Everyone knows that diabetes has been increasing at an alarming rate. Today, more than 9% of Americans live with the disease, and more than one quarter of the U.S. population has prediabetes. This is a slippery slope because 15 to 20% of the prediabetes cases will turn into Type 2 diabetes within five years. The Centers for Disease Control predicts that at this rate, a third of the U.S. population will have diabetes by 2050.
Diabetes is not fatal in itself, but it increases the risks of heart disease, stroke, kidney failure, loss of vision, and nerve damage. “Diabetes is the number one cause of non-traumatic amputations,” according to endocrinologist Dr. Jeremy Gilbert. So even if you don’t die from diabetes, it significantly reduces your quality of life and increases the risks of an early death.
I know this sounds gloomy, but you are not powerless. Diabetes is one of the conditions that you have some power over, and you’re about to get simple and easy tools to help you better your situation.
Of course, like everything in life, the more you use the tools and apply the methods, the better you’ll get at it — but first: How did we get here?
The obvious answer for Type 2 and prediabetes is the food you eat. We eat more processed food and a lot more sugar than our ancestors did, and our bodies are just not used to it. Our genes are still 10,000 years old, so our bodies react better to unprocessed natural foods — the kind of stuff we ate while we were hunters and gatherers. Food choices are at the base of the solution.
However, diet isn’t the only culprit. Have you noticed that most advancement in society comes with a reduced need for labor? Since our bodies are built for movement, it’s no surprise that we are so sick and riddled with disease. (This is actually old news. Bernardo Ramazzini, a 17th-century physician, was the first to note a link between sedentary behaviors and deteriorating health.) In 2011, researcher James O’Keefe published an article called “Exercise Like a Hunter-Gatherer.” In it, he suggested that we should move like our ancestors to maximize our gene expression. It is safe to say that a sedentary lifestyle doesn’t promote long-term health.
I know I’m stating the obvious — physical activity promotes health — but you can’t rely on exercise countering poor eating habits. Tim Noakes, an avid runner, wrote Lore of Running in 1985, advocating a diet very high in carbohydrates. However, his marathon training and running did not protect him from his carb abuse. At one point, he realized he was gaining weight despite his training. He was soon diagnosed with Type 2 diabetes. Don’t fall into the trap of the sweet treat after a little exercise, or you will just undo your good work. You need both sides of the coin. They work hand in hand.
And before you use the main reason for not exercising — lack of time — let me tell you that you’ll have options. Our ancestors engaged in many different activities, and you should do the same.
We’ll get to the exercise part soon, but first let me introduce you to your strongest ally in this battle.
Your muscles are the main site of glucose clearance. Yes, some glucose gets stored in your liver, but your muscles store the most. After a meal, blood glucose will go to the muscles and the liver first; when they are full, your fat cells will store the extra.
This means that it’s very important that you enlist the help of your muscles. Without them, it’s very hard to be successful at managing your blood sugar. Activating your muscles on a regular basis will make them thirstier for glucose. This will make them more sensitive to insulin and make it easier to clear glucose out of the blood.
Imagine a brand new tube of toothpaste. It’s full, and you cannot add any more to it. By squeezing it, you get some of the toothpaste out, and if you wanted to, you could get the same quantity toothpaste back in the tube.
Now imagine that your muscles are the tube and glucose is the toothpaste. If your muscles are full, they won’t accept more glucose. They will resist the action of insulin, and some glucose will linger in the blood. However, if you squeeze your muscles, you will make room for storage. Does that make sense? Now let’s look at how you can get your muscles to help.
Let’s start off easy: Sit less. If you think about it, you sit during your commute, you may sit at work, you sit for meals, and you sit in front of the TV. Recent research on the negative effects of prolonged sitting is very strong. Dr. James Levine, director of the Mayo Clinic-Arizona State University Obesity Solutions Initiative and inventor of the treadmill desk, is credited with coining the now-common phrase “sitting is the new smoking.”
Did you know that sitting less could influence your blood glucose? When healthy young people sit for most of the day, for only one day, they become less sensitive to insulin. Also, long sitting periods can reduce the health benefits of a regular exercise routine. So if this article gets you to change only one habit, this is it.
What can you do? For starters, break it up. Make it a habit of standing up every 30 to 60 minutes. These brief interruptions will have a positive effect; research shows that reducing your sitting time by just 25% can have a significant influence. Set an alarm to tell you to get up and move, so that periodically you’ll get up from your chair and walk around for a few minutes.
Every step counts
Now that you are on your feet a bit more and taking a few steps, remember that it all adds up — every bit of movement is important. Make a habit of walking a few minutes before getting into work, and do the same when you leave. Take the stairs instead of riding the escalator. Go for a walk around the block at lunch time. Grab every chance you can to move. Don’t be the person who waits in line to stand on the escalator; the stairs may be faster, and they’re definitely more beneficial. A study by researchers in Baton Rouge, Louisiana, published in Applied Physiology, Nutrition, and Metabolism, defines sedentary as fewer than 5,000 steps per day, so aim to gradually increase your steps to 7,500 steps per day. The more, the better.
