In this blog for our Evidence for Everyday Health Choices series, Dr Catriona Hilton looks at prediabetes and the evidence on whether diet and exercise can reduce your riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of developing type 2 diabetes.
Most of us will be aware that our modern world has a problem with diabetes, and that it’s getting worse. In type 2 diabetes the body becomes unable to control blood sugar levels, leading to a smorgasbord of complications that can affect almost every part of the body. Usefully, blood tests can detect the stage before full blown diabetes develops, when the body is just starting to have trouble suppressing blood sugar levels. We will call this ‘prediabetes’.
- Help! My doctor says I have prediabetes. What now?
- Eating well and exercising sounds like hard work. Will they stop me getting type 2 diabetes?
- So what does that really mean?
- Patients and researchers may have different priorities
- Where does this leave us?
- How One Woman With Prediabetes Uses Diet and Exercise to Prevent Diabetes
- The Prediabetes Diet Plan: How to Reverse Prediabetes and Prevent Diabetes Through Healthy Eating and Exercise
- Duality of Interest
- Benefits of exercise and physical activity
- Why should you be active?
- There are two types of exercise that can help keep you physically healthy:
- How does being more active help reduce your risk for developing diabetes?
- Diabetes Forecast
- Jacob Haus, PhD
- Help Support Diabetes Science
- Get Active!
- The importance of exercise when you have diabetes
- Preventing Prediabetes: Is Diet or Exercise More Important?
- The Case for a Healthy Diet
- The Case for Exercise
- So Which Is More Important?
Help! My doctor says I have prediabetes. What now?
First of all, having prediabetes does not mean that you will definitely get diabetes. In fact, fewer than half of people with prediabetes will develop type 2 diabetes within a decade. So, what can you do to avoid it?
As our society has become more overweight and sedentary the prevalenceThe proportion of a population who have a particular condition or characteristic. For example, the percentage of people in a city with a particular disease, or who smoke. of type 2 diabetes has skyrocketed. Surely it’s obvious then that weight loss and exercise can prevent diabetes? Well, perhaps not. People with prediabetes are currently advised to lose weight and get moving, but the evidence for this isn’t clear cut.
This recent Cochrane Review tried to clarify whether diet, physical activity or both combined can stop (or at least delay) people with prediabetes developing type 2 diabetes.
The authors looking for evidence found 12 randomisedRandomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). control trialsClinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. that tried to change people’s lifestyles for at least 2 years (and for up to 6 years). Together these studies included more than 5,000 people with prediabetes. The studies were all slightly different but they all allocated people with prediabetes to various interventions of diet and exercise (or continuing as usual) in different combinations.
Eating well and exercising sounds like hard work. Will they stop me getting type 2 diabetes?
The main findings from the review were that:
People who have prediabetes can probably prevent or delay the development of type 2 diabetes by changing their eating habits and increasing physical activity.
It isn’t clear whether diet or increased physical activity alone are effective.
It is uncertain whether diet and exercise affect the riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of heart disease, stroke or death in people with prediabetes. The studies included in the review didn’t mention other complications of diabetes such as kidney and eye disease.
People who have prediabetes can probably prevent or delay the development of type 2 diabetes by changing their eating habits and increasing physical activity
So what does that really mean?
People with prediabetes are currently advised to reduce their calorie intake and increase their physical activity. There is fairly good evidence from this review that this will help to prevent (or delay) the development of full blown type 2 diabetes. It won’t work for everyone though. In the group that the researchers targeted to lose weight and become more active 15 out of every 100 people got diabetes over the follow up period of the studies. In the ‘keep calm and carry on’ group 26 out of every 100 people with prediabetes went on to develop type 2 diabetes. So, you can probably make it less likely that you’ll end up with type 2 diabetes by embracing clean living, but you might still be unlucky.
It might be that changing eating habits or activity levels alone are also effective, but the number of people included in these studies was small, so it wasn’t possible to work out if any effect was real or due to the play of chance.
So, what did the people in the studies actually do? Well, that’s tricky. All the studies included in the review wanted to answer a similar question, but they all tried to do it in slightly different ways. Most dietary treatments aimed to get people to reduce their calorie intakes with the aim of losing various amounts of weight. Some studies also asked people to reduce their fat intake and increase dietary fibre. The exercise interventions also varied. Some studies required people to exercise more intensely, or for more minutes a week, than others.
