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3 Must Know Facts For The Diabetic Fitness Enthusiast

By Phil Graham

Renowned competitive body builder and Sports Nutritionist Phil Graham (BSc, CSSN) has established himself as one of UK’s leading fitness educators and coaches
Read more.

At present there are over 82 million people living with Diabetes in the world, of which 46% are undiagnosed. What’s worse is the majority of these conditions are Type 2, the preventable form of Diabetes.

Diabetic Fitness Enthusiast


Diabetes is a huge problem and the costs to society are high and escalating. The International Diabetes Federation reported that Diabetes caused 5.1 million deaths in 2013, that’s one death from diabetes every six seconds!

The cost to the economy doesn’t get much better with $548 billion dollars being spent in 2013, and estimated to be over $600 billion come 2035.

An increase in work place mechanization and availability of cheaper more convenient food could be considered major contributing factors. Either way governments should be working hard to increase public awareness and make relevant policy changes to slow the growth of this disease, particularly the preventable kind.


defining diabetes

Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose (hyperglycemia). It results from derangements in insulin production, insulin action or both.

Long term hyperglycemia as a result of diabetes is associated with significant damage, to various various organs and systems within the body, especially the eyes, kidneys, nerves, heart, and blood vessels.

Generally speaking, there are 4 main classes of diabetes.

Type 1 Diabetes

Cause Autoimmune destruction of pancreatic β-cells.
Age of Onset Common in Children/Adolescents, but can occur at any age.
Initiation Poorly defined – Proposed Environmental, Viral Factors.
Insulin Production Complete deficiency
Nutritional Status Thin or Overweight: Catabolic state (recent weight loss)

Type 2 Diabetes

Cause Obesity, poor nutrition, sedentary lifestyle and POP exposure
Age of Onset May occur at any age
Initiation Some genetic and environmental influences
Insulin Production Insulin Resistant
Nutritional Status Obese, overweight or normal: Little to no recent weight loss

Gestational Diabetes

Cause Obesity, poor nutrition, sedentary lifestyle and POP exposure
Age of Onset 24-28 weeks of gestation (carrying fetus)
Initiation Some genetic and environmental influences
Insulin Production Inadequate insulin response. Insulin resistance heightened by placental hormones
Nutritional Status Obese, overweight or normal

Other Forms of Diabetes

Caused as a result of:

  • Genetic Defects
  • Drugs and Chemicals
  • Pancreatic Disease
  • Surgery and Infection


Diabetes can be clinically diagnosed from the following marker

  • A1C Blood Test > 6.5%
  • Fasting Blood Glucose of >7.0 mmol/l
  • A 2hr Post Glucose Tolerance Test blood glucose reading of > 11.1mmol/l after consuming 75g oral dextrose
  • Classic Symptoms of Hyperglycemia which include; frequent urination, thirst, blurry vision and unexplained weight loss.


Diabetes is managed through a combination of medication, diet, exercise and lifestyle modification.

In this particular article I want to focus on the role exercise in diabetes management

Exercise and Diabetes – What’s The Deal?

It is well established that exercise and daily physical activity are important for all individuals with any type of diabetes (1).

man working out

In Type 1 Diabetes, combined weights resistance training and aerobic exercise has been shown to improve key health markers, blood glucose management and increase life expectancy (2). Surprisingly, research in respect to Type 1 Diabetes is somewhat limited in comparison to Type 2 Diabetes and thus warrants further investigation.

Besides living a sedentary lifestyle. There is a substantial amount of evidence to support the role of combined resistance training and cardiovascular exercise in the treatment of Type 2 Diabetes (3).

The research has largely shown the effects of resistance training are more efficacious than aerobic (4) exercise or diet (5) alone at improving rate of fat loss and body composition change.


Diabetics with no exercise experience may need to build a foundational level of fitness before progressing to more advanced exercise options like weight training. Simple increases in physical activity like trying to stand more throughout the day or use of a pedometer may be viable strategies.



Aerobic Exercise is an activity that uses large muscle groups at relatively low rates of muscular contraction that can be maintained continuously for prolonged periods of time (minutes to hours).

Aerobic exercise includes both low intensity steady state exercise such as walking and also more vigorous aerobic exercise such as High Intensity Interval Training which involves a combination of low intensity work combined with intermittent high intensity bouts

Woman lifting weights

Generally speaking, aerobic exercise has been shown to promote a reduction in blood glucose levels in both Type 1 and Type 2 Diabetics for 2-72 hours after the last bout of activity (6). Obviously, the blood glucose lowering effect is highly dependent upon exercise choice and duration.

More vigorous aerobic exercise may cause a transient increase in blood glucose levels due to the release of glucose raising hormones

Anaerobic Exercise is characterized by high rates of intense muscular contraction performed over a relatively short period of time. In the context of this text it would include weights resistance training and high intensity cardiovascular training.

Resistance training is known as a potent stimulator of the counter regulatory hormones catecholamine’s, cortisol and growth hormone. These hormones serve the purpose of increasing blood glucose. Increased levels of lactate (lactic acid) can be recycled into glucose and subsequently increase blood glucose levels.

In healthy individuals, the temporary rise in blood glucose levels is compensated at the end of training, keeping blood glucose levels in range.

Type 1 diabetics fail to produce enough insulin to bring blood glucose levels back down to normal levels, which can lead to hyperglycemia, if insulin medication isn’t administered. 

There are no current guidelines are in place as to suggest how much insulin a Type 1 Diabetic should administer to treat post exercise Hyperglycemia.

Type 2 Diabetics response to exercise will differ according to degree of insulin resistance. Needless to say the threat of hyperglycemia is not as high compared to Type 1 subjects who produce no insulin.

Initially within the first few hours of exercising blood glucose levels may rise.

