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Living with diabetes and trying to build a great body can be a challenge. From the muscle wasting effects of high blood glucose right through to consumption of unwanted calories to treat low blood glucose, training to build a stronger better looking diabetic body can be a frustrating task.

The purpose of this article is to highlight some of the major problems people with diabetes face when it comes to training for a better body. The naïve personal trainer will also gain a better insight into what diabetes is and how exercise can prove both beneficial and detrimental to diabetic health.



At present, over 82 million people are living with Diabetes in the world, of which 46% are undiagnosed. What’s worse is the majority of these conditions are Type 2, the preventable form of Diabetes.

Diabetes is a huge problem and the costs to society, and the economy is high and escalating.

The International Diabetes Federation reported that Diabetes caused 5.1 million deaths in 2013, that’s one death from diabetes every six seconds! The cost to the economy doesn’t get much better with $548 billion dollars spent in 2013.


By 2040, it’s estimated that:

  • One adult in 10 will have diabetes
  • 642 million people globally
  • Diabetes-related health expenditure will exceed $802 billion


Urgent Need For Focus

Given the sheer threat to society government policy must focus on:

  • Reducing the obesity Crisis (Type 2 Prevention)
  • Cost effective Type 2 Treatment
  • Cost effective Type 1 Management
  • Cost effective Gestational Diabetes treatment

Unless we do this, we are likely to see more people having to endure complications and an accompanying rise in diabetes spending that our government health services will simply not be able to afford.



Diabetes mellitus is a group of metabolic diseases characterised by high blood glucose (hyperglycemia). It results from derangements in insulin production, insulin action or both.

Long-term hyperglycemia as a consequence of diabetes results in significant damage, to various organs and systems within the body, especially the eyes, kidneys, nerves, heart, and blood vessels.


Genetics hold’s the gun. Lifestyle pulls the trigger

Genetic predisposition, in conjunction with today’s modern lifestyle and environment, is considered the leading causes of the epidemic.

Generally speaking, there are three main classes of diabetes.


Type 1 Diabetes

Cause Autoimmune destruction of pancreatic β-cells.
Age of Onset Common in Children/Adolescents, but can occur at any age.
Initiation Poorly defined – Proposed Environmental, Viral Factors.
Insulin Production Complete deficiency
Nutritional Status Thin or Overweight: Catabolic state (recent weight loss)


Type 2 Diabetes

Cause Obesity, poor nutrition, sedentary lifestyle and POP exposure
Age of Onset May occur at any age
Initiation Some genetic and environmental influences
Insulin Production Insulin Resistant
Nutritional Status Obese, overweight or normal: Little to no recent weight loss


Gestational Diabetes

Cause Obesity, poor nutrition, sedentary lifestyle and POP exposure
Age of Onset 24-28 weeks of gestation (carrying fetus)
Initiation Some genetic and environmental influences
Insulin Production Inadequate insulin response. Insulin resistance heightened by placental hormones
Nutritional Status Obese, overweight or normal


Other Forms of Diabetes

Caused as a result of:

  • Genetic Defects
  • Drugs and Chemicals
  • Pancreatic Disease
  • Surgery and Infection 


The WHO and IDF established methods and criteria for diagnosing Diabetes, include:

  • HbA1C greater than 6.5% (48mmol/mol)
  • A random blood sample showing a blood glucose concentration of >200 mg/dl or ≥ 11.1 mmol/l
  • A fasting blood sample showing a glucose concentration of >126 mg/dl or ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l)
  • A blood 2 hours after an oral glucose tolerance test (OGTT) showing a blood glucose concentration of >200 mg/dl or ≥ 11.1 mmol/l.
  • Classic Symptoms of Hyperglycemia which include; frequent urination, thirst, blurry vision and unexplained weight loss.




Diabetes is managed through a combination of medication, diet, exercise and lifestyle modification.



Exercise and Diabetes – What’s The Deal?


Exercise and daily physical activity are important for all individuals with any form of diabetes.

People with Type 1 Diabetes may want to lose fat or increase body mass.

Combined weights resistance training and aerobic exercise have been shown to improve key health markers, blood glucose management and increase life expectancy. Surprisingly, research with respect to Type 1 Diabetes is somewhat limited in comparison to Type 2 Diabetes and thus warrants further investigation.