Patients and researchers may have different priorities
Patients and researchers often have different questions. There are some things that matter to people with prediabetes that weren’t covered that well by the studies.
There are lots of reasons why people want to avoid getting diabetes. Because of the label, because they don’t want to have to take tablets or injections, because of the other health problems that go along with it. The studies included in this review didn’t make it clear whether changing diet and physical activity levels will affect how likely people are to get complications of diabetes (such as foot, eye or kidney problems) or to die. There wasn’t good evidence for a difference in how likely people were to have heart attacks or strokes.
Anyone who’s tried to eat less and move more will know that it’s hard and it requires a bit of sacrifice. It wasn’t clear from these studies whether the people who changed their lifestyles ended up with a better quality of life than those who did nothing.
It wasn’t clear whether the people who changed their lifestyles ended up with a better quality of life than those who did nothing
Where does this leave us?
At the end of the day, we all know that we should chose an apple over a double chocolate cookie and an evening jog over a scandi noir box set on the sofa, but in reality making healthier lifestyle choices is often easier said than done. Most of the studies included in this review used some form of contact sessions to motivate people to change their lifestyles. This just isn’t available to most of us in the real world. We still have a lot to learn how best to support and motivate people to eat well and move more.
On a positive note, there is plenty of evidence that eating a healthy balanced diet and being physically active helps people to live longer and protects against lots of other diseases, so perhaps it’s not a bad idea to give it a go anyway.
Catriona Hilton has nothing to disclose.
Hemmingsen B, Gimenez-Perez G, Mauricio D, Roqué i Figuls M, Metzendorf MI, Richter B. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of developing type 2 diabetes mellitus. Cochrane Database of Systematic ReviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2017, Issue 12. Art. No.: CD003054. DOI: 10.1002/14651858.CD003054.pub4.
How One Woman With Prediabetes Uses Diet and Exercise to Prevent Diabetes
Kathy Lawrence lost 15 pounds when she started exercising 45 minutes a day. (KATHY LAWRENCE)
Kathy Lawrence lost 15 pounds when she started exercising 45 minutes a day.(KATHY LAWRENCE)If you have prediabetes, two of the most important things you can do to avoid diabetes are change your diet and increase your exercise.
In a study published in 2002 by the Diabetes Prevention Program Research Group, people with prediabetes slashed their risk of diabetes by more than half if they lowered the fat and calories in their diet, boosted exercise, and lost weight.
Kathy Lawrence, who is 61 and lives in Austin, developed some worrying symptoms in her late 50s. She had cat scratches on her feet that refused to heal. Slow-healing wounds are a sign of diabetes, so she visited her doctor and had her blood sugar tested.
Lawrence had a fasting blood glucose of 119 mg/dL, just short of the level that signifies diabetes (over 126 mg/dL). Although she technically had prediabetes, not diabetes, her doctor told her: “We’re going to count you as having it.”
More about diabetes
- Why Belly Fat Increases Type 2 Diabetes Risk
- Prediabetes: Deal With It Now, Lower Your Risk
Alter your diet
She started by making some changes in her diet. “You ate your way into this disease, and you can eat your way out of it,” her gynecologist once told her. That’s not entirely true; she had some type 2 diabetes risk factors she couldn’t change—her age, a family history of the disease and gestational diabetes during pregnancy.
However, she did have some risk factors she could change, including her weight (she knew she could lose a few pounds in her midsection) and her activity level.
She first looked at the types of carbohydrates she was eating. Carbohydrates are a key part of the human diet, but some raise blood sugar more than others.
Next Page: Sticking with the diet She focused on getting carbohydrates from fruits, vegetables, and whole-grain foods, which are rich in nutrients and fiber, and fewer from snacks loaded with sugar and white flour, which cause blood sugar to zoom up faster.
Lawrence still enjoys treats. For example, she had a small piece of tiramisu at her daughter’s birthday party. But that phrase “You can eat your way out of it” pops up in her head whenever she’s tempted to have a more radical splurge, such as “eat a chocolate cake or engage in several days of bad activity,” she says.
Try the plate method
If you have prediabetes, a quick way to ensure that your food choices will help you avoid diabetes is to do “the plate method,” recommends Darci Cook, RD, formerly a dietitian and diabetes educator at Clarian Diabetes Centers in Indianapolis, Ind.
