Type 2 Diabetes Diet and Exercise Recommendations

It’s no secret that regular exercise is one of the key pillars of a healthy lifestyle. That’s especially true for those with type 2 diabetes. When combined with a nutrient-dense diet, regular workouts can improve glycemic control and reduce the risk of diabetic complications. (17)(25)(34) In fact, diet and exercise are two cost-effective ways to potentially reign in this growing health problem. 

The American Diabetes Association reports that approximately 32.6 million Americans—or about 10% of adults—currently have type 2 diabetes. (2) The Centers for Disease Control and Prevention (CDC) notes that another 88 million people, or 37%, suffer from prediabetes—a condition that puts them at a greater risk of developing full-blown type 2 diabetes. (6) And this figure is expected to rise to 40% by 2030. (22)

Addressing prediabetes and type 2 diabetes with diet and exercise may help slow this rising tide of cases. Research shows that exercise alone can reduce the odds of developing type 2 diabetes by 58% (and up to 71% in people over age 60). (8) A healthy lifestyle that includes regular exercise has been shown to significantly decrease the risk of cardiovascular disease in those already living with type 2 diabetes. (10) 

The benefits of diet and exercise for type 2 diabetes

How can something as simple as moving your body have such profound effects on type 2 diabetes? Exercise improves the uptake of glucose (blood sugar) by skeletal muscle while enhancing both insulin sensitivity and the disposal of excess glucose in the body. (20)(29) And more exercise appears to provide greater benefit. In one analysis of nine randomized trials, researchers at the University of Ottawa found that people with type 2 diabetes who participated in 20 weeks of moderate exercise (at 50 to 75% of their VO_2max) experienced a marked improvement in their hemoglobin A1C (HbA1c) levels, an indicator of long-term glycemic control. The researchers also reported that people who participated in intense exercise such as high-intensity interval training (HIIT) had greater blood glucose control than those partaking in more moderate exercise. (5)

Regular exercise also:

• Boosts the density of insulin receptors
• Decreases the risk of microvascular complications like peripheral artery disease
• Helps maintain a healthy weight by reducing body fat
• Improves insulin sensitivity
• Increases muscle flexibility and strength
• Lowers the risk of cardiovascular risk factors like high blood pressure or high cholesterol
• Reduces HbA1c levels 
• Reduces the risk of heart attack or stroke (24)(25)(27)(28)

Adding a healthy low-carbohydrate meal plan to a regular exercise program can also help you achieve your target blood glucose range. New research analyzing 23 clinical trials suggests that eating a low-carb diet improves blood glucose levels, supports weight loss, and may lead to lower medication use in people with type 2 diabetes. These findings led researchers to conclude that, compared to other diets, adhering to a low-carb diet can result in a 32% increase in diabetes remission. (18) But to properly manage your blood sugar, it’s important to balance what you eat and drink with your physical activity and medication, if you take any.

Did you know? Type 2 diabetes can shorten life expectancy by up to ten years. (14) But people with type 2 diabetes who get the recommended weekly amount of exercise live an average of 2.2 years longer than those who aren’t physically active. (11)

Incorporate exercise into your type 2 diabetes health plan

Starting an exercise program—especially if you’ve been sedentary—can seem daunting. However, there are a variety of workouts that can be both fun and effective. These include aerobic and resistance exercise, and it’s recommended that you include both types of exercise in your fitness plan for optimal blood sugar benefits. (13) 

Aerobic exercise is any physical activity that uses large muscle groups, causes you to breathe harder, and elevates your heart rate. (26) These activities can includes:

• Brisk walking
• Cycling
• Dancing and Zumba
• Elliptical training
• Hiking
• Jogging
• Rowing
• Running
• Soccer
• Swimming
• Tennis

Resistance exercise, on the other hand, increases muscle strength by making your muscles work against a weight or force. Also known as strength training, resistance exercise has been shown to be especially beneficial for those with type 2 diabetes because it can decrease visceral fat, enhance cardiovascular health, improve insulin sensitivity, and reduce HbA1c levels. (33) Resistance workouts can include those performed with:  

• Body weight only (e.g., squats, pushups)
• Free weights
• Kettlebells and medicine balls
• Resistance bands
• Weight machines

If you’re just embarking on workouts that include resistance training, it’s wise to consult a specialist, such as an exercise therapist or a certified personal trainer, to ensure safety and proper form. (32) This is especially important if you are unfamiliar with an exercise or a piece of weight equipment.

