Sugar vs. Strength: Can Exercise Reverse Diabetes
Diabetes and Exercise: When to Check Your Blood Sugar
Exercise plays an important role in managing diabetes. To help prevent complications, it’s important to monitor your blood sugar levels before, during, and after physical activity.
Exercise and diabetes: How to stay safe and monitor your blood sugar
Exercise is an essential part of diabetes management. It can help you:
- Improve blood sugar control
- Increase overall fitness
- Maintain a healthy weight
- Reduce your risk of heart disease and stroke
- Improve your overall health
However, managing diabetes while exercising comes with specific challenges. To stay safe and avoid potentially dangerous blood sugar fluctuations, some people with diabetes need to monitor their blood sugar levels before, during, and after physical activity. This helps you understand how your body responds to exercise and prevents sudden high or low levels.
Before you exercise: Check your blood sugar
Before starting any new workout routine, consult your healthcare provider—especially if you have type 1 diabetes. They can help you choose the right type of exercise and make sure it’s safe for your condition.
Exercise can lower blood sugar levels, sometimes causing hypoglycemia (low blood sugar), especially in people taking insulin. This risk also applies to individuals with type 2 diabetes who use insulin or other medications that affect blood sugar. Your healthcare provider can guide you in balancing your medications, food, and activity to reduce these risks.
Talk to your healthcare professional before exercising
Before starting or changing your exercise routine, talk to your healthcare provider. Ask questions such as:
- What effect might the activities I want to do have on my blood sugar?
- What is the best time for me to exercise?
- How will my diabetes medications affect my blood sugar as I become more active?
Depending on your treatment plan, your provider may recommend adjusting your medication or food intake before physical activity to help keep your blood sugar in a safe range.
Exercise guidelines for people with diabetes
To get the maximum health benefits, adults should aim for:
At least 150 minutes of moderate to vigorous aerobic activity per week. Examples include:
- Brisk walking or hiking
- Swimming laps or water aerobics
- Riding a bicycle
- Climbing stairs
- Dancing
- Playing basketball, tennis, or other sports
- Attending exercise classes
Strength train 2 to 3 times a week. Include at least one day of rest between sessions to allow muscles to recover.
For children and teens with diabetes:
- Aim for at least 60 minutes of moderate to vigorous aerobic activity per day.
- Include muscle and bone-strengthening activities at least 3 days a week, such as:
- Tug of war or bodyweight exercises for the muscles
- Running or jumping rope to strengthen bones
Monitoring blood sugar during exercise
Discuss your blood sugar monitoring needs with your healthcare professional:
If you manage type 2 diabetes without medication, you may not need to check your blood sugar before exercising.
- If you take insulin or other medications that can lower blood sugar, check your blood sugar 15 to 30 minutes before exercising.
- If you use a continuous glucose monitor (CGM), your provider may recommend finger-stick testing before, during, or after physical activity to confirm accuracy.
If you are on an automated insulin delivery system, get personalized advice from your provider about how to maintain healthy blood sugar levels during exercise, especially if you have hypoglycemia unawareness (when you don’t notice symptoms of low blood sugar).
Important note:
If you need help recovering from a severe low blood sugar episode in the past 24 hours, do not exercise.
Here are some general blood sugar level guidelines to follow before starting physical activity (in mg/dL or mmol/L):
[Insert blood sugar level chart or range — let me know if you’d like help creating one.
After Exercise: Monitor Your Blood Sugar
It’s important to check your blood sugar as soon as you finish exercising, and continue to monitor it over the next few hours. Physical activity uses up stored sugar in your muscles and liver. As your body works to replenish those reserves, it pulls sugar from your bloodstream, which can lower your blood sugar levels.
The more intense your workout, the longer it can impact your blood sugar. Low blood sugar can occur 4 to 8 hours after exercising. To help prevent a delayed drop, consider having a snack with slow-digesting carbohydrates after your workout. Good options include:
- A granola bar
- Trail mix
- Dried fruit
If you do experience low blood sugar after exercising, have a quick-acting source of carbs such as:
- Fruit
- Crackers
- Glucose tablets
- A half-cup (4 ounces or 118 mL) of fruit juice
Exercise offers many health benefits, especially for people with diabetes. But to stay safe, it’s important to test your blood sugar before, after, and sometimes during your workouts, just as carefully as you plan the activity itself.
