The Beginner Club - Resistance Training and Diabetes

Strength training, also known as weight training or resistance training, involves performing physical exercises designed to enhance the body’s capacity to express muscular force. It is commonly associated with lifting weights, although you can also use resistance bands or use bodyweight exercises.

This type of training is an important part of a well-rounded fitness program. This is because strength training improves joint function, bone density, muscle, tendon and ligament strength.

However, for people living with type 1 diabetes, as with all types of exercise, there are considerations to make so that you can exercise safely and effectively.

This blog article will discuss the health benefits of resistance training, its impact on glucose levels in individuals living with type 1 diabetes, and provide useful tips for incorporating resistance training into your routine.

Hormonal and Blood Glucose Response to Resistance Training in People with Type 1 Diabetes

Research in the area of resistance training and type 1 diabetes is limited. Only a handful of studies have investigated the effects of resistance training on glucose response in people with type 1 diabetes and these studies typically have small sample sizes. However, it is clear that improving muscle strength and quality offers significant health and functional benefits for individuals with diabetes.

The hormonal and metabolic responses to resistance exercise in individuals with type 1 diabetes are likely to vary depending on a host of factors, including the training program used (i.e. duration and intensity of the workout). Therefore, further research is required to fully understand the impact of factors such as movement speed, weight lifted, number of repetitions and sets, and rest interval duration on hormonal responses in type 1 diabetes. Additionally, it remains uncertain whether factors such as age, sex, and physical fitness level can influence these responses.

In people without type 1 diabetes, high-resistance, low- repetition routines are known to elicit similar responses to anaerobic activities like high-intensity running, which may result in an increase in blood glucose levels. Conversely, high-repetition, low-resistance programs with short rests between sets are more aerobic in nature and may therefore result in a decrease in blood glucose.

💡 Few studies have examined the glycemic responses to resistance exercise in people with type 1 diabetes, and those that have consisted mostly of moderate-intensity protocols involving three sets of eight repetitions.

The glucose response to resistance training also appears to differ depending on when the exercise is performed. For example, a study by Yardley and colleagues [1] found that resistance training was associated with declining blood glucose when performed in the afternoon. However, a different study showed that an almost identical resistance training protocol performed under fasted conditions in the morning caused an increase in blood glucose and post-exercise hyperglycemia [2, 3]. This phenomenon seems to be down to whether the exercise is being performed in the fed or fasted state and will be discussed in more detail in future articles.

Resistance exercise may also be combined alongside an aerobic workout. Combining resistance training with an aerobic workout is common for many people. If planning to combine exercise types, it’s useful to have an idea of the likely glucose response. Based on the research, it appears that when combined with aerobic exercise, resistance exercise may provide some protection against hypoglycemia. One study showed that performing 45 minutes of resistance exercise before 45 minutes of treadmill running delayed declines in blood glucose during the aerobic exercise [4]. On the other hand, blood glucose declines were immediate and rapid when aerobic exercise was performed first, but these were halted by the switch to resistance exercise.

💡 Therefore, it appears that individuals experiencing hyperglycemia during exercise should perform aerobic activities first. But those struggling with hypoglycemia during exercise should start their sessions with resistance exercise.

Recap on Glucose Response to Resistance Training

The glucose response to strength training can vary among individuals and can depend on several factors, including the duration, intensity, and type of exercise, as well as an individual's fitness level, diet, and insulin sensitivity. However, some general trends in glucose response to strength training include:

1. Immediate Effect: Initially, during strength training, blood glucose levels may rise due to the body's release of stress hormones like adrenaline and cortisol, which can temporarily increase blood glucose levels.

2. Post-Exercise Response: Following strength training, especially if it's intense, some individuals might experience a decrease in blood glucose levels. This is due to increased insulin sensitivity.

3. Delayed Response: In some cases, blood glucose levels might rise or decrease post-strength training. This can occur due to various factors, such as the release of stress hormones or the body's attempt to replenish glycogen stores used during exercise.

4. Individual Variability: Responses to strength training can differ widely among individuals. Factors like the intensity and duration of the workout, an individual's insulin sensitivity, and their overall health play significant roles in determining the glucose response.

It's important to note that while aerobic exercises often have a more immediate and pronounced effect on lowering blood sugar levels, strength training's impact on glucose levels might be more subtle and variable. However, consistent strength training over time can contribute to improved insulin sensitivity and better long-term blood glucose management in individuals with diabetes.

Monitoring blood glucose levels before, during, and after exercise, along with guidance from healthcare professionals, is crucial to managing diabetes effectively during strength training.

What are the Health Benefits of Resistance Training for Individuals with Type 1 Diabetes?

Strength training provides several benefits for individuals with type 1 diabetes. Here are is a list of potential health benefits:

1. Improved Insulin Sensitivity: Regular strength training can improve insulin sensitivity, enabling cells to utilise blood glucose more efficiently.

2. Blood Sugar Management: Engaging in strength training can improve the management of blood glucose levels. This applies both immediately after exercise and in the long term. Strength training can help regulate blood glucose levels, particularly when combined with cardiovascular exercise.

3. Weight Management: Strength training contributes to building lean muscle mass and increasing metabolism, aiding in weight management.

4. Reduced Risk of Complications: By helping to control blood glucose levels and improving overall health, strength training may decrease the risk of diabetes-related complications such as cardiovascular issues, nerve damage, and kidney problems.

5. Improved Cardiovascular Health: In addition to aerobic exercise, incorporating strength training can improve cardiovascular health, reducing the risk factors associated with diabetes-related heart complications.

6. Bone Health: Strength training supports bone health.

💡 It's essential for individuals with diabetes to consult with healthcare professionals, including doctors and certified trainers, before starting any exercise program. They can provide guidance on suitable exercises, intensity, duration, and precautions based on individual health conditions and medication requirements. Additionally, consistent monitoring of blood sugar levels before, during, and after exercise is crucial to ensure safety and effectiveness.

The Best Way to Promote Strength: Resistant Training

Resistance training is a form of exercise that utilises resistance to improve muscular strength, endurance, and muscle size. It involves applying an external force against the muscles to make them work harder. This resistance can come from various sources:

1. Weights: Such as dumbbells, barbells, kettlebells, or weight machines.

2. Bodyweight: Using your own body weight as resistance in exercises like push-ups, squats, or lunges.

3. Resistance bands: Elastic bands that provide resistance during exercises.

4. Cable machines: Equipment that uses adjustable pulleys and weights to create resistance.

5. Water: Engaging in exercises in water, like swimming, which provides natural resistance.

The primary goal of resistance training is to overload the muscles, forcing them to adapt and become stronger over time. By repeatedly challenging the muscles through resistance exercises, individuals can improve their muscle strength, endurance, and overall fitness levels. Resistance training can be tailored to specific goals, whether it's building muscle mass, improving athletic performance, or enhancing overall strength and function.

Types of Strength Training:

1. Isometric Training: Involves static muscle contractions without joint movement (e.g., planks, wall sits) to improve strength at specific joint angles.

2. Isotonic Training: Includes concentric (muscle shortening) and eccentric (muscle lengthening) movements. Common examples are bicep curls and squats.

3. Plyometric Training: Focuses on explosive movements to develop power. Exercises like box jumps and medicine ball throws fall under this category.

4. Resistance Training: Utilises external resistance (weights, bands, bodyweight) to challenge muscles, encouraging strength gains over time.

Benefits of Strength Training:

1. Increased Strength: Enhances the ability of muscles to produce force, aiding in daily tasks and athletic performance.

2. Improved Bone Health: Helps increase bone density, reducing the risk of osteoporosis and fractures.

3. Metabolic Boost: Increases resting metabolic rate, aiding in weight management and fat loss.

4. Injury Prevention: Strengthens muscles and joints, reducing the risk of injuries, especially in activities and sports.

5. Enhanced Functional Abilities: Improves balance, stability, and overall functional movement patterns.

Incorporating strength training into a well-rounded fitness routine can bring about numerous health benefits and contribute significantly to overall physical well-being. Consulting with a fitness professional can help design a personalised strength training program based on individual needs and goals.

How to get started with resistance training?

Resistance may be provided in the form of weights, body weight, or elastic resistance bands. Improving strength involves a combination of targeted exercises, progressive overload, proper planning, and adequate rest. Here are some ways to enhance your strength level:

Improving strength involves a combination of targeted exercises, progressive overload, proper nutrition, and adequate rest. Here are some ways to enhance strength:

1. Resistance Training: Engage in activities like weightlifting, bodyweight exercises, resistance bands, or using gym equipment. Focus on compound movements (exercises that engage multiple muscle groups) like squats, deadlifts, bench presses, and rows.

