Blog · Type 2 diabetes

Exercising with type 2 diabetes: your muscles are your biggest sugar store

By Remko Opdam · 21 August 2026 · 5 min read

In short

Your muscles take up most of the glucose from your blood. More muscle mass therefore means more storage room for sugar.
A contracting muscle takes in glucose without needing insulin for it. That route stays open, even if you are insulin resistant.
In the research the rule was: the stronger people became, the bigger the drop in their HbA1c. Moving alone is not the same as getting stronger.

Anyone told that their blood values are heading towards type 2 diabetes usually gets two pieces of advice with it: lose weight and move more. Both are fair, but something stays underexposed that matters especially after forty. Namely where that sugar in your body actually has to go.

For the record: I am a personal trainer, not a doctor. Your diagnosis, your blood values and your medication belong with your GP or your specialist. What follows is about training, and about what the research shows.

Where your sugar goes

Your muscles take up around eighty per cent of the glucose from your blood. That makes them by far the largest customer for the sugar you take in, and it makes muscle mass something other than a cosmetic goal. It is storage capacity. Anyone who loses muscle mass over the years, which happens by itself from around forty if you do nothing, also loses part of the room that sugar can go to.

There is something behind that which I find the finest part of this story. A contracting muscle pulls glucose in along a route that does not need insulin. Insulin and muscle contraction both switch on the same transport system, but through different switches. With insulin resistance one of those switches works less well. The other keeps doing exactly what it is supposed to do.

The very system that falters in type 2 diabetes is one you can bypass by putting your muscles to work. That is no miracle cure, but it does explain why training pays off so well here.

Not moving, but getting stronger

In a review of twenty randomised studies in more than eleven hundred people with type 2 diabetes, strength training lowered HbA1c, the measure of your average blood sugar over recent months, by an average of 0.39 percentage points compared with the control group. That is a modest number and it should not be dressed up. But the interesting part is the second finding.

The researchers also looked at how much stronger the participants became. And there the link was clear: the bigger the gain in strength, the bigger the drop in HbA1c. Programmes that genuinely made people stronger did more than programmes in which people were mostly just busy.

That is exactly why I keep hammering on the difference between moving and building. Going through a circuit twice a week feels like training, but if you are not lifting more after three months, not much has changed about the capacity of your muscles either. Progression here is not a gym ideal, it is the part that works.

With prediabetes there is even more on the table

If you are still in the stage before it, with raised values but no diagnosis, the gain is bigger than most people think. In the best-known study on this, people at high risk followed a lifestyle programme aiming for five to seven per cent weight loss plus regular exercise. After almost three years their chance of developing type 2 diabetes was fifty-eight per cent lower than in the control group, and lower than in the group that received medication. At the follow-up years later the effect was still visible.

And with existing type 2 diabetes, remission is even possible, meaning values back in the normal range without medication. In a British study that worked for forty-six per cent of participants after one year. One important detail: that went through a closely supervised diet, in people who had had diabetes for less than six years and were not using insulin. It shows what is possible, it is not a promise for everyone.

How much is enough?

The international guideline is concrete. At least one hundred and fifty minutes of moderate to vigorous activity per week, spread over at least three days, and never more than two days in a row without anything. Alongside that, strength training two to three times a week, on days that are not consecutive. And a third point that often gets skipped: break up long periods of sitting every thirty minutes, because that too is measurable in your blood sugar.

Those two days are not an arbitrary rule. The effect of a session on your insulin sensitivity is temporary. That is why regularity counts for more here than one hard session at the weekend.

What to watch out for

If you use insulin or tablets from the sulfonylurea group, you can have a hypo during or after exercise. Make sure you have fast-acting sugar with you, and measure around your session until you know how your body responds.
If you start training regularly, have your medication reviewed. If your insulin sensitivity improves, your dose may need adjusting. That is a conversation with your GP, not something to do yourself.
Watch your feet and your shoes. Reduced feeling in the feet is a known complication, and then you notice a developing blister or pressure point too late.
Tell your trainer what you use and what your values do. I can only take into account what I know.

What you can do with this yourself

Put two strength sessions a week into your diary. Major muscle groups, not two days in a row. That is the base everything else is built on.
Write down what you lift and make sure it goes up. Not because the number is sacred, but because it was the gain in strength that was linked to the drop in HbA1c. If you are still on the same weight after three months, your body is no longer training, you are only maintaining.
Walk for ten minutes after your biggest meal. And get up every half hour if you have a desk job. This is the easiest gain available, and you need nothing for it.

And if you do not know where to start, or you do not quite dare to lift with the values you have, have someone look at it with you. Not to hand you a standard schedule, but to work out what your body can handle now and how we build on that calmly.

Frequently asked questions

Can you reverse type 2 diabetes with exercise and weight loss?

For some people it is possible, and that is called remission: blood values back in the normal range without medication. In a British study in general practice, forty-six per cent of participants reached remission after one year, through a closely supervised diet with substantial weight loss. That applied to a specific group: people who had had diabetes for less than six years and were not using insulin. The longer you have had diabetes, the smaller the chance. If you are still in the stage before it, with raised values but no diagnosis, the gain is even bigger: in the best-known prevention study the risk of developing diabetes was fifty-eight per cent lower among people who lost five to seven per cent of their body weight and exercised regularly. Always discuss remission with your GP, not least because your medication will need adjusting. And remission is not an end point: without maintaining the weight loss and the training, the values usually come back.
Source: DiRECT study on remission of type 2 diabetes (The Lancet) →

Is strength training or cardio better for type 2 diabetes?

They both do something, and the guideline asks for both: at least one hundred and fifty minutes of moderate to vigorous activity a week plus two to three strength sessions. Strength training does have one advantage that often stays hidden. Your muscles take up most of the glucose from your blood, so more muscle mass means more storage room for sugar. On top of that, in a review of twenty randomised studies the drop in HbA1c was linked to how much stronger people became. Programmes that genuinely built strength worked better than programmes where people were mostly just moving. Cardio and a walk after your meal remain valuable, certainly for your heart and blood vessels, but if you have to choose where to start, start with strength. The best plan combines both across the week, with at least two strength sessions on non-consecutive days. That keeps the effect on your insulin sensitivity going between sessions too.
Source: meta-analysis of strength training and HbA1c (BMJ Open Diabetes Research & Care, 2022) →

Can I have a hypo while exercising with type 2 diabetes?

That depends mainly on your medication. If you only use metformin or lifestyle measures, the chance of a hypo during exercise is small. If you use insulin or tablets from the sulfonylurea group, that chance is real, because those drugs keep prompting your pancreas to release insulin while your muscles are taking up glucose at the same time. In that case, keep fast-acting sugar with you, such as glucose tablets, and measure your value around your session until you know how your body responds. If you start training regularly, have your medication reviewed by your GP, because better insulin sensitivity can mean your dose can come down. Never adjust your own medication based on a few good readings. And tell your trainer what you use, so they know what to watch for. A hypo often announces itself with sweating, trembling, going pale or dizziness, and you want someone on the gym floor who recognises those signs.
Source: Dutch Diabetes Fonds on exercise with diabetes →