At lunch and dinner, put vegetables on half your plate. Divide the remaining half of the plate in two, and cover one of those sections with a whole-grain carbohydrate. Cover the remaining portion with low-fat meat, such as fish or poultry, Cook recommends. This is a normal or small plate, by the way; your portion sizes still need to be reasonable.
If you have prediabetes, you need to also be extra-concerned about cholesterol as prediabetes boosts the risk of heart attack and stroke. A diet high in trans fat or saturated fat promotes bad cholesterol.
Lawrence lost 15 pounds and started exercising 45 minutes five days a week. She’s motivated by her desired to avoid needing insulin. And she wants many healthy years to enjoy her 17-year-old daughter and her future grandchildren.
“I decided that at my age, if I want to be able to be a grandmother and enjoy my retirement years one of these days without a lot of complications and other kinds of health risks, I need to take it seriously,” she said.
She keeps her walking clothes stacked neatly in her office, which serve as a reminder to go for her daily lunchtime walk.
“Learning to live a healthy lifestyle isn’t a hard thing to do,” Lawrence says. “At first it’s not so easy, but once you make the changes, the healthier habits are not that difficult to maintain.”
The Prediabetes Diet Plan: How to Reverse Prediabetes and Prevent Diabetes Through Healthy Eating and Exercise
The Prediabetes Diet Plan: How to Reverse Prediabetes and Prevent Diabetes Through Healthy Eating and Exercise
BY HILLARY WRIGHT, MED, RD
Publisher: Ten Speed Press
Publication date: 5 November 2013
More than 80 million adults in the United States have prediabetes, and up to 70% of them will develop type 2 diabetes. However, prediabetes is preventable and even reversible with the right information and lifestyle interventions.
Access to that information is essential, and this book by Hillary Wright is an excellent source of information for anyone who is at risk of developing prediabetes or type 2 diabetes, as well as anyone who would like to improve his or her overall health. Wright, a registered and licensed dietitian with degrees in human nutrition and health education, has more than 20 years of experience in diabetes-related nutrition education. The suggestions enumerated in her book are informed by thousands of patient encounters, successes, and even failures.
Not surprisingly, Ms. Wright’s vast knowledge shines through in The Prediabetes Diet Plan. The first quarter of the book (∼50 pages) contains a technical yet accessible introduction to prediabetes and insulin resistance. For those who already understand these concepts (or prefer to avoid lengthy, scientific explanations), skip ahead to the rest of the book, which outlines two carbohydrate-focused (but not strictly “low-carb”) prevention strategies. The first is a simple, four-step approach to balancing your plate with appropriate proportions of proteins, starches, and vegetables. The second approach also focuses on a “balanced plate,” but more closely aims to meet specific carbohydrate goals. Despite, or perhaps because of, the simplicity of these approaches, they are effective and sustainable strategies for reversing prediabetes. Sample meal plans and a food journal are included to help readers jumpstart their healthy eating plan.
Given that it was published in 2013, The Prediabetes Diet Plan does contain several now-controversial suggestions. For example, there is conflicting evidence on the potential benefits of drinking diet soda compared to sugar-sweetened soda (1). (Wright recommends the former, despite also cautioning her readers to limit their intake of artificial sweeteners.) Similarly, her proposal to limit fat consumption does not recognize the latest thinking that healthy fats may play an important role in satiety and blood glucose management (e.g., eating full-fat rather than low-fat yogurt) (2). That said, her excellent carbohydrate-conscious suggestions, which comprise the vast majority of her book, are supported by a wealth of scientific and anecdotal evidence as effective, well-balanced, and sustainable first steps for someone with prediabetes (3–5).
In all, The Prediabetes Diet Plan offers a wealth of information and empowering, practical tips on mindset, cooking, weight loss, snacking, exercise, supplements, grocery shopping, healthy restaurant dining, and more, and its focus on providing practical, sustainable, advice is appreciated. The challenge, as always, is to get resources such as this one into the hands of people who need them.
Duality of Interest
No potential conflicts of interest relevant to this article were reported.
- © 2018 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0 for details.