Acute effects of exercise on blood sugar
Physical activity has an immediate effect on glucose metabolism, particularly in skeletal muscle. During exercise, muscle contractions increase blood glucose absorption. This process is balanced by the liver, which maintains blood sugar levels through glucose production in the liver—initially through glycogenolysis (breaking down glycogen) and later through gluconeogenesis (production of glucose from non-carbohydrate sources). Exercise intensity and duration are major factors that affect glucose metabolism.
At the beginning of exercise, muscles use primarily glycogen, a branched form of stored glucose, as fuel. As exercise continues and glycogen stores are depleted, muscles become increasingly dependent on circulating blood glucose and free fatty acids released from adipose tissue. When glycogen is depleted, the liver switches from glycogenolysis to gluconeogenesis to meet the body’s energy demands.
Glucose absorption into muscles occurs via two distinct pathways:
At rest or after eating, glucose absorption is primarily insulin-dependent.
During exercise, muscles activate a non-insulin-dependent pathway, allowing glucose to enter cells even without insulin. This mechanism supports energy needs independently of insulin levels and supplements the breakdown of glycogen within muscle.
Glucose absorption into cells is facilitated by glucose transporter (GLUT) proteins, particularly GLUT4, which is the primary insulin-regulated transporter in muscle and adipose tissue. In people with type 2 diabetes, insulin-stimulated glucose absorption via GLUT4 is impaired. However, both aerobic and resistance exercise can increase the amount of available GLUT4, thereby improving glucose absorption despite insulin resistance.
In people with type 2 diabetes, moderate-intensity exercise promotes greater muscle glucose absorption than liver glucose production from glycogenolysis, leading to an overall reduction in blood sugar levels. Additionally, because plasma insulin levels naturally decrease during exercise, the risk of exercise-induced hypoglycemia is low—unless the person uses exogenous insulin or insulin-like medications.
Long-Term Effects of Exercise on Diabetes Management and Prevention
Engaging in regular physical activity offers significant long-term benefits for individuals with type 2 diabetes mellitus. One of the primary advantages is enhanced insulin sensitivity, which contributes to better blood glucose control over time.
Impact of Aerobic Exercise
Aerobic exercise is a key component of type 2 diabetes management. Research shows that even one week of aerobic training can improve both blood glucose levels and insulin responsiveness. Sustained moderate-intensity aerobic activity boosts the ability of skeletal muscles to respond to insulin by increasing the expression of GLUT4 transporters, which are responsible for glucose uptake.
Over time, aerobic exercise also shifts the body’s fuel usage. While individuals with diabetes typically rely more on carbohydrate metabolism and less on fat oxidation, long-term aerobic training enhances the body’s ability to burn fat. This adaptation helps conserve muscle glycogen and stabilize blood sugar levels, reducing the risk of sudden drops in glucose during exercise.
Benefits of Resistance Training
Resistance training also plays a crucial role in long-term blood sugar regulation. Increasing skeletal muscle mass improves insulin sensitivity and glucose uptake. For example, a 16-week randomized controlled trial found that participants who performed resistance exercises twice a week experienced:
- A 7.1% decrease in fasting blood glucose
- A 46.3% improvement in insulin action
- Significant reductions in visceral fat
These changes are largely attributed to the increase in muscle mass, which provides a greater area for glucose storage and usage, leading to better overall glycemic control.
Physical Activity and Type 2 Diabetes Prevention
In addition to managing existing diabetes, regular exercise also plays a preventive role. Multiple long-term studies, including both prospective and cross-sectional research, show that higher levels of physical activity are associated with a lower risk of developing type 2 diabetes.
This risk reduction is seen with:
- Moderate physical activity (at least 2.5 hours per week)
- Vigorous physical activity, regardless of the type
Regular movement helps maintain a healthy weight, improves insulin sensitivity, and supports metabolic health—all of which contribute to preventing the onset of type 2 diabetes, especially in individuals at high risk.
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