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The Best Exercise for Type 2 Diabetes Remission

Walking after meals, strength training and less sitting all lower blood sugar. Dr. Sayantan Banerjee explains what the trials show and gives a weekly plan for US and UK readers.

TYPE 2 DIABETES REMISSION

Dr. Sayantan Banerjee

10/31/20267 min read

Exercise on its own rarely puts type 2 diabetes into remission. That needs weight loss, which mostly comes from changes in eating. But exercise does things that diet can't. It pulls glucose out of your blood without needing much insulin, it reduces liver fat even when the scale barely moves, and it protects the muscle you need to keep weight off. People who stay in remission are almost always people who stay active.

So the right question isn't whether exercise works. It's which kinds of exercise work best, how much you need, and how to do it safely. This article answers all three.

How exercise lowers blood sugar

Your muscles are the biggest store of glucose in the body. After a meal, most of the glucose that leaves your blood ends up in muscle.

Normally, glucose gets into muscle cells with the help of insulin. Insulin signals the cell to move glucose transporters, called GLUT4, to its surface, where they let glucose in. In type 2 diabetes, muscle responds less well to insulin, so less glucose gets in.

Exercise uses a second route. When muscles contract, they move GLUT4 transporters to the surface on their own, without needing insulin. That is why a walk after dinner can lower your glucose even if you are very insulin resistant. The effect lasts for hours after you stop, and regular exercise makes muscles more sensitive to insulin for a day or two afterwards.

Over weeks and months, exercise also:

reduces fat in the liver, which lowers fasting glucose
reduces visceral fat around the organs
increases the amount of muscle, giving glucose more places to go
lowers blood pressure and improves cholesterol
improves sleep and mood, which both affect glucose

What the guidelines say

US and UK guidance is broadly similar.

The American Diabetes Association recommends that adults with type 2 diabetes:

do at least 150 minutes a week of moderate to vigorous aerobic activity, spread over at least three days, with no more than two days in a row without activity
do resistance (strength) exercise two to three times a week, on non-consecutive days
break up long periods of sitting every 30 minutes or so with a few minutes of light movement
include flexibility and balance work, especially if they are older

The UK Chief Medical Officers' guidelines for all adults recommend at least 150 minutes of moderate activity or 75 minutes of vigorous activity a week, strength activities on at least two days, and less time sitting.

Moderate activity means you can talk but not sing. Brisk walking, cycling on flat ground, swimming at a steady pace and dancing all count. Vigorous activity means you can only say a few words before needing a breath.

Walking after meals: the simplest powerful habit

If you only make one change, make it this.

A 2016 study from the University of Otago in New Zealand, published in Diabetologia, compared two ways of walking for 41 adults with type 2 diabetes. In one phase they walked for 30 minutes once a day, at any time. In the other they walked for 10 minutes after each main meal. The total was the same.

Walking after meals lowered the rise in glucose after eating by about 12% compared with a single daily walk. After the evening meal, when people ate the most carbohydrate and were usually least active, the benefit was about 22%.

The reason is timing. Glucose peaks between about 30 and 90 minutes after eating. Moving your muscles during that window pulls glucose out of the blood just when it is highest.

You don't need to walk fast or far. Ten to fifteen minutes at a comfortable pace is enough to make a difference. If walking outside isn't possible, marching on the spot, climbing stairs, or doing housework all help.

Strength training: the long-term investment

Resistance exercise builds and preserves muscle. More muscle means more capacity to store glucose, a higher resting metabolism, and better strength and balance as you age.

It also matters a great deal when you are losing weight. Some of the weight lost on any diet comes from lean tissue. Strength training, together with enough protein, means more of what you lose is fat. This is especially important for people using GLP-1 medicines, where weight loss can be rapid.

You don't need a gym. A good home routine works the major muscle groups with simple movements:

legs and hips: sit-to-stand from a chair, squats, step-ups onto a low step, lunges
chest and arms: push-ups against a wall or kitchen counter, moving to the floor as you get stronger
back: rows with a resistance band, or with a bag of shopping or a water bottle in each hand
shoulders: overhead presses with light weights or bands
core: planks against a wall or on the floor, and slow controlled leg raises

Aim for two or three sessions a week of about 20 to 40 minutes. Do 8 to 15 repetitions of each exercise, for two or three sets. The last few repetitions should feel hard but possible with good form. Make it gradually harder over time, by adding repetitions, a heavier band or weight, or an extra set.

High-intensity interval training

High-intensity interval training, or HIIT, alternates short bursts of hard effort with periods of easier recovery. For example, 30 seconds of fast cycling followed by 90 seconds of slow pedalling, repeated eight to ten times.

Studies suggest HIIT can improve fitness and insulin sensitivity in less time than steady exercise. It suits people who are short of time and already reasonably fit. It isn't necessary, and it isn't the best place to start if you are new to exercise or have heart problems. Check with your doctor first.

One thing to know: hard exercise can temporarily raise blood glucose, because stress hormones such as adrenaline tell the liver to release glucose. This is normal and usually settles within an hour or two. I explain it in detail in my article on why blood sugar rises after exercise.

