Type 2 Diabetes & Prediabetes

Type 2 diabetes (T2DM) involves insulin resistance and elevated blood glucose; prediabetes is an intermediate stage. Exercise improves insulin sensitivity and glycemic control and lowers cardiovascular risk. ADA / ACSM joint guidance:

• Aerobic: ≥150 min/week of moderate-to-vigorous activity, spread over ≥3 days/week, with no more than 2 consecutive days without exercise (the glucose-lowering effect of a session is relatively short-lived).
• Resistance: 2–3 days/week (nonconsecutive), all major muscle groups — independently improves glycemic control; combined aerobic + resistance is superior to either alone.
• Reduce/interrupt sedentary time: break up prolonged sitting with brief activity every ~30 minutes for glucose benefit.
• Flexibility/balance as adjuncts, especially for older adults or those with neuropathy.

• Hypoglycemia risk with insulin or insulin secretagogues (sulfonylureas): glucose can drop during/after exercise (sometimes hours later/overnight). Monitor blood glucose around exercise; carry rapid carbohydrate; a common guide is to take carbohydrate if pre-exercise glucose is low (e.g., < ~90–100 mg/dL). Metformin and most other agents carry low hypoglycemia risk.
• Complications screening: check for peripheral neuropathy (foot care, proper footwear, low-impact options, inspect feet), retinopathy (avoid high-intensity/Valsalva or jarring activity with proliferative/unstable retinopathy), autonomic neuropathy (blunted HR/BP responses — use RPE; orthostatic caution), and nephropathy.
• Stay well hydrated; manage feet meticulously to prevent ulcers.

• Obtain medical clearance and complication screening, especially before vigorous exercise or if CVD risk is high (medical-clearance-screening).
• Do not exercise with very high glucose plus illness/ketosis without guidance; treat symptomatic hypoglycemia immediately.
• Stop for chest pain, severe dizziness, confusion (possible hypoglycemia), or vision changes.

Educational only; not medical advice. Diabetes and exercise should be managed with a physician/diabetes care team; do not change medication or monitoring based on this content.

• Aerobic ≥150 min/wk moderate-vigorous, ≥3 d/wk, no >2 consecutive days off.
• Resistance 2–3 d/wk nonconsecutive; combined aerobic+resistance is best.
• Break up sitting every ~30 min.
• Hypoglycemia risk with insulin/sulfonylureas — monitor glucose, carry carbs.
• Screen/adjust for neuropathy, retinopathy, autonomic neuropathy, nephropathy.

• metabolic-syndrome / obesity — frequently coexist.
• cardiovascular-disease — shared CV risk reduction.
• exercise-is-medicine — diabetes is a flagship "exercise is medicine" condition.
• fitt-vp-cardio — building the aerobic dose.