Nutrition and Exercise with Type 2 Diabetes
- t2diabetesnetwork
- 2 days ago
- 7 min read
Key Insights
✅ Nutrition and exercise are key for managing T2D.
✅ Combined aerobic and resistance training improves blood sugar.
✅ Gym-based resistance training is most effective.
✅ Canadians are mostly sedentary; fruit and vegetable intake low.
✅ Small, practical goals improve adherence and long-term success.
Practical guidance, evidence, and Canadian context
Living with type 2 diabetes (T2D) means managing blood glucose, body weight, cardiovascular risk, and quality of life, and two of the most powerful tools for doing that are what you eat and how you move.
Nutrition and physical activity work together: food choices affect blood glucose and weight, while exercise improves insulin sensitivity, cardiovascular fitness and the way your body uses carbohydrates. This article pulls together current evidence and practical, person-centered advice for people with T2D, highlights Canadian statistics about diet and activity, and links to key research and guideline resources so you can read the original studies if you’d like.
Why diet and exercise matter in T2D
T2D is fundamentally a condition of insulin resistance and relative insulin deficiency. Nutrition and physical activity influence the two core problems; how the body responds to insulin and how much glucose is available in the bloodstream. Weight loss (when needed) improves insulin sensitivity; dietary patterns that lower post-meal glucose spikes reduce glycemic variability; and both aerobic and resistance exercise increase glucose uptake by muscle even without insulin.
Clinically meaningful improvements in HbA1c (average blood glucose over 2–3 months) have been demonstrated with combined lifestyle interventions and with specific dietary patterns such as Mediterranean-style diets, while structured exercise programs (aerobic, resistance, or combined) consistently lower HbA1c and improve fitness and body composition.
What Canadian guidelines recommend
Canadian recommendations for people with diabetes mirror international guidance: aim for regular aerobic exercise (the typical target is at least 150 minutes per week of moderate-intensity activity, spread over at least 3 days, with no more than two consecutive days without activity) plus resistance training at least twice weekly to maintain or increase muscle mass and strength.
Diabetes Canada’s clinical practice guidelines emphasize that smaller amounts of activity are still beneficial and that recommendations should be individualized to fitness level, comorbidities and treatment plan (for example, insulin therapy may change the approach to exercise and hypoglycemia prevention). The guidelines also describe nutrition therapy as individualized, there is no single “diabetes diet”, but recommend energy balance for weight management, focus on whole foods (vegetables, fruits, whole grains, legumes, nuts), emphasis on unsaturated fats, and limiting refined carbohydrates and sugar-sweetened beverages.
How much activity are Canadians getting?
Understanding population-level behaviour helps shape realistic clinical and public-health goals. Recent Canadian data show room for improvement:
ParticipACTION’s national summary reports that roughly 49% of Canadian adults meet the 150 minutes/week moderate-to-vigorous physical activity guideline (measured by questionnaire). This leaves about half of adults below recommended levels, with variations by age and sex.
National surveillance using device-based measures (accelerometers) from the Canadian Health Measures Survey indicates differences by age and shifting trends; direct-measure reports emphasize that many Canadians spend large portions of the day sedentary and that youth activity is declining. Between 2022 and 2024, Canadian adults averaged 9.3 hours of sedentary time per day, with only about 42% meeting recommended limits. Men were less likely than women to meet the guideline, with 35% versus 49% compliance, respectively. These objective measures often show lower compliance with guidelines than self-reported estimates.
On the nutrition side, Statistics Canada and other national reports document that many Canadians do not meet recommended intakes of fruits and vegetables and that obesity prevalence has been rising (over 30% of adults living with obesity in recent profiles).
In fact, in 2023, only 1 in 5 Canadians aged 12+ consumed fruits and vegetables five or more times per day. Intake was lowest among 18–34-year-olds (17.8%) and highest in adults 65+ (25.6%), showing a clear trend of increasing consumption with age. Younger Canadians continue to fall short of recommended fruit and vegetable intake.
These population patterns are important because excess weight and suboptimal diet quality are major contributors to diabetes development and complications.
Physical activity: what type, how often, and why it helps
Aerobic exercise (walking, cycling, swimming, brisk housework) improves cardiorespiratory fitness and insulin sensitivity. A general target is ≥150 minutes per week of moderate-intensity aerobic activity (or 75 minutes vigorous, or a combination), in sessions of at least 10 minutes if needed. For blood-glucose control, timing matters: exercising after meals often lowers post-prandial (after-eating) glucose more effectively than before meals for many people.
Resistance training (weights, resistance bands, bodyweight exercises) increases muscle mass and strength; muscle is a major sink for glucose, so more and stronger muscle helps with glucose disposal. Most guidelines recommend 2 or more sessions per week, targeting major muscle groups. Recent meta-analyses show resistance training reduces HbA1c in people with T2D; supervised, gym-based programs tend to achieve higher effect sizes (potentially due to better adherence and progressive overload).
Combined training (aerobic + resistance) often provides the best of both worlds: improved glycemic control, improved body composition, and cardiovascular benefits. Systematic reviews and meta-analyses that pool many trials show clinically meaningful reductions in HbA1c with combined programs, and improvements in blood pressure and lipid profiles. While not for everyone, high-intensity interval training (HIIT) has also shown promising glucose benefits in trials - safety, preference and baseline fitness determine appropriateness.
