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Dietary Choices and Exercise for Type 2 Diabetes

Regular moderate-intensity exercise and adherence to Mediterranean dietary choices may help control type 2 diabetes and related conditions.

Type 2 diabetes (T2D) is a condition where a hormone called insulin can no longer regulate the movement of blood sugar, or glucose, into cells.

As a result, glucose remains in the blood which damages blood vessels and organs. This increases the risk for secondary complications such as heart disease, blindness, kidney problems, amputations, and nerve damage.

Individuals with diabetes are also more likely to suffer from depression.

In the Diabetes Prevention Program Study, individuals at risk for diabetes who engaged in regular exercise and adhered to a low-fat, high-fiber diet were 34% less likely to develop T2D whereas patients taking an anti-diabetic medication lowered their risk by 18%1.

Fortunately for individuals who have already developed diabetes, lifestyle changes can aid with the management of this condition.

The heart-healthy Mediterranean diet

Individuals with T2D are 2 times more likely to develop heart disease so it is important to protect this vital organ in addition to managing glucose levels.

The Mediterranean diet refers to the general pro-heart diet consumed in areas around the Mediterranean Sea. This diet is characterized by:

  • high consumption of carbohydrate foods like fruits and vegetables,
  • lower consumption of red meats,
  • eating low-fat sources of dairy,
  • using monounsaturated fats like olive oil,
  • and consuming lean protein sources like fish and turkey and vegetarian sources like beans and legumes.

Choose your dietary carbohydrates carefully

Carbohydrates, or carbs, are allowed! Shunning all carbs from your diet may not be the best approach for healthy long terms dietary choices.

Dietary carbohydrates can be an important source of microbiome-fueling fiber and nutrients that help keep you full and healthy. However, opt for complex carbs rather than simple carbs.

Complex carbs come from sources like legumes, vegetables, whole-grain breads, and pasta.

Simple carbs are most often found in confectionary, dessert, and highly-processed foods like sodas, candies, and donuts.

Heart-healthy dietary fats

Fats can be categorized as unsaturated and saturated. The primary fat source in the Mediterranean diet is the monounsaturated olive oil.

Other sources of mono or polyunsaturated heart-healthy fat that you can include in your diet include fish, nuts, and seeds.

Saturated fats usually come from animal sources such as meat, cheese, butter, and ice cream, but can also come from non-animal sources like coconut and palm oil.

Saturated fats in high amounts or for those susceptible to certain conditions are considered unhealthy.

The unhealthy reputation is because saturated fats are chemically ‘less fluid’ and ‘more stiff’ than unsaturated fats.

To put this in perspective, imagine trying to get to your destination by swimming through deep, thick sludgy mud versus swimming in a calm, warm, and shallow lake; this is part of the struggle nutrients and cells face can face in your body with too much-saturated fat.

Tip: Use olive oil-based dressings and try replacing butter sticks with non-hydrogenated margarine. Hydrogenation is the process that makes an unsaturated fat a saturated fat. Hydrogenated fats are often most often found in desserts and pastries.

Wine and dine

The Mediterranean diet also includes red wine (no more than 1 glass/day for women and 2 glasses/day for men).

Moderate consumption of red wine is associated with healthy cholesterol levels and lowered risk of cardiovascular disease. Red wine also contains antioxidants that help protect against high blood pressure and clogged arteries.

Tip: Don’t overdo it! High consumption of alcohol has the opposite effect and can actually increase your health risk.

Exercise for type 2 diabetes

Remaining physically active is an important aspect of diabetes care.

Although the thought of starting an exercise program may be intimidating for individuals who are relatively inactive, small steps can result in large gains in health.

Start small but go often

To reap the health benefits of exercise for diabetes, it’s not about going hard, but about going often.

Muscle contraction stimulates the movement of sugar from the blood into muscle cells without a need for insulin (i.e. this mechanism is insulin-independent).

Furthermore, exercise improves the sensitivity of insulin (i.e. your insulin will work better).

This improvement in insulin sensitivity often lasts for 24-48 hours meaning that if you exercise most days of the week, you can improve your blood sugar levels and insulin sensitivity.

All it takes is 20-30 minutes of activities such as brisk walking, swimming, raking leaves, or water aerobics on most days of the week.

Activities can be done continuously (i.e. one bout of 30 minutes) or throughout the day (e.g. 10 minute-bout, 3 times a day).

But, remember, you need to regularly monitor your blood sugar levels to prevent drastic reductions in blood glucose levels (i.e. less than 5 mmol/L).

Hit the weights

Since glucose is the main energy source for muscles and muscle contraction can draw in glucose without insulin, the more muscle you have and use, the more glucose you will remove from the blood.

The best way to promote muscle growth is through resistance training exercises with free weights (e.g. dumbbells) or weight machines. Start by:

  • Performing 10-15 repetitions of an exercise such as a bicep curl for one set
  •  Progress to 2 sets of 10-15 repetitions after a few weeks
  • Progress to 3 sets of 10-15 repetitions at a heavier weight a few weeks after that

Be sure to incorporate as many muscle groups as possible (e.g. shoulders, biceps, chest, back, legs, etc.) and let muscle groups rest for 48 hours before continuing with your resistance training exercises.

Tip: Bring a buddy! If you are new to resistance training, it is important to bring a friend that can both help you stay motivated and can also help ‘spot’ you and make sure you don’t hurt yourself.

Improving cardiorespiratory fitness

Cardiorespiratory fitness refers to the ability of your heart and lungs to work to carry oxygen and nutrients throughout the body.

Those with cardiorespiratory fitness are less likely to have heart disease and tend to live longer. To improve this type of fitness, continuous, rhythmic exercise or short high-intensity bouts using large muscle groups for at least 10 minutes is a start.

Cardiorespiratory fitness can also help promote

  • weight loss (which helps improve glucose control in those with type 2 diabetes),
  • healthy circulation (important in the prevention of diabetes-related amputations),
  • improved moods (aerobic exercises release ‘feel-good’ chemicals in the brain that can help manage depression),
  • and healthy sexual functioning.

Tip: Don’t force yourself into something you won’t enjoy. If you really don’t like cycling but prefer swimming, then swim. Find an activity you enjoy and keep at it – but push yourself. Starting to exercise can be challenging but the longer you stick to it, the better it gets!

It is crucial to continue to monitor blood glucose levels.

Speak with a doctor before making drastic changes to your diet or starting an exercise program.


Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study [published correction appears in Lancet. 2009 Dec 19;374(9707):2054]. Lancet. 2009;374(9702):1677-1686. doi:10.1016/S0140-6736(09)61457-4.



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