November is National Diabetes Awareness Month, and the UN General Assembly officially adopted November 14th as World Diabetes Day. November in the U.S. and November 14th globally were chosen to honor Dr. Frederick Banting, who discovered insulin in 1922. His birthday was November 14th, 1891.

The Numbers

According to the American Diabetes Association, 38.4 million Americans, or 11.6% of the population, have diabetes. In 2023, Diabetes was the 8th leading cause of death in the United States. According to the International Diabetes Federation, 537 million adults (20-79) live with diabetes worldwide. This represents 10.5% of the world’s population, or 1 in 10 adults. The IDF projects that by 2045, 1 in 8 adults approximately 783 million, will be living with diabetes, an increase of 46%. Diabetes is one of the leading causes of disability and death. More people die of Diabetes each year than Breast Cancer and AIDS combined. As a fitness professional, you are in a unique position to help people reverse Type 2 Diabetes, and greatly improve the lifestyle of those with Type 1 Diabetes. Before diving into how you can help in the fight against Diabetes, it’s important to understand what causes this deadly disease.

Back to the Basics

As I’m sure you will remember in the Book of Personal Training, like gasoline for a car, your body uses fuel in the form of food to function. Foods from plants and/or animals contain stored energy in the form of carbohydrates, fats, and/or proteins. Gasoline is manufactured at a refinery from oil (raw fuel). The body’s raw fuels are carbohydrates and fats. Under extreme circumstances, the body can also utilize amino acids (proteins) to generate either carbohydrates or fats for additional fuel. As you lower your stores of raw fuels, you need to replenish them with food just as an oil refinery needs to receive constant shipments of oil. This is why we need to eat—to replace the raw fuels that we store in the body.

The Roadmap

When you eat a carbohydrate-rich food such as a black bean, sweet potato, or nut, it flows down your esophagus to your stomach. Glucose (the simplest form of sugar used in the body) is released as the food is broken down. The glucose travels to the intestines for absorption and moves into your bloodstream. This is where insulin comes in. Insulin is produced in the pancreas. It is a hormone that transports Glucose from your blood into your cells. After your body has used the Glucose it needs, the rest is stored in the form of Glycogen (chains of glucose) in the liver and muscles.

Our blood glucose levels (the amount of sugar present in your blood), fluctuate throughout the day. If it’s been several hours since you have eaten, and the blood glucose levels (also referred to as blood sugar level) drop. As a result, your pancreas slows the release of insulin. A normal fasting blood glucose level (glucose level between meals) is less than 100 milligrams/dL. When we eat, the opposite occurs. Our blood glucose levels rise, and the pancreas pumps out insulin. Our insulin levels rapidly climb and peak in about 45 minutes to an hour before they fall again.

The Roadblock

Hyperglycemia develops when there’s too much sugar in your blood. This occurs when the pancreas is unable to produce enough insulin, causing glucose to stay in the bloodstream. Hyperglycemia usually indicates diabetes.

Prediabetic: When fasting blood sugar levels are between 100-125mg/dL
Diabetes: When fasting blood sugar levels are 126mg/dL or higher

Types of Diabetes

There is currently no cure for Type 1 Diabetes. It is believed to be an autoimmune reaction. The body attacks and destroys cells in your pancreas, where insulin is made by mistake. As a result, your body does not produce insulin. You must take insulin every day to survive. Type 1 Diabetes is usually diagnosed in children and young adults, but can be diagnosed at any age. Type 2 Diabetes is reversible. In Type 2 Diabetes, your pancreas can make insulin, but your cells don’t respond well to the insulin. As a result, your pancreas needs to make more and more insulin to offset your cells’ inability to utilize the insulin. Over time, this damages your pancreas, and your body cannot make enough insulin to meet your body’s needs. Gestational Diabetes occurs during pregnancy when a woman’s body has trouble producing insulin. Gestational Diabetes typically goes away after pregnancy, but it does increase the risk of developing Type 2 Diabetes later in life.