- Suez J,
- Korem T,
- Zeevi D, et al
. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 2014;514:181–186
- McKenzie AL,
- Hallberg SJ,
- Creighton BC, et al
. A novel intervention including individualized nutritional recommendations reduces hemoglobin A1c level, medication use, and weight in type 2 diabetes. JMIR Diabetes 2017;2:e5 (DOI: 10.2196/diabetes.6981)
- Saslow LR,
- Daubenmier JJ,
- Moskowitz JT, et al
. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr Diabetes 2017;7:304
- Saslow LR,
- Kim S,
- Daubenmier JJ, et al
. A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PLoS One 2014;9:e91027
- Tay J,
- Luscombe-Marsh ND,
- Thompson CH, et al
. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr 2015;102:780–790
If you’re one of the nearly 50% of Americans with diabetes or pre-diabetes, chances are you’ve heard the advice to exercise regularly: The science is clear that physical activity is an excellent way to help keep your blood sugar under control.
But now, research reveals even better news: You can tailor your workouts to target blood sugar and shed pounds. Make the most of your sweat sessions with these 3 guidelines.
1. Go for Short Bursts
Susan Chiang/Getty Images
Longer workouts aren’t necessarily better, suggests recent research from Canada’s University of Western Ontario. To compare long, steady efforts to short, intense bursts of activity, researchers asked people with type 2 diabetes to get 30 minutes of moderate exercise (65% of target heart rate) or to split up three 10-minute bouts of vigorous exercise (85% of target heart rate), 5 days a week for 3 months.
The result: The 10-minute workouts had a bigger impact on diabetes patients’ health. They improved hemoglobin (a marker of blood sugar) levels by twice as much as the continuous exercisers. They also doubled their drop in LDL, or “bad,” cholesterol while lowering body mass index (a measure of height versus weight) by three times as much.
Those assigned to the short-burst group also exercised longer on average, logging about 100 more minutes per month. “Shorter workouts are easier for people to fit into their schedules,” explains lead researcher Avinash Pandey, an undergraduate student. However, even when the time exercised was the same, the benefits to short bursts still held up. One theory is that higher-intensity workouts burn more calories and fat, and that has a more dramatic effect on blood sugar. (Prevention’s Fit in 10 DVD is exactly what you need to transform your body and health in just 10 minutes a day—check it out!)
MORE: 10 Exercises That Burn More Calories Than Running
2. Break Up Your Workouts
Spreading physical activity throughout the day may also help lower your blood sugar. “Sitting for extended periods is deleterious to health,” says Pandey. In fact, a study published in the journal Diabetes Care found that people who sat for 5 hours after consuming a meal experienced a 24% greater spike in blood sugar, compared with those who got up every 20 minutes.
Adding more activity throughout your day can help prevent those spikes in blood sugar whether you do high-intensity sprints or a short stroll around the block. And the short-burst plan from Pandey’s study—people ran for 10 minutes in the morning, afternoon, and at night—can also help control blood sugar, he says.
MORE: Top 10 Cholesterol-Fighting Foods
3. Work with Weights
Muscle is great for helping your body better regulate its blood sugar, and that’s why your exercise regimen needs a strength-training component. According to a study published in the Journal of the American Medical Association, people with type 2 diabetes who combined aerobic conditioning with strength training cut blood sugar by a third more (34%) than those who did aerobic exercise alone (24%). The weight training—performed twice a week—included one set of 10 to 12 repetitions of each of the following moves:
- Chest press
- Leg curls (front and back)
- Seated row
- Shoulder press
- Leg press
- Lat pull-down
- Back extensions
Your diabetes exercise Rx: 5 days a week of three short-burst cardio sessions, and 2 days a week of strength training, one set each of nine exercises. You’ll be pleasantly surprised at how little time this takes—and you’ll love the results on your blood sugar and waistline!
Sharon Liao Sharon Liao is a former associate editor with Prevention.
Benefits of exercise and physical activity
Why should you be active?
Lack of regular exercise puts you at risk for obesity, diabetes, heart disease and other diseases.
When you exercise on a regular basis, it helps increase your tolerance for activity, and more exercise improves your overall health, and reduces your risk for disease.
Regular exercise also helps you handle and recover from stress.
The American Heart Association recommends moderate exercise for 30 to 60 minutes most days each week.
If you move your body, you will most likely feel better. Even a little is better than none. Recent research suggests that even three 10-minute bursts of exercise can be as beneficial as 30 minutes of exercise at one time, as long as you work hard enough to raise your heart rate.
There are two types of exercise that can help keep you physically healthy:
- aerobic: Aerobic exercise is a rhythmic, repetitive activity such as walking, swimming and biking that continues for at least 30 minutes. This exercise restores a steady supply of oxygen to the muscles that are being exercised.
