Exercise for Diabetes: A Safe Weekly Routine and Warning Signs

World Diabetes Day falls on 14 November, a good moment to build a routine you can keep all year. The American Diabetes Association (ADA) recommends that most adults with diabetes do at least 150 minutes a week of moderate to vigorous activity, spread over at least three days, with no more than two days in a row off.

Add two to three strength sessions a week on non-consecutive days, plus balance exercises two to three times a week if you are 50 or older. In type 2 diabetes, the ADA says regular training lowers A1C (the long-term sugar test), blood pressure and insulin resistance.

Guidelines written for Indians set a higher bar: consensus physical activity guidelines for Asian Indians suggest 60 minutes of activity a day for healthy adults, and note that Asian Indians tend to be more sedentary than white Caucasians. Treat 150 minutes a week as a floor, not a ceiling.

Start at a low intensity and build up as you are able. The ADA also recommends supervised training over going it alone where possible, so have a trainer or physiotherapist check your form early on.

A sample week for someone with no complications:

The ADA advises interrupting long sitting with light activity every 30 minutes, at least for adults with type 2 diabetes. One study it cites used 3 minutes of light walking and simple body-weight moves each time.

If you have no symptoms, you usually do not need medical clearance for brisk walking or other moderate activity, says the ADA. See your doctor before vigorous workouts or if you have heart, eye, nerve or foot problems, since heart trouble during exercise may not cause chest pain in people with diabetes. Stop at once and seek medical attention for chest pain, pain that spreads, or shortness of breath.

If you use insulin, or tablets your doctor says can cause lows, check your sugar before exercising. For type 1 diabetes, the ADA suggests starting between 90 and 250 mg/dL, eating some fast-acting carbohydrate first if you are below 90, delaying intense exercise at 250 or above, and postponing exercise if blood ketones are raised. Ask your doctor for your own numbers.

Habits that help:

The CDC calls blood sugar below 70 mg/dL low and below 55 mg/dL severely low. Early signs include a fast heartbeat, shaking, sweating, nervousness, irritability or confusion, dizziness and hunger.

Lows can come late: the ADA notes they typically appear 6 to 15 hours after exercise, and the CDC lists activity close to bedtime as a cause of night-time lows. Some people get no warning signs at all; the CDC advises them to check more often, especially before driving or exercise.

A severe low can cause weakness, trouble walking or seeing, confusion, seizures or fainting. Give sugar by mouth only if the person is awake and can swallow, and get emergency medical help.

If you feel a low coming on, stop and follow the CDC's 15-15 rule:

Feet: check them every day for blisters, sores or ulcers, and keep them dry. Avoid weight-bearing exercise such as walking while an ulcer is unhealed, and favour a stationary cycle or seated exercises if your feet are numb or your walking has changed. After barefoot yoga, check your soles.

Eyes: with severe or unstable diabetic eye disease (retinopathy), the ADA advises avoiding vigorous cardio or strength work, jumping, jarring, head-down positions and breath-holding, so skip headstands and other inversions. With moderate disease, avoid very heavy lifting such as powerlifting. Do not exercise at all while there is bleeding inside the eye, and ask your eye doctor what is safe for you.

Blood pressure and nerves: with high blood pressure, avoid holding your breath while lifting; breathe out as you push. If you have been told you have autonomic neuropathy (a type of diabetic nerve damage), get your doctor's approval first, avoid exercising in the heat and drink enough water.

A 2019 review of studies found that people with diabetes were more likely to report low back pain and neck pain, though it could not show that diabetes causes the pain.

If walking makes your back pain worse, try shorter walks on flat ground, a stationary cycle or chair-based strength work, and build up slowly. Gym-goers with a back strain can lift lighter, keep breathing through each rep and skip moves that bring on pain until a professional has checked them. Told you may need spine surgery? Ask your surgeon which activities are safe for now.

A physiotherapist can adapt exercises to your pain while your diabetes doctor sets your sugar targets. Physenta, an online spine, back and neck physiotherapy service in India, offers a free AI assessment that maps your pain on a 3D body in about three minutes and screens for red flags, plus a free first video session with a physiotherapist or doctor. The assessment is general guidance, not a diagnosis.