Undiagnosed or Untreated Diabetes

According to the CDC, of the 38.4 million Americans with diabetes, 8.7 million were undiagnosed. Mild to moderate blood sugar levels often don’t cause symptoms. In the early stages of Type 2 Diabetes, unless a physician draws a blood sample (A1C Test) to check your blood glucose level, you might be unaware you have this disease. It can also be misdiagnosed depending on what symptoms initially present.

The Symptoms

The CDC recommends if you are presenting with any of the following symptoms, to see your doctor to get your blood sugar tested.

• Urinate (pee) a lot, often at night
• Are very thirsty
• Lose weight without trying
• Are very hungry
• Have blurry vision
• Have numb or tingling hands or feet
• Feel very tired
• Have very dry skin
• Have sores that heal slowly
• Have more infections than usual

The Domino Effect might be even worse than you think. Diabetes causes joint issues, bone damage, heart disease, nerve damage, kidney failure, vision loss, and gum infection. The World Health Organization reports that 460,000 kidney disease deaths were caused by diabetes and around 20% of cardiovascular deaths.

Risk Factors

With Type 1 Diabetes, family history of the disease and age (children, teens, or young adults) are the only known risk factors at this time. Prediabetes and Type 2 Diabetes share all the same risk factors below. If you already have prediabetes, you are more at risk of developing Type 2 Diabetes. In 2021, 97.6 million Americans 18 years and older had prediabetes.

• Are overweight or obese.
• Are age 45 or older.
• Have a parent or sibling with type 2 diabetes.
• Are physically active less than 3 times a week.
• Have non-alcoholic fatty liver disease (NAFLD).
• Previously had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds.

How to Treat Diabetes?

During the client consultant phase with a new client, you will discover what diseases, disabilities, and dysfunctions your client has before training them. If your client has Type 1 or Type 2 diabetes, they are undoubtedly on oral medication, insulin injections, or an insulin pump. They will also have regular testing of blood glucose levels and regular screening with their doctor.

Let the Doctors focus on the medicine to manage the disease, your job as an IFPA Personal Trainer is to focus on the CURE, diet, and exercise. There have been numerous studies at this point to prove how diet and exercise can reverse Pre Diabetes and Type 2 diabetes, as well as greatly improve the quality of life for those that have Type 1 Diabetes.

Dr. Janelle Duah, a Yale Medicine Primary Care Physician explained, “Overall, exercise is incredibly beneficial for blood sugar control. Studies show sticking to an exercise program for even just eight weeks can lower blood sugar levels to points that are on par with diabetes medications. The more muscle you have, the better your blood sugar control, as the muscles are able to take that sugar up from the blood and use it to create energy.”

Just like any fitness program you start with, regardless of the client’s condition, the goal is to get your clients lifting weights as soon as possible. However, it is important to remember that Gradual Progressive Overload (GPO) is the cornerstone of every Program Design.

Depending on the severity of the client’s current condition, a short walk might be all they can handle. Unfortunately, as you probably know, it is not uncommon that a client who comes to you with Type 2 Diabetes can also be presenting with other diseases, disabilities, and dysfunctions such as morbid obesity.

We want to elevate the clients’ heart rate significantly. Again, the starting point will vary greatly from client to client. This could look like a slow to brisk walk, jog, run, swim, bike, etc. Weights are just, if not more, important. The same principles for all your exercise prescriptions apply.

You Make a Difference

As a personal trainer, you can prevent the death of your clients, friends, and loved ones with proper exercise and nutrition programming. Remember to always encourage both your new and current clients to keep up with their annual health screening. As you treat one client, you affect a chain of people (your client’s spouse, kids, family, and friends) you never meet. Never doubt your value. You make this world a better, healthier, and happier place. What you do matters, and we are proud to call you an IFPA Trainer.