- strength training: Strength training improves your muscle strength and tone, reduces body fat and may reduce pain in your low back. There are several different types of strength training: elastic bands, cuff and hand weights, free weights, wall pulleys, weight machines, yoga and Pilates.
How does being more active help reduce your risk for developing diabetes?
- improves your blood glucose level
- improves how insulin works
- lowers your blood pressure
- improves HDL (good cholesterol), and lowers LDL (bad cholesterol) and triglycerides (fats in the bloodstream)
- burns calories and fat
- increases your muscle mass, strength and endurance
- improves your metabolism
- increases your energy and helps you feel better
- lowers your stress level
By: Sue Cotey and Andrea Harris, RNs
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
If you have diabetes, exercise offers surprising benefits. As it lowers your stress levels, it lowers your blood sugar level.
How much exercise is right for you? For people with diabetes, The National Institutes of Health (NIH) recommends 150 minutes of aerobic exercise each week. Exercise is so important for people with diabetes that the American Diabetes Association recommends that these patients miss no more than two days of aerobic exercise in a row.
5 exercises for people with diabetes
There are many exercises that will benefit people with diabetes. Here are five we recommend:
- Walking — Because anyone can do it almost anywhere, walking is the most popular exercise and one we highly recommend for people with diabetes. Thirty minutes to one hour of brisk walking, three times each week is a great, easy way to increase your physical activity.
- Tai Chi —This Chinese form of exercise uses slow, smooth body movements to relax the mind and body. In 2009, researchers at the University of Florida studied 62 Korean women assigned to one of two groups—a control group and an exercise group that began a regular practice of Tai Chi. Those who completed the tai chi sessions showed significant improvement in blood sugar control. They also reported increased vitality, energy and mental health.
- Yoga — A traditional form of exercise, yoga incorporates fluid movements that build flexibility, strength and balance. It is helpful for people with a variety of chronic conditions, including diabetes. It lowers stress and improves nerve function, which leads to an increased state of mental health and wellness. According to the ADA, yoga may improve blood glucose levels due to improved muscle mass.
- Dancing —Dancing is not only great for your body. The mental work to remember dance steps and sequences actually boosts brain power and improves memory. For those with diabetes, it is a fun and exciting way to increase physical activity, promote weight loss, improve flexibility, lower blood sugar and reduce stress. Chair dancing, which incorporates the use of a chair to support people with limited physical abilities, makes dancing an option for many people. In just 30 minutes, a 150-pound adult can burn up to 150 calories.
- Swimming — Swimming stretches and relaxes your muscles and doesn’t put pressure on your joints, which is great for people with diabetes. For those with diabetes or at risk for developing diabetes, studies show it improves cholesterol levels, burns calories and lowers stress levels. To get the most benefit from swimming, we recommend that you swim at least three times a week for at least ten minutes and gradually increase the length of the workout. Make sure to have a snack and monitor blood sugars. Lastly, let the lifeguard know that you have diabetes before you get in the pool.
Before starting an exercise program, talk to your doctor to be sure the exercise you choose is safe and appropriate for your type of diabetes. Remember to start slowly, especially if you have not been physically active for a while.
Below, find other safety tips:
- Check your blood sugar before and after exercise until you are aware of how your body responds to exercise.
- Whether you have Type 1 or Type 2 diabetes, make sure your blood sugar is less than 250 mg/dl before exercising. For people with Type 1 diabetes, exercising with a blood sugar higher than 250 mg/dl may cause ketoacidosis, which can be a life threatening condition resulting from a lack of insulin in the blood.
- Do a five-minute warm-up before and a five-minute cool down after exercising.
- Drink plenty of water before, during and after exercise to prevent dehydration.
- Be prepared for any episodes of low blood sugar. Have something available that can bring sugar levels up, such as hard candy, glucose tablets or 4 oz. of juice.
- Wear a medical alert ID band. If an emergency occurs, EMS will know how to treat you properly.
- Always carry a cell phone.
- Avoid exercising in extremely hot or cold temperatures.
- Wear proper shoes and socks to protect your feet.
Listen to your body. If you become short of breath, dizzy or lightheaded, stop exercising. Report any unusual problems you experience to your doctor.