People with Type 2 Diabetes almost always need to drop body fat and improve their body composition. However, there are exceptions with many Type 2’s being underweight or normal weight.

There is a substantial amount of evidence to support the role of combined resistance training and cardiovascular exercise in the treatment of Type 2 Diabetes. 

The research has mainly shown the effects of resistance training are more efficacious than aerobic exercise or diet alone at improving rate of fat loss and body composition change.




Diabetics with no exercise experience may need to build a foundational level of fitness before progressing to more advanced exercise options like weight training. Simple increases in physical activity like trying to stand more throughout the day or use of a pedometer may be viable strategies.


Bodybuilding with Insulin: A Diabetic Perspective

During my years as a successful junior bodybuilder, many people claimed my use of insulin (to treat my Type 1 Diabetes) was the secret behind my success; this couldn’t be further from the truth. In fact, I recorded a 15-minute video on the topic to put the record straight. Make sure to check out the article below after you read this.



Although insulin is an anabolic hormone, Diabetes is a catabolic disease, especially if uncontrolled.

Lack of insulin reduces the body’s ability to use and store energy, consequently starving the cells of fuel resulting in the breakdown of body tissues, notably fat and protein. A decrease in muscle protein results in:

  • Weaker muscles
  • Reduced metabolic rate
  • Reduced muscular size

One of the most celebrated Greek physicians Aretaeus of Cappadocian some 1900 years ago described diabetes as a condition with “a melting down of the flesh and limbs into the urine.” Remarkably, his observations were amazingly accurate even by the standards of today


Measure Everything!

If you aren’t assessing your blood glucose control, you’re just guessing.

Tracking blood glucose continuously allows you to ascertain your body’s reaction to certain foods, doses of medication and a host of other factors like stress and physical activity.

Consistent measuring allows you to identify problems and work towards better long-term control, meaning fewer complications and better quality of life.


I urge you to track the following:

  • Fasting blood sugar
  • Pre-meal blood sugar
  • Meal macro content (specifically quantity and type of carbs)
  • Post feeding blood sugar (1 hour)
  • Pre and Post-exercise blood sugars

• Overall Blood Panel (conducted by your health professional team




Aerobic Exercise is an activity that uses large muscle groups at relatively low rates of muscular contraction that can be maintained continuously for prolonged periods of time (minutes to hours).


Aerobic exercise includes both low-intensity steady state exercise such as walking and also more vigorous aerobic exercise such as High-Intensity Interval Training which involves a combination of low-intensity work combined with intermittent high-intensity bouts

Generally speaking, aerobic exercise has been shown to promote a reduction in blood glucose levels in both Type 1 and Type 2 Diabetics for 2-72 hours after the last bout of activity. Obviously, the blood glucose lowering effect is highly dependent upon exercise choice and duration.

More vigorous aerobic exercise may cause a transient increase in blood glucose levels due to the release of glucose-raising hormones


Anaerobic Exercise is involves high rates of intense muscular contraction performed over a relatively short period. In the context of this article, this would include bodybuilding related training such as weights resistance training and high-intensity cardiovascular training.

Resistance training is known as a potent stimulator of the counter-regulatory hormones catecholamine’s, cortisol and growth hormone. These hormones serve the purpose of increasing blood glucose. Increased levels of lactate (lactic acid) can be recycled into glucose and subsequently increase blood glucose levels.


In healthy individuals, the temporary rise in blood glucose levels is compensated at the end of training, keeping blood glucose levels in range.


Type 1 Diabetics fail to produce enough insulin to bring blood glucose levels back down to normal levels, which can lead to hyperglycemia if insulin medication isn’t administered.

No current guidelines are in place as to suggest how much insulin a Type 1 Diabetic should administer to treat post exercise Hyperglycemia.


Type 2 Diabetics response to exercise will differ according to the degree of insulin resistance. Needless to say, the threat of hyperglycemia is not as high compared to Type 1 subjects who produce no insulin.

Initially within the first few hours of exercising blood glucose levels may rise.

However, due to the fact anaerobic exercise depletes glycogen stores, can result in a blood glucose lowering effect post the 1-2 hour training period after counter-regulatory hormones ware off.



