How to Build Muscle with Diabetes


Editor’s Note: Phil Graham (BSc, CISSN) is a certified sports nutritionist and competitive body builder. Learn more of his training tips on his site Diabetic Muscle and Fitness

This is a basic overview of how muscle tissue is built and the important considerations people living with diabetes need to make in order to maximize their muscle growth potential. This advice is suitable for anyone interested in improving the look of their body or for the professional bodybuilder and athlete looking to increase performance.

How do you build muscle?

  • Lift heavy weights?
  • Consume enough protein?
  • Get enough rest?

Pretty much! Generally speaking, these behaviours can be classified into two distinct categories:

  • Stimulus
  • Recovery


Throughout our life, muscle mass increases as we age up until a certain point. This is naturally dictated by our day-to-day activity, genetics and the influence of key hormones.

Everyone has the potential to build muscle. However, some people want to build more muscle than others. This is largely for aesthetic and sporting performance reasons.

To accelerate muscle growth, there needs to be a stimulus. Weight-resistance training serves as the perfect stimulus for muscle growth. While the body’s muscles are challenged on a daily basis through movements like squat, deadlift, press and pull. Not many of these movements are loaded heavily or frequently enough to stimulate substantial gains in muscle mass. This is where scheduled weight training comes into play.

Through frequent training exposure, the body adapts itself to deal with loaded movements by increasing its physical strength through newly acquired muscle mass. Load and training frequency are the limiting factors to muscle growth; however, for the body to make the most out of a regular load training stimulus, another process must come into play.


In order for the body to adapt to a specific training stimulus it must have adequate recovery resources available. These include:

  • Appropriate calorific intake (the major determinant of weight loss and muscle gain)
  • Essential Nutrients (fats, protein and micronutrients)
  • Adequate sleep—seven to eight hours per day (including naps)
  • Taking adequate rest between training sessions

Recovery needs increase according to stress demand. Therefore, as training load and frequency increase, recovery demands also increase. When you add something in (training wise), you need to add something else in (recovery wise). You also need to consider additional life stressors will impede recovery and muscle growth. Diabetes is one of them! 

Enter Diabetes

While all the above may sound familiar. It’s easy to overlook the effect of diabetes on the muscle building process. I see so many people with diabetes struggle to build muscle mass and increase their physical strength. Often times, they are left disheartened and end up jeopardizing their well-being.

I want to highlight the three biggest problems people with diabetes face when it comes to getting the most out of weight training and building a better looking body.

1. Diabetes is a catabolic disease when left uncontrolled

  • Lack of insulin hinders the body’s ability to store and utilize nutrients (fuel) properly. Uncontrolled diabetes is a state of undernutrition. If nutrients can’t get into cells both performance (stimulus) and recovery capacity are jeopardized, which limits muscle growth.
  • High blood glucose levels increase protein breakdown and reduce protein synthesis. These are the two most important biological processes when it comes to building muscle.
  • Low blood glucose will steal energy and mental focus making training difficult.


It’s essential to obsess over your blood glucose control. Do all you can to keep blood glucose levels in healthy range. This requires dedicated monitoring of blood glucose levels in response to medication and dietary intake.

Instead of tracking aimlessly, feedback the data to your healthcare team and do your best to identify patterns when blood glucose levels dip or rise into unhealthy ranges. Anticipate and react appropriately next time round.

2. Side effects of injectable insulin

People who take injectable insulin run the risk of taking too much and too little.

  • Too little insulin and blood glucose goes high into hyperglycemia.
  • Too much insulin and blood glucose plummets into hypoglycemia.

The greatest risk of hypoglycemia in people using injectable insulin is during aerobic exercise. This is due to the low-stress nature of the exercise which doesn’t bring about an increase in glucose-raising hormones typically produced during higher intensity exercise.

Hypos during higher intensity exercise are less likely due to increased production of glucose from the liver. However, if there is too much circulating insulin – hypos are still a real possibility.

High levels of insulin (hyperinsulinemia) suppress the action of glucose-raising hormones like glucagon, which normally signal the release of stored glucose from the liver into the blood stream to rectify low blood glucose levels. This abnormal response doesn’t normally occur in the body of a non-diabetic because insulin production is tightly regulated.


Learn to dose precisely. Injecting the correct amount of insulin is a fine art and requires constant assessment. The more consistent you are with diet, training and lifestyle—the easier it is to pinpoint control.

Be mindful of injecting insulin into a trained muscle group. This leads to faster onset and increased risk of hypoglycemia.

3. The mental burden of diabetes

Living with diabetes can be stressful. It’s not uncommon for people with diabetes to suffer from depression and anxiety. The burden of managing blood glucose levels, injecting in public and complications from poor control (both short and long-term) add additional stress to an already stressful modern lifestyle.

It’s hard to train properly when you’re stressed. As a result, the training stimulus is never as good. Chronic long-term stress is detrimental to health and diabetes management. If left uncontrolled stress can manifest into a host of adverse health problems including:

  • Reduced immune function
  • Lack of energy
  • Digestive issues

(Not an ideal environment for building muscle building.)


It’s incredibly important to focus on what you can control and leave the rest to the universe. Increasing your self-awareness around stress, health and diabetes is essential.

Take time away from social media, meditate, journal and surround yourself with as many positive people as possible. Doing so will give you a clear mind, and allow for better decision making. Health starts from within!

Take Home

People with diabetes can build muscle. Don’t let anyone tell you otherwise. Your potential to build muscle is directly correlated to your level of motivation to keep blood glucose levels in control. You must stay motivated to learn all you can about your condition and empower yourself with the knowledge needed to understand why blood glucose levels behave the way they do. Go out of your way to get accountable to a mixed team of professionals including a diabetes specialist, exercise physiologist, sports nutritionist, psychologist and strength coach.

Read 10 Reasons for Hyperglycemia during Training by Phil Graham.

WRITTEN BY Phil Graham (BSc, CISSN), POSTED 01/04/17, UPDATED 10/05/22

Renowned sports nutritionist and author and competitive bodybuilder Phil Graham (a certified sports nutritionist) has established himself as one of UK’s leading fitness educators, coaches and personal trainers. Phil coaches 1000s of personal trainers every year through his seminars and workshops. He actively writes for many of the major fitness publications, hosts the popular Podcast Elite Muscle Radio and has recently published the first muscle building and fat loss fitness book for people living with diabetes (The Diabetic Muscle and Fitness Guide). Learn more about Phil's work: