Over the last 16 years I’ve trained more clients in London with type 2 diabetes than I can remember. Every personal trainer should have at least a basic knowledge of the causes and consequences of type 2 diabetes, how to train a diabetic client, and how best to advise on nutrition.
Exercise for diabetics
If you’re a client with type 2 diabetes you are unlikely to be super-fit and ready for intensive exercise from the outset, so all the same rules apply to a diabetic as they would to any unfit client. I focus on moderate exercise in the first few sessions, focusing on a balance between cardiovascular exercise (for healthy heart and lungs) and resistance exercise (to build lean muscle mass and burn fat).
The key thing to watch out for with type 2 diabetics is exercise-induced hypoglycaemia. This is when the client’s blood sugar falls to dangerously low levels, and symptoms range from dizziness, extreme fatigue, anxiety, loss of co-ordination, nausea, and eventually loss of consciousness. In extreme cases the client can lapse into a coma. Would all personal trainers know what to do in this situation? Or better still, prevent it happening in the first place?
The cause of this rapid drop in blood sugar is often that the client has not eaten for many hours prior to the workout, and/or has recently taken their diabetes medication, usually metformin. This drug decreases the amount of glucose released by the liver, and boosts insulin production by the pancreas. If the client exercises too soon after taking these meds, which can be anything up to 2 hours before exercise, blood sugar levels will be too low. The muscles and the brain will both be starved of crucial glucose in this situation, with the effects listed above.
The personal trainer’s responsibility is to remind the client to eat around two hours before exercise, and not take their meds just before the PT session. As a precaution, the client should carry some glucose gel with them, and tell the PT where it is, so in the event of a hypo episode, the PT can squeeze some glucose gel into the client’s mouth to revive them.
Nutrition for diabetics
My key advice is to minimize the consumption of simple sugars and refined carbohydrates. Avoid sugary drinks, sugar in tea/coffee, energy drinks, sweets, cakes, pastries, white pasta/rice, pizza, white bread, boxes of breakfast cereal.
Another less obvious thing to avoid is fruit juice, often thought to be healthy, but not helpful for people with type 2 diabetes. Fruit should be kept to a minimum, no more than two portions of fruit a day, as it’s high in fructose (fruit sugar). I once had a client who had been drinking gallons of fruit juice, thinking this was the best way to improve his nutrition.
I recommend a diet high in protein, ideally from foods which also contain ‘good fats’. Examples include nuts, seeds, red meat, dairy, eggs (free range of course).
Carbohydrates should be kept under control, sticking to complex carbohydrates such as brown rice, sweet potato, whose glucose is released slowly into the bloodstream, preventing any sharp rise in blood glucose and the insulin spike which results.
As my personal training clients will tell you, I’m a big fan of vegetables, the secret weapon in any healthy eating plan. Focus particularly on green veg (broccoli, spinach, spring greens, cabbage, asparagus, kale) and also a range of colours such as red pepper, yellow pepper, beetroot, mushrooms.
With the rise of the junk food & drink industry we’ve seen the rise in metabolic syndrome, which is the combination in one person of a range of conditions: high blood pressure, high levels of LDL (bad) cholesterol, low levels of HDL (good) cholesterol, obesity, and type 2 diabetes.
If you have this combination, take action as a matter of urgency.
The dangers of type 2 diabetes
Left untreated, type 2 diabetes has some crippling effects. Because excess sugar is toxic to all the cells of the body, excess blood sugar over time can result in stroke, high blood pressure, heart disease, active retinopathy (leading to blindness), nerve damage particularly in hands and feet (leading to amputation of feet and lower legs in extreme cases), tooth & gum disease, and kidney failure.
So it’s a wise move if you have type 2 diabetes to invest in a personal trainer and prevent these things happening to you.
Dominic Londesborough is a personal trainer and nutrition coach in London with over 16 years’ experience.