Diabetes Health Center


Smart Strategies for Weight Loss With Type 2 Diabetes

By Denise Maher
Smart Strategies for Weight Loss With Type 2 Diabetes

If you’re thinking, I’d love to drop a pants size, now is the time to forget the fads, stick to the facts, get serious and do it.

Why the urgency? If you’re at risk for developing type 2 diabetes, losing weight—or curbing midlife weight gain—can help you avoid ever getting the disease. (Carrying extra weight, especially in your midsection, is a major risk factor for developing type 2 diabetes). If you’ve already been diagnosed with type 2 diabetes, losing weight can increase your energy, improve your body’s response to glucose, reduce your need for medication and help stave off life-threatening complications. And the kicker? It doesn’t take a major life change to reap the benefits. Reducing your total body weight by as little as 5 to 7 percent can get you there.

If you’ve just been diagnosed with diabetes, there’s no better time to start getting a grip on your weight. A diagnosis is a great opportunity to change course before serious complications such as kidney disease or heart disease develop. In fact, research suggests that the process of learning that you have type 2 diabetes — and the support, education and tools that come with the news — can help spark healthy change. Individuals who lost weight soon after being diagnosed with type 2 diabetes had better blood sugar and blood pressure control and were more likely to retain those benefits, even if they regained weight, according to a study by Kaiser Permanente researchers published in the journal Diabetes Care.

Take the Long Road

By now, you know losing weight is much harder than putting it on. But when you have diabetes, it can be even more challenging. For starters, you have to eat at regularly scheduled times and carefully balance your carb intake. That means no fad juice fasts, protein-only diets, skipping meals or other shortcuts. What’s more, certain diabetes medications can make it difficult to shed pounds. So how can you lose that extra weight and, more important, keep it off? The bottom line: Do it slowly and steadily (read: sustainably) through a combination of changes to your diet, getting regular exercise and finding ways to manage stress.

Choose to Lose

Once you connect with a doctor or a certified diabetes educator (CDE), you can start to understand the role of blood glucose (blood sugar), how to manage it, plan meals and set some realistic short- and long-term goals.

“Certified diabetes educators can help people with diabetes figure out which strategies — such as counting carbohydrates, using the glycemic index or the plate method — to use to keep blood sugar levels steady,” says Academy of Nutrition and Dietetics spokesperson Angela Ginn, RD, CDE. Don’t have a CDE? Call your health insurance company to connect with an educator whose services may be covered by your plan.

As you learn to keep food and/or glucose logs — tools that help you monitor and track blood sugar and the foods you eat — you’ll gain the confidence you need to take charge. Make no mistake, says Ginn, “diabetes is a self-management disease and you are in the driver’s seat.” Your doctor, CDE, nurse and pharmacist will offer support, recommendations and tools, but the goals are your own, and actually reaching them is on you.

To start, Ginn often offers advice about eating less food gradually by cutting down on portion sizes. Her favorite tips: Serve food in the kitchen onto individual plates — not family style on the table or straight out of a to-go container — to better track intake and make it harder to grab seconds. Next, scale down to a 9-inch plate — not the large platters that some use — to keep serving sizes in check. Using smaller plates can help create the illusion of the plate being more full, making it psychologically more satisfying.

Another key focus in the beginning of diabetes education is balance. Meals should deliver an even amount of carbohydrates (30 to 45 grams per meal for women, about 60 for men) and include foods high in healthy monounsaturated fats such as peanut butter or almond butter, almonds and walnuts. Balance makes meals more satisfying and helps tame your appetite. For example, a healthful, balanced snack like whole grain crackers with reduced-fat cheese won’t spike blood sugar levels, but should satisfy. What’s more, whole grains, with their extra fiber, protein and other nutrients, steady sugar levels so that hunger isn’t revved — making it easier for you to stop eating. Balance remains important in your snacks, since grains are still carbohydrates and portion control is still important.

Finally, know this: Understanding good diabetes nutrition will teach you not only what to eat and avoid, but also how to fit in your favorite foods. For example, if you strategize, you can slip in some dessert. Helping people with type 2 diabetes figure out ways to safely eat their old favorites every once in a while is another one of Ginn’s tried-and-true CDE tactics. Ice cream, anyone?

Move It to Lose It

Another great tool for keeping blood sugar in check? Exercise. The simple act of using your muscles improves blood glucose and insulin sensitivity at the same time it burns calories (sugar). Need to see the effects to believe it? Try measuring your blood sugar just before you exercise, when you finish and one hour afterward, suggests exercise physiologist Sheri Colberg-Ochs, Ph.D., professor of exercise science at Old Dominion University, adjunct professor of internal medicine at EasternVirginiaMedicalSchool and American Diabetes Association spokesperson.

Exercise delivers immediate heart and holistic health benefits, too. It boosts energy levels and mood, helps you sleep better, strengthens bones, helps ease joint pain, and improves flexibility, blood pressure and cholesterol levels. Physical activity can also lower blood glucose and weight, so it may help you need less medicine. In fact, some people can control diabetes through diet, exercise and stress management alone.

While any physical activity will get your muscles moving and help burn calories, researchers have found that cardio exercise along with resistance training is the ideal combo for fighting diabetes. In fact, one study published in The Journal of the American Medical Association conducted by Louisiana State University System researchers found that a combination of aerobic exercise and resistance training improves HbA1c levels, reduces the need for diabetes medication and leads to more overall weight loss in people with diabetes than doing just aerobic exercise or resistance training alone.