Jacob Haus, PhD
Photo courtesy of Troy Heinzeroth
Jacob Haus, PhD
Kinesiologist, University of Illinois
American Diabetes Association Research Funding
Junior Faculty Award
Exercise is one of the most commonly prescribed and effective ways to prevent or treat type 2 diabetes. Researchers have shown that working out regularly can be more effective at controlling blood glucose than drugs like metformin. Tight blood glucose control, in turn, helps to keep complications—such as eye disease, nerve damage, and kidney disease—at bay.
What’s not entirely clear is why exercise works so well. There’s emerging evidence that exercise does more than just burn off glucose. At the cellular level, workouts may help the body reshape the way its cells work, making cells more resilient.
That remodeling may also help reduce inflammation, which is thought to be a culprit in many diabetes-related illnesses. “When you become obese, there’s a chronic level of inflammation that leads to more complications,” says Jacob Haus, PhD, a professor of kinesiology and nutrition at the University of Illinois in Chicago.
Inflammation, Haus explains, is the equivalent of a constant low-grade infection: The body’s immune cells are active when they shouldn’t be, and over time that takes a toll. The biology is complex, but at its most basic, one source of inflammation associated with obesity and type 2 diabetes is the result of a lack of physical activity or structured exercise. “When you take in more calories than you expend, you store the extra energy as fat. The body needs somewhere for the excess calories to go,” Haus says. “It starts to push fat into fat cells, and the fat cell isn’t able to adapt. As a result, the fat cells become angry.”
This pressure on the fat cell resembles what might happen to the body when coming under attack by a virus. “It starts to get angry and calls in for immune cells,” Haus says. The immune cells, rather than acting as the body’s defenders, instead chew up the irritated fat cell and spit it into the blood. Researchers now think that this constant destructive churn contributes to type 2 diabetes and many of its complications, such as nerve and kidney damage, eye problems, and heart disease.
Appropriately enough, one of the signature byproducts of these angry fat cells and inflammation is something called a receptor for advanced glycation end products—RAGE, for short. Advanced glycation end products (AGEs) are harmful substances created when sugars combine with fat or protein in the body—a recipe that’s highly prevalent in poorly managed diabetes. Researchers think they may play a big role in diabetes. RAGEs, in turn, increase the likelihood that AGEs will be absorbed into the cells. Too many RAGEs result in a higher risk of type 2 diabetes and its complications.
Haus thinks exercise might be a good way to reduce RAGEs. To learn more, Haus is working to measure the effects of intense exercise on the chemistry of muscle cells. His experiment, which is funded by the American Diabetes Association, explores whether regular workouts can remodel the cells of overweight and obese older adults with type 2 diabetes to resemble those of lean, healthy people in their 20s.
In a lab full of exercise equipment, Haus pushes participants close to their limits. By the end of the experiment, he hopes to have brought 40 people with diabetes into the lab to exercise on a treadmill at 75 percent of what they can do for about an hour, five days a week. Another group of 40 people with type 2 diabetes will get diet and exercise counseling but no intense workouts. Finally, Haus is having a smaller group of lean, healthy participants work out to see if their bodies respond in the same way to exercise.
After the workouts, Haus and his team take muscle tissue samples, comparing the people with diabetes and the healthy participants. The goal is to see if people with diabetes can use exercise as a tool to improve the way their cells respond to inflammation, producing proteins that reduce it rather than ramp it up. “We’re trying to understand how exercise remodels the body,” Haus explains. “Just like muscles become stronger and more adapted with exercise, exercise is important to remodeling the cell walls and decreasing low-grade inflammation that leads to complications.”
Early results suggest exercise is enough to make the cells of people with diabetes resemble those of people without, but only sometimes. More research is needed to figure out why some people respond better than others. If the mechanisms can be identified, there might be a way to develop treatments to recreate the beneficial cellular effects of workouts. “If we can identify proteins and how they work in the cell, they can be targeted for drugs in the future,” Haus says.
In the meantime, Haus, a rugby referee in his spare time who has had type 1 diabetes for over 20 years, recommends simply spending more time working out. “Exercise is a beautiful tool to stress the body ,” he says.
Help Support Diabetes Science
If you would like to support diabetes research, such as that being done by Jacob Haus, PhD, please go to diabetes.org/researchdonation.
Physical activity is very important for people with diabetes! Good news – it’s not as hard as you might think to be more active.
Being More Active Is Better for You
If you have diabetes, being active makes your body more sensitive to insulin (the hormone that allows cells in your body to use blood sugar for energy), which helps manage your diabetes. Physical activity also helps control blood sugar levels and lowers your risk of heart disease and nerve damage.