Sitting less: the hidden factor

Even people who exercise regularly can spend 10 hours a day or more sitting. Long, unbroken sitting is linked to higher glucose and insulin levels, independent of exercise.

Several laboratory studies have found that breaking up sitting every 30 minutes with two or three minutes of light walking or simple body-weight movements lowers glucose and insulin after meals. These are sometimes called exercise snacks.

Practical ideas: stand up during phone calls, walk to a colleague instead of emailing, set a timer to stand every half hour, or do a few chair squats during television adverts.

Can exercise alone lead to remission?

Usually not. Exercise without changes to eating tends to produce only modest weight loss, because people often eat a little more to compensate. Remission is closely tied to weight loss, as I describe in my article on how much weight you need to lose.

But exercise makes every other part of a remission plan work better. It increases the glucose-lowering effect of weight loss, reduces liver fat further, protects muscle, and is one of the strongest predictors of keeping weight off. In the US National Weight Control Registry, people who have kept off significant weight for years report high levels of daily activity, often around an hour a day, with walking the most common choice.

Safety

Exercise is safe for almost everyone with type 2 diabetes, but some precautions matter.

Low blood sugar. If you take insulin or a sulfonylurea such as gliclazide or glipizide, exercise can cause hypos, especially if it is longer or harder than usual. Check your glucose before and after exercise, carry fast-acting glucose, and ask your doctor whether doses should change on exercise days.

Heart health. If you have heart disease, chest pain, or have been inactive for a long time, talk to your doctor before starting anything vigorous.

Eyes. If you have advanced diabetic eye disease (proliferative retinopathy), heavy lifting and straining can be risky. Ask your eye clinic what is safe.

Feet. If you have reduced feeling in your feet, wear well-fitting shoes, check your feet daily for blisters or cuts, and consider low-impact options such as swimming or cycling.

Joints. If you have arthritis, water-based exercise, cycling and strength training with careful technique are usually well tolerated.

A sample week

This is a starting plan for someone who is moderately active. Adjust it to your own fitness and health.

Monday — Activity: 10-minute walk after each main meal; 25 minutes of strength exercises
Tuesday — Activity: 30-minute brisk walk; walk after dinner
Wednesday — Activity: 10-minute walk after each main meal; 25 minutes of strength exercises
Thursday — Activity: 30 minutes of cycling, swimming or a fitness class
Friday — Activity: 10-minute walk after each main meal; 25 minutes of strength exercises
Saturday — Activity: A longer walk, 45 to 60 minutes, ideally with family or friends
Sunday — Activity: Rest or gentle activity; stretching or yoga

Throughout every day, stand up and move for a few minutes every 30 to 60 minutes when you can.

If you are new to exercise, start with just the walks after meals for two weeks, then add two short strength sessions. Build up gradually over two or three months.

Tracking your progress

The scale isn't the best measure of what exercise does. Better signs include lower glucose readings after meals, a smaller waist, being able to walk further or climb stairs more easily, and doing more repetitions in your strength routine. If you use a glucose monitor, you can see the effect of a walk after dinner directly, which many people find motivating.

Making it stick

The best exercise plan is the one you are still doing next year. A few things make that more likely.

Attach exercise to something you already do. A walk after dinner every evening is easier to keep than a walk "sometime today". Strength exercises while the kettle boils, or during the evening news, work the same way.

Start smaller than you think you need to. Five minutes of walking after each meal is a perfectly good start. You can build from there once the habit is fixed.

Find something you enjoy. Dancing, gardening, swimming, cycling to the shops, or walking with a friend all count. Enjoyment predicts whether people keep going far better than willpower does.

Plan for bad weather and busy days. Have a short indoor routine you can do in 10 minutes, such as marching on the spot, stair climbing and chair squats, for days when you can't get out.

And be patient. Fitness and strength take weeks to build, but glucose responds to a single walk. That immediate effect is a good reason to start today.

How my book can help

Progressive exercise is one of the four strategies in The Type II Diabetes Remission Strategy, along with everyday nutrition, strategic intermittent fasting and daily habits. The book's 16-week programme brings exercise in step by step, and its tracker journal lets you record activity alongside your readings. See the book page.

Frequently asked questions

What is the best exercise to lower blood sugar quickly? A 10 to 15 minute walk after a meal is one of the simplest and most effective.

Is walking enough for type 2 diabetes? Walking is excellent, but adding strength training two or three times a week gives extra benefit.

How long after eating should I walk? Starting within about 30 minutes of finishing a meal works well, since glucose peaks 30 to 90 minutes after eating.

Why does my blood sugar go up after exercise? Hard exercise releases stress hormones that raise glucose for a short time. It usually comes down within an hour or two.

Can I exercise if I take insulin? Yes, but check your glucose before and after, carry fast-acting glucose, and ask your team about dose changes.

Does exercise reduce liver fat? Yes, both aerobic and strength exercise reduce liver fat, even without much weight loss.