In 2010, the American Diabetes Association and the American College of Sports Medicine updated their joint exercise guidelines for people with type 2 diabetes after it became evident that aerobic plus strength training is the winning combo. Specifically, the guidelines call for:

  • Moderate-to-vigorous aerobic exercise, such as brisk walking, at least 150 minutes a week, spread out over at least three days.
  • In addition to aerobic exercise, resistance (strength) training at least two to three times a week, on nonconsecutive days. (Resistance training is the use of free weights, resistance bands or your own body weight to build muscle.)
  • Regular and consistent exercise, with no more than two consecutive days between aerobic workouts.

Get Started

Starting slow is a smart strategy in fitness as well as diet, experts say, so focus on moving more — but not necessarily training for a marathon. If you’re new to working out, ease your way into exercising. A CDE can help you set realistic short-term goals and build on your progress. Some like this approach: Aim to walk for 10 minutes three times a week. Once you reach that goal, increase the number of minutes you walk in five- to 10-minute increments each week. Next, try for four times a week.

Because of the need for equipment like dumbbells and weight machines for resistance training—and the realities of inclement weather — you may need to visit a local fitness center to do some workouts, or…

Get Creative

There are fitness opportunities all around you. Hitting the stairwell for 10 minutes before your lunch break at work will help curb appetite and give you a nice afternoon workout. Even parking your car at the far end of the parking lot and walking an extra few minutes on the way to and from the grocery store can add up. It’s about creating an attitude that embraces what, when and where you can add a little extra physical activity to your day. Need even more incentive? WalkwithWalgreens is an excellent program to help you stay in step with all the benefits and rewards you get from a simple walk.

Beat Stress

A less defined but highly valued aspect of exercise is the important role that it plays in stress relief. But exercise isn’t the only way to reduce stress: Yoga and less physically demanding activities such as relaxation practices, deep breathing, meditation or quiet contemplation can also help manage blood glucose. How? Mental stress raises levels of cortisol, a hormone known to contribute to insulin resistance and weight storage. Training your body and mind to stay calm in tense situations may make you less likely to experience an abrupt increase in cortisol and blood sugar levels. What’s more, deep breathing stimulates the production of insulin, which helps to lower blood sugar levels. Also, stress is known to contribute to mindless eating and weight gain — curbing stress may help you cut back on comfort foods.

Fitness Precautions

“Complications should not be used as an excuse to avoid participation in physical activity,” stresses Colberg-Ochs. It’s best to get medical clearance before you get moving. However, “most people with type 2 diabetes can exercise safely, as long as certain precautions are taken,” explains Colberg-Ochs. If you’re concerned about your limitations, ask about low-impact activities, such as swimming, that might be right for you.

Hypoglycemia (low blood sugar) as a result of working out is a concern for people who take insulin, but if you have type 2 diabetes and are not using insulin, it is unlikely that you’ll experience exercise-related low blood sugar. Insulin users should consult their doctors about supplementing with carbohydrate as needed to prevent hypoglycemia during and after exercise.

Know What You’re Up Against

Many insulin and oral diabetes medications like glyburide cause the side effect of slight weight gain. On the flip side, some weight-neutral and even weight-loss-friendly appetite-suppressing diabetes medications exist. Ask your doctor about the medications you are taking and if there are other options, suggests Colberg-Ochs.

Real Life Change: How to Make It Happen

Now that you have a sense of what to do, how do you put those strategies in place? There are really two parts to making healthful lifestyle changes stick, says motivation expert Michelle Segar, Ph.D., associate director of the University of Michigan’s Sport, Health and Activity Research and Policy Center for Women and Girls, who coaches people trying to lead healthier lives.

The first part is feeling motivated to do the physical exercise and eat better, she explains. Ask yourself: Why do you want to control your blood sugar and lose weight? If you’re like most people, you might answer, “To be healthy!” But the idea of “being healthy” is a little too abstract to be motivating. “Try to be more specific,” says Segar. You’re more likely to be successful if you can find a way to hook the changes into how you want to live your life, says Segar. “Maybe you want to play actively with your kids or grandkids, or you simply want to be a role model for them,” she suggests. Other possible motivators include feeling good enough to finally take that trip to Europe or simply the desire to have a better sex life (both weight loss and good blood sugar control can help in that department).

But the second part to making healthy changes stick — finding time to exercise and eat well—is often overlooked. How can you fit these new time-consuming goals into your life?

“Have patience with yourself and view your life as an experiment,” says Segar. “Expect setbacks. You’re going to need to try a lot of things before you discover what’s right for you.”

Her advice: Schedule a weekly check-in with yourself over the first four weeks you’re making a change — block 30 minutes on your calendar to be sure it happens. During that time, think about the coming week, what your daily goals are and what you need to accomplish them. (How will you remember to take your medication regularly? Do you need to arrange childcare or eldercare so you can get to the gym or go grocery shopping?)

Then, at your check-in the following week, review and assess your success. “Ask yourself: What did I learn from the last week?” suggests Segar. “Given the hindsight, what might I try next time?”

Denise Maher is a health writer, reporter and editor who lives in Brooklyn, NY. She blogs at alternahealthgrrrl.com. 

Reviewed by Joseph Sclafani, MD on December 11, 2013















Ginn, Angela, RD, LDN, CDE. Personal interview. Aug. 2012. 

Colberg-Ochs, Sheri, Ph.D. Professor of exercise science at Old Dominion University, adjunct professor of internal medicine at EasternVirginiaMedicalSchool. Personal interview. Aug. 2012. 

Segar, Michelle, Ph.D. Associate director of the University of Michigan’s Sport, Health and Activity Research and Policy Center for Women and Girls. Personal interview. Aug. 2012.  

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