Did you know? A single workout session can increase insulin sensitivity for up to 48 hours. (16)

Type 2 diabetes and exercise precautions

While everyone should check with their healthcare provider before beginning any type of exercise routine, this step is especially important if you have type 2 diabetes. That said, studies suggest that most types of exercise are safe for those with the condition. (12) If you’re not used to working out, perhaps commit to just 30 minutes of exercise three times per week. Regardless of the type of workout, begin with a 5 to 10-minute warmup like walking on a treadmill. Spend the next 20 minutes or so doing low- to moderate-intensity exercises at 50 to 60% of your maximum heart rate. (27)(28) To establish your maximum heart rate, simply subtract your age from 220. (7) Finish your workout with a few minutes of low-intensity recovery exercise like static stretching. (31) As your fitness level improves, work up to completing 150 minutes of moderate exercise each week while gradually adding more intensity to your workouts. (15)

If you’re diabetic, it’s important to wear cotton socks and well-fitting athletic shoes. Once your workout is done, check your feet for sores, blisters, irritation, or other injuries. Inform your healthcare practitioner if an injury doesn’t begin to heal within a couple of days. (9)

For those experiencing diabetic complications like neuropathy, vision loss, or soft tissue damage to the feet, extra precautions should be taken. (4) For instance, many aerobic exercises like walking may not be suitable for those with diabetic neuropathy, while weight lifting may not be recommended for those with diabetic retinopathy. (27) Talk with your healthcare practitioner for help in setting up an appropriate exercise program for your individual situation. 

Pre- and post-workout nutrition

Adopting a healthy diet is frequently the first step for those trying to prevent or manage type 2 diabetes. The Mediterranean diet is often recommended for those with diabetes because it focuses on consuming a variety of minimally processed foods like fatty fish, antioxidant-rich fruits and vegetables, and extra-virgin olive oil. (23) The New Nordic Diet is another option shown to improve glucose control and prevent type 2 diabetes. (30) What may help make both diets effective is their basis on whole nutrient-dense foods instead of ultra-processed fare. (3) 

If you’re exercising with type 2 diabetes, the Academy of Nutrition and Dietetics notes that it’s likely you’ll need to take extra care with your pre- and post-workout nutrition. (21) Check your blood sugar before your workout, especially if you take insulin. If it’s below 100 mg/dL, eat a small snack containing 15 to 30 g of carbohydrates such as two tablespoons of raisins, a half a cup of fruit juice, or a piece of fruit. (9)

If your blood sugar is above 240 mg/dL, you may not be able to participate in exercise safely. Speak to your healthcare provider and test your urine for ketones. If ketones are detected, your body may not have enough insulin to control your blood sugar during your workout. This can result in ketoacidosis—a serious condition that can require immediate medical attention. (9)

Test your blood sugar again after your workout. If needed, eat a healthy snack or meal containing carbohydrates and protein or adjust your medication (if applicable). (15)

Did you know?  As you exercise, your body begins to use insulin more efficiently. This can, in turn, lower your blood sugar for up to 24 hours. (1)

The bottom line

Controlling your blood sugar levels through diet and exercise can help prevent the onset of type 2 diabetes. If you’ve already been diagnosed with the condition, these lifestyle changes can also help slow the progression of the disease and can prevent long-term health problems. (12) Adopting an appropriate exercise routine and fueling your workouts based on your blood sugar levels can improve insulin sensitivity, reduce HbA1c levels, and lower cardiovascular complications. 

Be sure to consult with your healthcare practitioner prior to making any dietary changes or engaging in exercise. Doing so can help ensure success in your journey to improve both your type 2 diabetes and your overall health.