2. Progressive Overload: Gradually increase the demands on your muscles over time. This can be achieved by increasing weight, repetitions, sets, or intensity of exercises progressively. It challenges muscles to adapt and grow stronger.

3. Proper Form: Ensure correct form and technique in exercises to target specific muscle groups effectively and reduce the risk of injury.

4. Balanced Workout Routine: Include exercises targeting different muscle groups to achieve overall strength. Balance between pushing and pulling movements is essential for symmetry and injury prevention.

5. Rest and Recovery: Muscles need time to repair and grow stronger after intense workouts. Ensure adequate rest days between sessions to allow for recovery.

6. Nutrition: Consume a balanced diet rich in protein, carbohydrates, and healthy fats to provide the energy and nutrients needed for muscle repair and growth.

7. Consistency: Regularly engage in strength training exercises to see progress. Consistency is key to developing and maintaining strength levels.

8. Variation: Introduce variety in your workouts to prevent plateaus and keep the body challenged. This can include changing exercises, rep ranges, or incorporating new techniques.

💡 Remember, progress in strength training is individualised and can vary based on factors like genetics, age, and training history. Listen to your body, avoid overtraining, and consider consulting a fitness professional for personalized guidance.

Tips for Managing your Glucose Levels Around Strength Training

Managing glucose levels during strength training with type 1 diabetes requires careful planning and monitoring. Here's are some factors that may be useful to keep in mind:

Before Strength Training:

1. Check Blood Glucose Levels: Begin with a blood glucose check. Aim for a level between 100-250 mg/dL (5.6-13.9 mmol/L) before starting. Adjust as per your individual range, as advised by your healthcare provider.

2. Carbohydrate Consumption: Consider a light carbohydrate snack if your blood glucose is on the lower end of the range or decreasing. Opt for a snack that won't cause rapid spikes or crashes in blood glucose levels.

During Strength Training:

1. Monitor Regularly: Check blood glucose levels periodically, especially if you're exercising for an extended duration.

2. Stay Hydrated: Drink water regularly throughout your workout to prevent dehydration.

3. Carry Fast-Acting Carbs: Have fast-acting carbohydrates (e.g., glucose tablets, juice) readily available in case your blood sugar drops unexpectedly.

After Strength Training:

1. Check Blood Sugar Again: Monitor your blood sugar levels post-exercise. They might drop further after you've finished.

2. Replenish: If needed, consume a balanced snack or meal that combines protein and carbohydrates to help stabilise blood sugar levels.

3. Continue Monitoring: Keep an eye on your blood sugar levels for several hours after exercising, as they can fluctuate even after you've finished your workout.

Additional Tips:

1. Work with a Professional: Collaborate with a diabetes educator or healthcare provider or a coach to create an exercise plan tailored to your needs and to determine appropriate blood glucose targets before, during, and after exercise.

2. Keep Records: Maintain a log of your workouts, noting the duration, intensity, and any changes in blood glucose levels. This helps in understanding patterns and making necessary adjustments.

3. Listen to Your Body: Pay attention to how your body responds to different types and intensities of exercise. Adjust your routine based on what works best for you.

4. Be Prepared: Always carry glucose tablets or any necessary supplies to manage low blood glucose levels.

Remember, individual responses to exercise vary. Regular monitoring, adaptation of insulin dosage or carbohydrate intake, and understanding your body's signals are crucial for effectively managing glucose levels during strength training with diabetes. Consulting your healthcare professionals for personalised advice is always recommended.

References

[1] Yardley JE, Kenny GP, Perkins BA, Riddell MC, Balaa N, Malcolm J, et al. Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Diabetes Care. 2013;36(3):537–42.

[2] Turner D, Luzio S, Gray BJ, Bain SC, Hanley S, Richards A, et al. Algorithm that delivers an individualized rapid-acting insulin dose after morning resistance exercise counters post-exercise hypergly- caemia in people with type 1 diabetes. Diabet Med J Br Diabet Assoc. 2016;33(4):506–10.

[3] Turner D, Luzio S, Gray BJ, Dunseath G, Rees ED, Kilduff LP, et al. Impact of single and multiple sets of resistance exercise in type 1 diabetes. Scand J Med Sci Sports. 2015;25(1):e99 109.

[4] Yardley JE, Kenny GP, Perkins BA, Riddell MC, Malcolm J, Boulay P, et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes Care. 2012;35(4):669–75.