Diabetes is one of the most common chronic diseases in the US and many parts of the world. Currently, the CDC reports that over 1 in 10 adults in the US have diabetes, and 1 in 3 have prediabetes or early signs of diabetes development.
As a health coach, you may have a client with diabetes who has sought your services to support them in adopting a lifestyle to manage their diabetes. They may have questions about whether exercising and physical activity is safe for them, or they may be seeking your support for ways to carry out exercise safely while living with diabetes.
In this article, we describe the benefits of exercise for people with diabetes and provide tips for supporting a client with diabetes to make physical activity part of their life.
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Types of Diabetes
Diabetes is a chronic metabolic disease characterized by an inability of the body to process and utilize blood glucose effectively. As a result, diabetes patients tend to have higher-than-normal blood glucose levels.
There are three main forms of diabetes: type 1, type 2, and gestational.
- Type 1 diabetes is an autoimmune disease where the immune system attacks the insulin-producing islet cells in the pancreas. Since insulin is the hormone responsible for the effective uptake of glucose into the cells, the cells cannot access the energy provided by glucose. These patients tend to be dependent on exogenous insulin.
- Type 2 diabetes is characterized by insulin resistance and/or a relative lack of insulin. In this type of diabetes, the body’s cells don’t respond to insulin, and glucose builds up in the bloodstream.
- Gestational diabetes is a type of diabetes that only occurs during pregnancy. Women with gestational diabetes develop a reduced secretion of insulin and are at high risk of high blood glucose. Unmanaged gestational diabetes can put the woman and the fetus at risk of death. When managed effectively, most women revert to normal glucose metabolism after giving birth.
Prediabetes, sometimes called borderline diabetes, is a condition where a person’s body is showing early signs of insulin resistance that could lead to diabetes. Usually, people with prediabetes don’t have any symptoms, but it can be detected with the fasting plasma glucose test (FPG), a glucose tolerance test, or an A1C test. The prediabetes diagnosis was developed to identify people who are at risk of developing diabetes. When a person is diagnosed with prediabetes, if they modify their lifestyle habits or take medication, the development of type 2 diabetes can be prevented or delayed.
Both genetic and environmental factors influence the development of the different types of diabetes.
The American Diabetes Association Position Statement on Exercise and Physical Activity
The American Diabetes Association (ADA) is one of the leading research and advocacy organizations for people living with diabetes. They are often considered the primary authority on guidelines for diabetes management, treatment, and diagnoses.
In 2016, the ADA published a position statement summarizing the latest findings on the relationship between exercise, physical activity, and diabetes management.
Exercise is planned and structured physical activity, and physical activity is all movement that increases energy use.
The ADA states that:
- Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, contributes to weight loss, and improves well-being.
- Regular exercise may prevent or delay type 2 diabetes development.
- Regular exercise has considerable health benefits for people with type 1 diabetes, including improved cardiovascular fitness, muscle strength, and insulin sensitivity.
- The challenges related to blood glucose management vary with diabetes type, activity type, and presence of diabetes-related complications.
- Physical activity and exercise recommendations, therefore, should be tailored to meet the specific needs of each individual.
In general, exercise is beneficial for people with all types of diabetes. Even so, it is important to tailor physical activity plans and approaches to each individual’s medical and personal needs and possibilities.
Supporting Clients with Diabetes to Stay Physically Active
Even though researchers have demonstrated the multiple benefits of exercise for people with different types of diabetes, people living with diabetes may face significant challenges to exercise regularly. It’s important to be mindful of these challenges before giving your exercise recommendations.
Some of these challenges include:
- Pain from the nerve damage diabetes can cause
- Pain and inflammation in the joints
- Physical discomfort felt during exercise
- Low energy due to poor energy metabolism
- Time limitations due to work obligations, frequent doctor visits, and greater time investment in medical care and treatment
- Mental health challenges, such as depression and anxiety
- Fear of hypoglycemia (low blood sugar)
- Lack of childcare
- Social responsibilities and family affairs
- Lack of motivation
- Lack of physician advice regarding exercise
- Misinformation of family members
- Other health conditions
- No easily accessible place to exercise (no sidewalks, street lighting, safety)
- Cultural taboos that limit the ability to partake in exercise
Many of the barriers mentioned above are partially or entirely out of a person’s control. It is important for health coaches to create a safe space and bring to light the reasons your clients living with diabetes are not exercising.
Some of the ways you can support clients in integrating exercise and physical activity into their lives in a way that makes sense to them include:
- Let them tell you what they want to achieve and build your coaching style and plan around that.
- Ask about their day-to-day activities and suggest ways to increase physical activity, rather than planned, regimented exercise.
- Remind them that all types of physical activity are beneficial.
- Invite them to bring a family member or friend who will support them in carrying out physical activity to the session. This may include exercising with them or taking responsibility for other activities, like housework or childcare, while your client exercises.
- If exercising outside or joining a gym isn’t an option, ask if home-based, app-based, or web-based training programs seem right to them.
- Ask them to tell you how they feel after exercising. This may indicate their blood glucose levels, and you may need to adjust the physical activity plans accordingly.
- Remind them to reach out to their primary care team immediately if they feel overly tired or suddenly sleepy, as it may be a sign of hyperglycemia or hypoglycemia.
- If they do not have an easily accessible primary care team, you can help them navigate the health system, if appropriate, and identify a healthcare team that meets their needs.
Additionally, you may want to work on creating a trauma-informed environment to understand how diabetes and other conditions may be directly related to past trauma and to work directly with your clients in reaching goals that are sensitive to their experiences, limitations, and needs.