Being physically active can be fun. When it’s possible, go outside with a friend, connect, and enjoy the weather.
Some additional benefits include:
- Maintaining a healthy weight
- Losing weight, if needed
- Feeling happier
- Sleeping better
- Improving your memory
- Controlling your blood pressure
- Lowering LDL (“bad”) cholesterol and raising HDL (“good”) cholesterol
How To Benefit From Physical Activity
The goal is to get at least 150 minutes per week of moderate-intensity physical activity. One way to do this is to try to fit in at least 20 to 25 minutes of activity every day. Also, on 2 or more days a week, include activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).
Examples of moderate-intensity physical activities include:
- Walking briskly
- Doing housework
- Mowing the lawn
- Playing Sports
These activities work your large muscles, increase your heart rate, and make you breathe harder, which are important goals for fitness. Stretching helps to make you flexible and prevent soreness after being physically active. Find out more by reading tips for being active with diabetes pdf icon.
Ways To Get Started
Finding an activity you enjoy and having a partner helps you stick with it.
- Find something you like. Exercising by doing something you enjoy is important because if you don’t like it, you won’t stick with it. Find an activity that you and your health care provider agree you can do regularly for the best results.
- Start small. If you’re not already physically active you should begin slowly and work your way up to the desired level. For example, you could park farther from the door, take the stairs, do yard work, or walk the dog. Start small and gradually add a little more time and intensity each week.
- Find a partner. It’s more fun when someone else is counting on you to show up. Having a partner may help you continue to be active.
- Pick a goal. An example of a goal could be to walk a mile every day for a month or to be active every weekday for 30 minutes. Be specific and realistic. Always discuss your activity goals with your health care provider.
- Schedule it in. The more regular activity you do, the quicker it will become a habit. Think of ways to link activity to daily life. For example, you could schedule walking with a co-worker after lunch. Try not to go more than 2 days in a row without being active.
Ways To Turn Excuses Into Solutions
For every excuse, there is a workable solution. Listed below are some of the most common excuses and suggested solutions.
The importance of exercise when you have diabetes
For people who have diabetes—or almost any other disease, for that matter—the benefits of exercise can’t be overstated. Exercise helps control weight, lower blood pressure, lower harmful LDL cholesterol and triglycerides, raise healthy HDL cholesterol, strengthen muscles and bones, reduce anxiety, and improve your general well-being. There are added benefits for people with diabetes: exercise lowers blood glucose levels and boosts your body’s sensitivity to insulin, countering insulin resistance.
Many studies underscore these and other benefits from exercise. Following are some highlights of those results:
- Exercise lowered HbA1c values by 0.7 percentage point in people of different ethnic groups with diabetes who were taking different medications and following a variety of diets—and this improvement occurred even though they didn’t lose any weight.
- All forms of exercise—aerobic, resistance, or doing both (combined training)—were equally good at lowering HbA1c values in people with diabetes.
- Resistance training and aerobic exercise both helped to lower insulin resistance in previously sedentary older adults with abdominal obesity at risk for diabetes. Combining the two types of exercise proved more beneficial than doing either one alone.
- People with diabetes who walked at least two hours a week were less likely to die of heart disease than their sedentary counter- parts, and those who exercised three to four hours a week cut their risk even more.
- Women with diabetes who spent at least four hours a week doing moderate exercise (including walking) or vigorous exercise had a 40% lower risk of developing heart disease than those who didn’t exercise. These benefits persisted even after researchers adjusted for confounding factors, including BMI, smoking, and other heart disease risk factors.
In general, the best time to exercise is one to three hours after eating, when your blood sugar level is likely to be higher. If you use insulin, it’s important to test your blood sugar before exercising. If the level before exercise is below 100 mg/dL, eating a piece of fruit or having a small snack will boost it and help you avoid hypoglycemia. Testing again 30 minutes later will show whether your blood sugar level is stable. It’s also a good idea to check your blood sugar after any particularly grueling workout or activity. If you’re taking insulin, your risk of developing hypoglycemia may be highest six to 12 hours after exercising. Experts also caution against exercising if your blood sugar is too high (over 250), because exercise can sometimes raise blood sugar even higher.
Because of the dangers associated with diabetes, always wear a medical alert bracelet indicating that you have diabetes and whether you take insulin. Also keep hard candy or glucose tablets with you while exercising in case your blood sugar drops precipitously.
