You’ve heard the “diet and exercise” lecture a thousand times, and you know you should lose weight to help ease your type 2 diabetes management. But it’s easier said than done: Comprehensive lifestyle adjustments can feel overwhelming and often lead only to frustration and relapse.
If you’re still struggling to hit your A1C goal, it may instead be time to make a few targeted but impactful changes. Specific, strategic shifts in your habits and treatment plan can stabilize your blood sugar and should be easier to work into your current lifestyle.
1. Go for a Short Walk After Every Meal
Moving your body immediately after mealtime can have a noticeable impact on your blood sugar.
“Aerobic exercise causes muscles to rapidly absorb the readily available circulating blood glucose for energy, and it also increases insulin sensitivity,” says Jennifer Chung, MD, a functional and lifestyle medicine physician specializing in cardiometabolic health in Richmond, Virginia.
A short walk immediately after your meal may help even more than a longer walk later in the day. A very small Japanese study measured blood sugar changes in 12 healthy young adults who consumed a sugary drink and then either rested, took an immediate 10-minute walk, or took a 30-minute walk 30 minutes after finishing the beverage. While both walking options lowered overall blood sugar throughout the next two hours, only the immediate 10-minute walk lowered peak blood sugar levels significantly.
Meanwhile, another meta-analysis of seven studies including more than 450 participants (most of whom were overweight or had obesity) found walking for as little as 2 to 5 minutes after a meal resulted in smaller blood sugar spikes than when participants remained seated or stood still.
“The general recommendation for most people with type 2 diabetes is a minimum of 30 minutes of dedicated walking per day,” says Carole Jakucs, CDCES, a certified diabetes care and education specialist based in Los Angeles. Jakucs adds that this movement goal can be broken down into 10-minute intervals three times per day, especially after eating, to help lower post-meal blood sugar.
And if a walk isn’t always an option, perhaps because of a sedentary job, opt for some standing calf raises at your desk to support post-meal blood sugar regulation.
2. Mind Your Carbohydrates
Not all carbohydrates are created equal.
Simple carbohydrates, which are found in foods like sugar, honey, fruit juice, syrup, and highly processed foods like soda, cookies, cakes, and candies, spike your blood sugar quickly, making it difficult to manage diabetes. Refined grains in foods like white bread, white pasta, cereals, and pastries have the same effect.
Complex carbohydrates, on the other hand, increase blood sugar more slowly because of their starch and fiber content, which the body digests more slowly. These carbohydrates are found in starchy vegetables like corn and potatoes, legumes, and whole grains.
“If you don’t know how many carbohydrates to limit [yourself to], the easiest thing to do is not count carbs but to make a commitment to only eat them in their minimally processed, whole form,” says Dr. Chung.
For those looking for a simple but effective dietary change, replace sugar-sweetened beverages with water, unsweetened tea, or coffee. “Highly processed and sugary foods consumed on a regular basis are the lowest-hanging fruits to eliminate if you want to take small, meaningful steps towards better health,” says Chung.
3. Test Your Blood Sugar More Frequently
Just tracking the data may be enough to motivate healthy changes. One meta-analysis of 14 randomized controlled trials including nearly 1,650 participants found continuous glucose monitoring helped significantly lower A1C levels in people with type 2 diabetes compared with self-monitoring.
“Real-time data like this can be a powerful tool in changing behavior — and in this situation, tweaking meals and timing of exercise to improve blood glucose levels,” says Chung.
4. Lift Weights
Strength training can be particularly helpful in improving blood sugar. Some evidence suggests that it’s more effective than aerobic exercise.
In one nine-month study of adults with type 2 diabetes and normal weight, participants who strength trained saw a significant reduction in their A1C levels. Interestingly, participants who performed both aerobic and strength training didn’t experience additional benefits compared with those who only strength trained.
“Resistance training increases muscle mass, which means muscle cells become bigger,” says Chung. “Larger muscle cells have more insulin receptors and more insulin-independent glucose transporters that pull glucose into the muscle cells without the need for insulin.”
5. Review Your Medications
At your next checkup, it may be a good idea to go over your prescriptions with your doctor, one by one, to see if you’re taking anything that’s actually working against your diabetes management goals.
“If you’ve been prescribed medications in these categories but haven’t started taking them, speak with your physician candidly about your concerns, and discuss alternatives or a follow-up plan to monitor,” says Chung. If you’re already on these medications and can recall that the onset of weight gain and poor blood glucose control occurred around the same time you started taking them, it’s also important to share this information with your physician so you can discuss alternatives, she says.
It also may be a good time to consider adding or switching to a newer diabetes medication. Many people with diabetes are stuck in therapeutic inertia, meaning your doctor may not adjust your therapy in a timely manner even though you’re not hitting your A1C target.
The new kids on the block, GLP-1 and SGLT2 inhibitor drugs, don’t just help keep your blood sugar in check, they are also associated with weight loss and better long-term heart and kidney health. Though diabetes experts are urging the increased adoption of these new options, doctors do not always prescribe these drugs to qualifying patients, even when they have good insurance coverage.
6. Treat Sleep Apnea
“Untreated obstructive sleep apnea deprives the brain of oxygen at night, increasing stress hormones like cortisol and adrenaline, and decreasing insulin sensitivity, directly increasing blood glucose levels,” says Chung.
Treating sleep apnea can have a direct positive effect on your diabetes management. One small Chinese study including 60 participants with type 2 diabetes and obstructive sleep apnea found that those who received continuous positive airway pressure (CPAP) treatment for sleep apnea had significantly lower blood sugar levels than those who didn’t receive treatment.
7. Meet With a Diabetes Educator
A certified diabetes care and education specialist (CDCES) has specialized expertise in applying diabetes management strategies. They can teach you how to best manage your A1C levels, use insulin correctly, and integrate diabetes management technology effectively into your care plan.
“In my practice as a primary care physician, I have found that patients who participate in frequent meetings with a health educator create and sustain meaningful changes,” says Chung. “The health educator, whether a dietitian, diabetes educator, or health coach, provides accountability and ‘coaching’ that encourages habit changes.”
Chung says these specialists often can offer longer meetings with patients than the 15- to 20-minute check-in you may expect from a primary care physician, in which engaging in a deeper discussion about health goals is difficult.
“We typically have more time allotted for our visits than physicians and other prescribers,” says Jakucs. “We review lifestyle, including eating habits, when and how you take your diabetes medications, how much sleep you get, your activity level, stressors, and more.”
The Takeaway
- To reach your A1C goals when you have type 2 diabetes, don’t just “exercise.” Incorporate strategic physical activity into your days, such as walking for 10 minutes immediately after meals and strength training to increase your insulin sensitivity.
- Consider prioritizing carb quality rather than carb quantity: Replace refined carbohydrates with high-fiber, whole-food sources of complex carbohydrates.
- Be proactive: Check your blood sugar more frequently, and collaborate with your doctor to ensure other medications or untreated conditions like sleep apnea aren’t negatively impacting your blood sugar.
- For long-term success, work with a certified diabetes educator for personalized coaching, and advocate for yourself if your current therapies aren’t helping you meet your A1C targets.
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