A compounding effect of multiple short bouts
We just covered unstructured activities, different ways to sneak in some movement into your day. Now let’s look into more planned activities.
You may be surprised to know that you don’t have to spend hours exercising to get the benefits. Short exercise bouts are easier to schedule, and you’re more likely to maintain the habit. You could get the same results from three sessions of ten minutes compared to one session of 30 minutes. The added benefit is that you could work harder during those 10 minutes. Research reports that you get more benefits from higher-intensity activities.
Aerobic type activities like cycling or running has been shown to have a positive influence on insulin sensitivity and blood glucose. But another type of activity has even more influence.
Resistance is not futile
For the past few decades, traditional cardio activities like walking and cycling have become the go-to options because researchers know this type of exercise is beneficial to heart health. But since the ’90s, resistance training has been getting more attention, and deservedly so. It’s now considered very important to a long-term health plan.
A walking program may frustrate you with the lack of long-term benefits on blood sugar. You see, walking will help clear the sugar in your bloodstream, but it does virtually nothing to increase your muscle mass — and increasing muscle mass is the main thing that contributes to long-term blood glucose control.
Resistance training has many health benefits but is of higher importance for people with diabetes. As we age, we all tend to lose muscle mass, and people with Type 2 diabetes tend to lose more than people who don’t have diabetes. So your muscle tissue should be to you what the ring was to Gollum: your precious. The key to your long-term success in managing blood glucose is to increase your muscle mass.
This is pretty simple. By challenging your muscles, you will reduce the glucose reserves. Your body will be driven to restock, and it also will tend to store more than before. Why? Because it plans for next time and doesn’t want to be in the same situation. Gradually challenging your muscles will make them get stronger and more sensitive to insulin. A 2009 study published in Diabetology & Metabolic Syndrome reported that resistance training was associated with better glycemic control than treadmill exercise.
Let’s get a little technical. (Don’t worry, it won’t be too painful.) Your muscle cells have glucose transporters called GLUT4 that are activated by the action of insulin on the muscle cell membrane. GLUT4s come to the surface to move glucose from the bloodstream to inside the muscle cell to be used for energy or stored for later. When this process is repeated regularly, your muscles adapt. They become more sensitive to insulin, and — you guessed it — will create more GLUT4. If you force your muscles to part with their glucose reserves, they want more; all they want is to be ready for the next challenging workout. If the muscles are always stocked up, they will not store more glucose, so they will resist the action of insulin. Most times, the muscle is functioning well — it just doesn’t need the extra glucose that we are trying to force-feed it.
Now think about the typical cardio workout. Most of it is done mainly using the leg muscles, and it is rarely done in a way that involves most of the muscle fibers of a muscle. On the flip side, most people do resistance training for lower and upper body, which results in more muscles being challenged to nearly the point of fatigue. When more fibers are put to work, the result is an increased storage capacity for glucose.
How much difference can resistance training make? A study published in Diabetes Care looked at men in their 60s with Type 2 diabetes. The men were not exercising and had recently been diagnosed. After following a resistance training program twice a week for 16 weeks, they not only got stronger but also lost abdominal fat and improved their insulin sensitivity and fasting blood sugar. Sounds like win-win to me.
How can you get started? Pick exercises that use a lot of muscles — they will give you a better return on your time. Two basic exercises that you can do at home are squats and pushups.
Start doing squats simply by sitting in and out of a chair without using your hands. Always keep your heels on the floor; if your heels come up from the floor, chances are your knees will remind you. And control the movement up and down. When you feel your legs are getting tired, take a rest for a minute or two; repeat two or three times. From week to week you should be able to do a few more.
The easiest way to do pushups is from the wall. Stand in front of a wall and step away from it a few inches, then push yourself away from the wall. You can gradually increase the difficulty of the pushups by stepping further away from the wall. When this gets too easy, try them from the kitchen counter.
Here’s a word of caution on starting an exercise routine. Diabetes is a risk factor for cardiovascular disease, so talk to a doctor before you do high-intensity activities. And if your blood glucose is high (240 mg/dl), do light activities until it comes back down — pushing yourself could make it worse. Also, be aware that a more demanding exercise session may increase your blood sugar, but only for a short time.
Now you’ve got options. Obviously, the more movement you include in your life, the more control you’ll have. It’s never too late to take back control of your blood sugar and your health. It is within your reach.
Want to learn more about using physical activity to help manage your diabetes? Read “Exercise Myths and Facts,” “Making Exercise More Fun,” and “Picking the Right Activity to Meet Your Fitness Goals.”