For more on how to live well after you’ve been diagnosed with diabetes, read Living Well With Diabetes, a Special Health Report from Harvard Medical School.
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Preventing Prediabetes: Is Diet or Exercise More Important?
Diet may have a slight edge over exercise when it comes to losing weight, but pairing that healthy diet with a regular exercise routine is key if you’re looking to prevent prediabetes.
According to a study published in the Summer 2014 issue of The Permanente Journal, an estimated 34 percent of adults in the United States have prediabetes, which means their blood glucose levels are higher than normal but not high enough to qualify as full-blown type 2 diabetes.
You can chalk some of that up to genetics, but your chances of developing diabetes aren’t based on family history alone. Think of it this way: You might inherit a predisposition to the disease, but then something in your environment has to trigger it, according to the Joslin Diabetes Center.
“While certain genetic factors influence the likelihood of developing insulin resistance, it’s the lifestyle factors — what we do about it — that determine whether metabolic health worsens or stays intact,” says Theresa Link, RD, CDE, with Virta Health in San Francisco.
That means prediabetes is preventable — so long as you make healthy choices. This leads us to the age-old question: Does exercise or diet play a bigger role in keeping you healthy?
The Case for a Healthy Diet
According to the Centers for Disease Control and Prevention (CDC), the single most important way to prevent diabetes is to control your weight. Research has shown that losing 5 to 10 percent of your body weight can lower your chances of developing the disease by 58 percent, according to Johns Hopkins Medicine.
And when weight loss is the No. 1 goal, diet beats out exercise, according to a study published in October 2014 in the Journal of the Academy of Nutrition and Dietetics. After all, losing weight comes down to caloric deficit, and most people would agree it’s easier to skip the Starbucks Frappuccino than to work out on the elliptical for an hour.
Making smart food choices — by consuming minimally processed whole foods without added sugars, and limiting grains and starches, Link says — is one part of it. But timing is also important if you’re at risk of developing diabetes. “Since diabetes is a metabolic disease, it’s most important to know how to fuel your body to keep your metabolism running efficiently,” says Kathy Namolik, RD, CDE, a consultant for Sarasota Memorial Health Care System in Venice, Florida.
So while you might be tempted to skip meals to lose weight, fueling your body every four to five hours is a better approach to avoid “hangry,” I-want-to-eat-everything-in-sight feelings, Namolik says.
The Case for Exercise
Movement also burns calories, of course, but don’t rely on exercise alone to slim down. “Research has demonstrated that exercise is not a good weight-loss tool, so it would be unwise to attempt exercising away the pounds,” Link says.
There’s more to it, though — exercise can help improve your body’s ability to use glucose, which can keep prediabetes at bay. Malachy McHugh, MD, director of research at the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City, says exercise can reduce the risk of developing diabetes even better than medication can. This is because exercise naturally lowers your blood glucose levels by making your cells more sensitive to insulin, says Christopher J. Visco, MD, assistant professor in the department of rehabilitation and regenerative medicine and director of the sports medicine fellowship at Columbia University Medical Center in New York City.
A study published in October 2016 in the journal Diabetologia explored whether exercise alone could affect oral glucose tolerance, an indicator of whether glucose levels will progress to diabetes. It turns out that exercise comes pretty close to the exercise-plus-diet approach. In the study, the group that adjusted their diet and exercise habits saw an 8.2 percent improvement in glucose tolerance, while the group that solely adopted a moderate-intensity workout program improved their tolerance by 6.4 percent.
The researchers concluded walking about 11 miles per week at a moderate intensity can be almost as effective as the diet, exercise, and weight-loss overhaul. But the key word there is “almost.”
So Which Is More Important?
If you had to choose only one, diet wins. “For most individuals, exercise alone will not prevent the onset of prediabetes and type 2 diabetes,” Link says. “Diet changes make the greatest impact on prevention.”
But at the end of the day, committing to both a healthy diet and regular exercise is the way to go. “The danger of comparing the benefits of diet versus exercise for the prevention of prediabetes is that it might sway patients to target one versus the other, when the goal should be to incorporate both,” Dr. McHugh says.
In doing so, you’ll reduce your risk of developing prediabetes as well as the comorbidities that go with it, including obesity, cardiovascular disease, chronic kidney disease, and sleep disorders.