The success of your training or ‘physical activity’ plan should not simply be gauged by how much it lowers your blood glucose.

Too many diabetics start to exercise and think the bigger the drop, the better.

The reality, significant drops in blood glucose jepordize control and are one sure way to screw up training performance (the stimulus for muscle growth) and hinder fat loss due to unwanted extra calorie consumption (to dig you back out of the hypoglycemic hole you put yourself in)

All insulin users (regardless of the type of diabetes) need to follow hypo prevention strategies.

If not, you’ll seriously ruin your exercise performance.



Diabetics should avoid exercising while hyperglycemic or in a state of ketonemia (abnormally high concentrations of ketone bodies in the blood). Not only will you burn off valuable muscle tissue and defeat the purpose of bodybuilding, your performance will suffer from dehydration and fatigue brought on by hyperglycemia.

Also, you’ll be at increased risk for further deteriorations in blood glucose, not a nice combo!

Research suggests delaying exercise if blood glucose is higher than 14mmol/L and if blood/urine ketones are present.

If you’re tight for time and blood glucose is slow to respond skip the session and train another time. If you’re serious about making strength and body composition goals, high performance in the weight room is essential. Not just a matter of showing up!



For most people with diabetes, a low-level of physical activity can be pursued without the need for medical examination.

However, those looking to participate in planned vigorous exercise are strongly recommended to consult with their health professional team and undertake all the necessary medical evaluations before hand.


This is particularly the case for individuals who struggle with their control and have underlying health complications including:

  • Obesity (and everything that comes with)
  • Cardiovascular complications associated with the heart, blood vessels, eyes, kidneys, feet and nervous system.
  • Nerve damage
  • Orthopaedic limitations (prior joint surgery, unhealed ulcerations or wounds on the feet, etc.)
  • Other underlying medical conditions that may hinder exercise performance.
  • History of smoking

The Fitness professional must be aware of these complications before subscribing exercise plans. An orthopaedic limitation such as unhealed ulcerations or amputation will significantly affect exercise program design.

In any case, where complications do exist, an individual’s response to exercise must be measured and progressed accordingly.


DIABETES KEY NOTE: Don’t let pre-exercising glucose testing be a barrier to exercise.

Bouncing blood sugars is a big problem for a lot of diabetics (including me).

Although I keep my control in check, there are times when my blood sugars swing from high to low and back again.

One of the main contributing factors for this is over eating to treat hypoglycemia (low blood sugar), especially in the middle of the night.


The sudden anxiety and craving for carbs often lead a diabetic to overeat into a state of hyperglycemia (high blood sugar). This issue then needs to be treated accordingly with the right amount of insulin. Depending on what type and amount of food that was eaten, blood sugar levels may continue to rise and take a while to come down.

This often leads to panic and over the administration of insulin. Which, inevitably puts the diabetic back into a hypo state. Hence the term ‘bouncing.’

These fluctuations wreak havoc with mood and energy, especially performance in the gym. Also, the intake of unnecessary calories is a great way to accelerate unwanted fat gain.

The speed at which a diabetic comes out of a low is highly dependent upon how low they are, to begin with. This may be due to too much circulating insulin, too much time without food or too much exercise.


Here’re 5 Personal Tips I Use To Avoid Bouncing


  1. Use fast acting carbs you can ‘feel’ over what you typically find in the breakfast cupboard.
  1. Chocolate and biscuits often take a while to ‘hit’ the blood and also provide unnecessary excess calories.
  1. If in doubt, always check your sugar levels.
  1. Learn to differentiate between hunger and Hypos
  1. If you need to fast temporarily until insulin does its job and sugar levels return to baseline, so be it.



Understanding how exercise affects your blood glucose is essential if you want to get the most out of your bodybuilding efforts. Type 1 Diabetics have considerably more work to do than their Type 2 counterparts due to the counter-regulatory effect of certain hormones that increase during exercise.


As a diabetic, you must keep a clear head and know exactly what you’re eating, when you last took your medication and how to react when blood glucose decides to change.


To shred fat and build maximum amounts of muscle keeping blood glucose levels within physiological range is an absolute must.



Check out www.diabeticmuscleandfitness.com – An incredibly detailed online resource dedicated to Bodybuilding with diabetes.