Practical points
Start where you are: any increase from sedentary is beneficial. Even short, frequent walks reduce post-meal glucose spikes.
Aim for consistency: frequent, moderate sessions are better than long sessions once per week.
Consider supervised or group programs, which improve adherence for many people.
Tailor exercise to medications: people on insulin or sulfonylureas should monitor for hypoglycemia and may need carbohydrate adjustments when exercising. Discuss medication timing and blood-glucose targets with your care team.
Nutrition approaches with the greatest evidence in T2D
There is no single “best” diet universally, individual preferences, cultural foods, affordability and comorbidities all matter. Still, several dietary patterns and principles have strong evidence for preventing or managing T2D:
1. Mediterranean-style dietary patterns
Consistent evidence links Mediterranean-style diets (high in vegetables, fruits, legumes, whole grains, fish, nuts, and olive oil; moderate dairy and limited red meat and sugars) with lower diabetes risk and improved glycemic control in people with T2D. Multiple meta-analyses and systematic reviews report benefits for HbA1c, cardiovascular risk factors and weight when compared to lower-quality diets. The pattern is flexible, palatable and compatible with many cultural foods.
2. Energy-restricted diets for weight loss
For people living with overweight/obesity, calorie reduction with a structured plan often produces meaningful weight loss and HbA1c reduction. Weight loss of 5–10% of body weight can improve glycemic control and some cardiovascular risk factors; larger weight losses can produce diabetes remission in some individuals (especially with greater early weight loss or with surgical approaches). Individualize the rate of loss, ensure adequate protein and micronutrients, and include behaviour support.
3. Lower-carbohydrate options
Moderate carbohydrate reduction (not extreme restriction) can reduce postprandial glucose excursions and sometimes HbA1c, particularly in the short term. Evidence for very-low-carbohydrate diets shows early glucose improvements and weight loss, but long-term sustainability, safety and effects on lipids vary between studies. Shared decision-making is key: if a lower-carb approach helps a person adhere and achieve goals safely, it can be used with monitoring.
4. Plant-forward and higher-quality carbohydrate choices
Emphasize whole grains, legumes, vegetables, and fruit rather than refined carbohydrates and sugary drinks. Dietary fiber is beneficial for glycemic control and satiety. Swapping refined grain products for wholegrain alternatives and prioritizing legumes and non-starchy vegetables helps moderate post-meal glycemic responses.
Putting it into practice: a realistic, person-centered plan
Set one small nutrition goal for 2–4 weeks
Example: add a vegetable to two meals per day, swap sugary drinks for water or unsweetened tea, or replace white rice with a legume-and-vegetable mix twice weekly. Small wins build confidence and create momentum.
Start with achievable movement
If you’re mostly sedentary, start with 10–15 minute brisk walks after meals (this helps post-prandial glucose). Gradually increase duration and frequency until you reach ~30 minutes most days. Add two short resistance sessions per week (bodyweight squats, push-ups against a wall, resistance-band rows) to begin building strength.
Combine strategies for better results
If weight loss is a goal, combine moderate energy restriction with higher-protein meals to preserve lean mass, add resistance training, and use behavioural supports (goal-setting, self-monitoring, and structured follow-up).
Plan for medication interactions
If you take insulin or insulin-stimulating medicines (sulfonylureas), learn how to check glucose before and after exercise and carry quick-acting carbohydrate to treat hypoglycemia. Review medication timing with your prescribing clinician when you start a new exercise program.
Use community resources
Consider diabetes education programs, supervised exercise classes, or working with a registered dietitian or exercise physiologist. Group classes and supervised programs increase adherence and safety, especially when starting out or when
there are comorbidities.
Barriers and how to overcome them
Common barriers include pain or mobility limitations, fear of hypoglycemia, time constraints, cost, low confidence, and lack of culturally relevant guidance.
Practical solutions:
Choose low-impact activities (cycling, water aerobics) if joint pain is a problem.
Start with short sessions and build up gradually to manage time barriers.
Use free local resources (walking groups, community rec centres) and online guided sessions.
Seek culturally sensitive nutrition advice, healthy patterns can be adapted to many cuisines (e.g., Mediterranean principles can be applied using local staples).
If hypoglycemia is a concern, plan snacks or adjust medication timing in conversation with your healthcare team.
Monitoring progress and safety
Track outcomes that matter to you: blood glucose patterns (particularly fasting and post-prandial values), weight (if relevant), waist circumference, energy/fatigue, sleep quality, and mood. HbA1c remains the standard for average glycaemia, but daily patterns and how you feel are critical for day-to-day decisions. If you have cardiovascular disease, proliferative retinopathy, severe neuropathy, or other complications, get medical clearance for high-intensity exercise and tailor programs accordingly.
Final thoughts
For people living with T2D, nutrition and exercise are not optional extras - they are foundational therapies that reduce blood glucose, lower cardiovascular risk and improve overall wellbeing. The best plan is one you can follow long-term: a pattern of whole, minimally processed foods tailored to your needs, plus regular aerobic and resistance activity that fits your life.