However, due to the fact anaerobic exercise generally depletes glycogen stores, can result in a blood glucose lowering effect post the 1-2 hour exercise period after counter regulatory hormones ware off.


For most people with diabetes, low-level physical activity can be pursued without the need for medical examination.

However, those looking to participate in planned vigorous exercise are strongly recommended to consult with their health professional team and undertake all the necessary medical evaluations before hand.

This is especially true for individuals who struggle with their control and have underlying health complications including:

For example if you combine a Turkish Get Up using a decent size kb, and do 1 minute of kettlebell swings  and doing a single leg deadlift you are gonna’ have a ready-made strength program.

These 3 exercises are 20% of exercises that every triathlete should be doing. As they are incredible powerful and train the posterior chain, and allow the body to work together as a unit- and you need this functional force if you are an endurance athlete.

woman lifting weights
  • Obesity (and everything that comes with)
  • Cardiovascular complications associated with the heart, blood vessels, eyes, kidneys, feet and nervous system.
  • Nerve damage
  • Orthopedic limitations (prior joint surgery, unhealed ulcerations or wounds on the feet etc.)
  • Other underlying medical conditions that may hinder exercise performance.
  • History of smoking

The Fitness professional must be aware of these complications before subscribing exercise plans. An orthopedic limitation such as unhealed ulcerations or amputation will significantly affect exercise program design.

In any case where complications do exist, an individual’s response to exercise must be measured and progressed accordingly.

Key Note: Don’t let pre exercising testing be a barrier to exercise. Its for you own safety.


man lifting weights

It’s worth avoiding exercising whilst hyperglycemic or in a state of ketonaemia (abnormally high concentrations of ketone bodies in the blood).Not only will your performance suck, you’ll burn up valuable muscle tissue for fuel. Also you’ll be at increased risk for further deteriorations in blood glucose, not a nice combo!

I hate the idea that my muscles aren’t receiving the muscle building nutrients they should be. Research suggests delaying exercise if blood glucose is higher than 14mmol/L and if blood/urine ketones are present (7).

If your tight for time and blood glucose is slow to respond skip the session and train another time. If you’re serious about making strength and body composition goals, high performance in the weight room is essential. Not just a matter of showing up!

Diabetic Check List

  • Keep a clear head
  • Know what you’re eating
  • Know when you last took your medication
  • Know how to react and take the best options to regain control


Head over to where you can download your free Diabetic Fitness report from our leading writer Phil Graham and stay updated for the launch of his new book The Diabetic Muscle and Fitness Guide and Online Diabetic Muscle and Fitness Community.

Phil Graham

About Phil

Renowned competitive body builder and Sports Nutritionist Phil Graham (BSc, CSSN) has established himself as one of UK’s leading fitness educators and coaches. He has helped and inspired a diverse range of clientele ranging from every day members of the public, fellow fitness professionals right through to professional athletes across a wide variety of sports.

Phil has written for mostly all of the major fitness publications, (e.g. Muscle & Fitness, Train, Flex, Men’s Health, Iron life), speaks regularly at some of the worlds largest fitness exhibitions, hosts the very popular Podcast Elite Muscle Radio which is available on iTunes and also works as Genetic Supplements resident nutrition expert for product development.

Phil has also been living with Type 1 Diabetes for over 12 years, and is in the process of writing his first book on Diabetes, The Diabetic Muscle and Fitness Guide.

You can visit Phil’s website, or connect on FacebookTwitterYouTube and Instagram


  • Exercise and Diabetes: A Clinician's Guide to Prescribing Physical Activity Paperback – 30 Jul 2013 by Sheri R. Colberg (Author)
  • Jane E. Yardley, PHD, Glen P. Kenny, PHD, Bruce A. Perkins, MD, MPH, Michael C. Riddell, PHD4, Nadia Balaa, BSC, Janine Malcolm, MD, Pierre Boulay, PHD, Farah Khandwala, MSC and Ronald J. Sigal, MD, MPH. Resistance Versus Aerobic Exercise Acute effects on glycemia in type 1 diabetes. Diabetes Care March 2013 vol. 36 no. 3 537-542
  • Moy CS, Songer TJ, LaPorte RE, Dorman JS, Kriska AM, Orchard TJ, Becker DJ, Drash AL. Insulin-dependent diabetes mellitus, physical activity, and death.Am J Epidemiol. 1993 Jan 1;137(1):74-81.
  • Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis.
  • Cauza E,Hanusch-Enserer U, Strasser B, Ludvik B, Metz-Schimmerl S, Pacini G, Wagner O, Georg P, Prager R, Kostner K, Dunky A, Haber P: The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil2005; 86: 1527– 1533
  • Wycherley TP1, Noakes M, Clifton PM, Cleanthous X, Keogh JB, Brinkworth GD. A high-protein diet with resistance exercise training improves weight loss and body composition in overweight and obese patients with type 2 diabetes. Diabetes Care. 2010 May;33(5):969-76. doi: 10.2337/dc09-1974. Epub 2010 Feb 11.
  • King DS, Baldus PJ, Sharp RL, Kesl LD, Feltmeyer TL, Riddle MS. Time course for exercise-induced alterations in insulin action and glucose tolerance in middle-aged people. J Appl Physiol (1985). 1995 Jan;78(1):17-22.
  • Exercise and Diabetes: A Clinician's Guide to Prescribing Physical Activity Paperback – 30 Jul 2013 by Sheri R. Colberg (Author)
  • Sigal R, Kenny G, Oh P, Perkins BA, Plotnikoff RC, Prud’homme D et al. Physical Activity and Diabetes Canadian diabetes association clinical practice guidelines expert committee agreement of diabetes in Canada. Can J Diabetes. 2008;32(1)S37-9
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