these fluctuations and prevent hypoglycaemia or hyperglycaemia.10 Exercise must always be prepared for in advance, and insulin or food adjustments might be needed in order to stay within the optimal blood glucose range.8
Type 2 and Exercise
Type 2 diabetes is often managed with a healthy diet and increased physical activity.3 The development of type 2 diabetes is associated with obesity, particularly abdominal obesity and it is estimated that around 80% of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment.11,12
People living with type 2 diabetes do not usually experience such pronounced blood glucose fluctuations, particularly if they have not progressed to insulin therapy and are still producing their own insulin.13
Abdominal fat more readily releases fatty acids into the blood, which inhibit the effect of insulin, and fat cells produce hormones which also inhibit the effect of insulin.11 This is known as insulin resistance, which is the cause of type 2 diabetes.11 Exercise can help someone overweight or obese lose weight, including abdominal fat, and reduce insulin resistance.11
30-45 minutes of aerobic exercise a day, 3-5 days a week, or 150 minutes a week is recommended8
Aerobic exercise will differ depending on a person’s individual fitness level, but could include walking, swimming or bike riding, and should be intense enough to raise the heart rate.
Type 1 diabetes and exercise
Exercise can pose some unique challenges for people living with type 1 diabetes as many variables can potentially cause the blood glucose to fluctuate significantly.14 A person living with type 1 has to carefully balance their insulin dose with the carbohydrates they eat/drink and the amount of exercise, as well as taking into other considerations which can affect blood glucose.10,15
Getting the balance right to avoid potentially dangerous hypoglycaemia or hypoglycaemia can sometimes be complicated. Therefore, it is especially important for people living with type 1 diabetes to frequently monitor blood glucose levels before, during (for exercise duration of more than 1 hour) and after exercise.16 It is important to learn individual response to different types of physical activity through observation. This, along with frequent blood glucose monitoring, will help adjust blood glucose levels and avoid hypoglycaemia.10
Lessons from Team Novo Nordisk17
Professional cycling is widely regarded as one of the most physically challenging endurance sports. Riders undertake demanding training and racing schedules and must work at high intensities for many hours at a time. Team Novo Nordisk is the first professional cycling team to consist solely of people with diabetes and the riders manage their diabetes while training and competing at a professional level.
Team Novo Nordisk athletes work hard to manage their diabetes and work closely with the team doctor to find a regimen that works for them. Athletes closely monitor their blood sugar before, during and after the race, developing a deep understanding of how their body responds to exercise. They learn how to adjust their nutritional intake and insulin to stay within the optimal blood glucose range.
If the athlete’s blood sugar is above target, they may take medication. If their blood sugar is below target, they may eat or drink something with carbohydrates. Everyone is different and it is important for individuals to work with a healthcare professional to find the method that works for them.
The achievements of Team Novo Nordisk demonstrate that as long as people are educated about their condition, and are disciplined and committed to managing their diabetes, with the help of experienced healthcare professionals, diabetes does not need to preclude them from intense physical activity and even endurance sports.9
Just like the Team Novo Nordisk athletes, people with diabetes who want to progress from regular exercise to endurance sports, should speak to their healthcare professionals first and follow an individually designed training programme.
- International Diabetes Federation.
IDF Diabetes Atlas, 6th Edition, 2014 Update. Brussels, Belgium: International Diabetes Federation. Available at: http://www.idf.org/diabetesatlas/update-2014.
Last accessed: April 2015.
- International Diabetes Federation.
IDF Diabetes Atlas 6th Edition, 2014 Update, Atlas Poster. Brussels, Belgium: International Diabetes Federation. Available at: http://www.idf.org/sites/default/files/Atlas-poster-2014_EN.pdf. Last accessed: April 2015.
- International Diabetes Federation. IDF Diabetes Atlas 6th Edition, 2013 Update. Brussels, Belgium: International Diabetes Federation. Available at: http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf. Last accessed: April 2015
- World Health Organisation, Diabetes Factsheet 312. Available at: http://www.who.int/mediacentre/factsheets/fs312/en/.
Last accessed: April 2015
- NHS Choices, Hypoglycaemia (low blood sugar). Available at:
http://www.nhs.uk/conditions/hypoglycaemia/pages/introduction.aspx. Last accessed April 2015.
- International Diabetes Federation toolkit, physical activity. Available at: http://www.idf.org/worlddiabetesday/toolkit/pwd/physical-activity Last accessed: June 2015
- International Diabetes Federation, Position Statement: Self-Management Education. Available at: http://www.idf.org/education/self-management-education. Last accessed: April 2015
- International Diabetes Federation, World Diabetes Day, physical activity toolkit. Available at: http://www.idf.org/worlddiabetesday/toolkit/pwd/physical-activity
- Piłaciński, S., & Zozulińska-Ziółkiewicz, D. A. Influence of lifestyle on the course of type 1 diabetes mellitus. Archives of Medical Science : AMS,
(2014), 10(1), 124–134.
- International Diabetes Federation, toolkit, diabetes and physical activity. Available at: http://www.idf.org/worlddiabetesday/toolkit/children/physical-activity. Last accessed: April 2015
- Poynten A, Donald C. Insulin Resistance: The Link Between Diabetes and Cardiovascular Disease. Diabetes Voice 2001:Vol. 46 No. 2/2001. Available at: http://www.idf.org/diabetesvoice/articles/insulin-resistance-the-link-between-diabetes-and-cardiovascular-disease.
Last accessed: April 2015
- International Diabetes Federation, toolkit, diabetes misconceptions. Available at: http://www.idf.org/worlddiabetesday/toolkit/gp/diabetes-misconceptions. Last accessed April 2015
- Colberg S, et al. Exercise and Type 2 Diabetes. The American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010;33(12):e147-67
- American Diabetes Association, ADA. Diabetes Care. Diabetes Mellitus and Exercise. Available at: http://care.diabetesjournals.org/content/25/suppl_1/s64.full. Last accessed: April 2015
- Briscoe VJ, et al. Hypoglycemia in Type 1 and Type 2 Diabetes: Physiology, Pathphysiology, and Management. Clinical Diabetes, July 2006 Vol. 24 No. 3 115-121
- Pugliese G, et al. Self glucose monitoring and physical exercise in diabetes. Diabetes Metab Res Rev. 2009 1:S11-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19662620. Last accessed: June 2015
- Lessons from the professionals: diabetes and pro cycling. Practical Diabetes 2013; 30(7): 266-270