Whether you’re lifting weights or just trying to carry the groceries inside, you may notice that your muscles aren’t as strong as they once were. “Struggling with muscle loss and tiredness,” one DiabetesTeam member said.

Research shows that type 2 diabetes can increase the risk of muscle loss over time. Nearly 1 in 5 people with diabetes have sarcopenia (decreased muscle mass). This lost muscle mass can affect strength, balance, body fat distribution, and even blood sugar control.

Fortunately, muscle loss can be prevented. Understanding why it’s more likely to happen and what you can do about it can help protect your strength and independence.

Does Muscle Loss Have Anything To Do With Diabetes?

Yes, there is a link between diabetes and muscle loss. In fact, people with diabetes are three times more likely to experience muscle loss than those without diabetes.

Skeletal muscle is one of the main areas where the body uses blood glucose (sugar). After you eat, insulin helps move glucose from your blood into your muscle cells, where it’s used for energy. With type 2 diabetes, insulin resistance makes this process less efficient. Over time, several changes can affect muscle health in people with diabetes.

Impaired Muscle Protein Synthesis

Insulin doesn’t just move sugar into the cells. It also plays a role in building the proteins that contribute to muscle. When cells don’t react well to insulin, the body’s signal to build muscle becomes weaker. This can reduce muscle protein synthesis, the process that repairs and grows muscle tissue.

Without strong repair signals, muscle can break down faster than it’s built.

Chronic High Blood Sugar

Over time, hyperglycemia (high blood sugar) can damage small blood vessels and nerves. Poor circulation of blood through the body due to vessel damage may limit the nutrients and oxygen reaching the muscles. Over time, this can contribute to muscle weakness and reduced muscle mass.

Ongoing Inflammation

Type 2 diabetes and obesity are often linked with constant, low-grade inflammation throughout the body. Inflammatory chemicals in the body also promote muscle breakdown.

Together, insulin resistance, inflammation, and chronic high blood sugar levels can gradually push the body toward losing muscle rather than maintaining it.

Why Muscle Loss Matters in Type 2 Diabetes

Muscle does much more than help you move. It plays a central role in metabolism and blood sugar control. Here’s how muscle loss can affect your overall health:

• Reduced strength — Everyday tasks such as carrying your kids or climbing stairs may feel harder.
• Lower metabolic rate — Muscle burns more calories than fat, even at rest. Having less muscle can slow metabolism and lead to fat mass gain.
• Worsening insulin resistance — Muscle is a major place where glucose is stored. Less muscle means fewer places for glucose to go, which may lead to worse blood sugar control.
• Higher fall risk — Weak muscles can increase balance problems.
• Difficulty exercising — Less muscle mass makes exercise harder. This, in turn, can also make it harder to control blood sugar.

Muscle loss in type 2 diabetes mellitus can create a cycle. Reduced muscle mass worsens insulin resistance, which can worsen diabetes, leading to even more muscle loss.

Who’s at Higher Risk?

Certain factors can make people with type 2 diabetes more likely to lose muscle mass:

• Age — After age 30, adults gradually lose muscle mass each decade. Diabetes may speed up this process.
• Long-standing high blood sugar — The longer blood sugar remains high, the more likely it is to affect nerves, circulation, and muscle metabolism.
• Obesity-related inflammation — Excess body fat can increase inflammation that promotes the breakdown of muscle.
• Physical inactivity — Muscles need to be used regularly to stay strong. If fatigue, pain, or diabetes complications limit activity, muscles can shrink more quickly.
• Neuropathy — Peripheral neuropathy can cause numbness, tingling, or pain in the feet or legs and may limit exercise.
• Fear of hypoglycemia — Some people avoid exercise because they worry about their sugar dropping too low.
• Retinopathy — People with diabetic retinopathy need to avoid some forms of strenuous exercise, such as jumping or running, because the blood vessels in the retina of their eyes have been weakened and are more prone to bleed.

Balancing fatigue, pain, glucose swings, and motivational challenges isn’t easy. If exercise feels overwhelming, start small and talk with your healthcare team about physical therapy, personal training, or other strategies to build back muscle mass.

Early Warning Signs of Muscle Loss

Muscle loss can happen gradually. You might notice:

• Increased weakness
• Slower walking speed
• Difficulty getting up from a chair without using your hands
• Trouble climbing stairs
• Unintended weight loss
• Changes in how your clothes fit

Muscle loss, also called muscle atrophy, can be treated. The first step is speaking with your clinician. Muscle loss isn’t something to ignore. Early action can make a big difference.

Prevention and Management

Muscle responds to training and nutrition at almost any age. Evidence-based strategies can help protect and rebuild muscle.

Prioritize Resistance Training

Strength training is one of the most effective tools against muscle loss. Aim for resistance-based exercises two or three times per week, targeting major muscle groups. This could include using:

• Your body weight for exercises like squats or wall pushups
• Resistance bands
• Free weights
• Weight machines

You don’t need a gym membership to do strength training. Even soup cans and water bottles can serve as handheld weights. Light weights can promote muscle growth if used correctly and consistently.

If you’re unsure where to start, ask your provider for a referral to a physical therapist. This can be especially helpful if you have neuropathy, balance concerns, or joint pain.

Walking is also beneficial for blood sugar control, but it doesn’t fully replace resistance training for building muscle.

Improve Protein Intake

Protein provides the building blocks for muscle repair. Doctors recommend spreading your protein throughout the day instead of saving it all for dinner. Good sources of protein for people with diabetes include:

• Lean meats
• Fish
• Eggs
• Greek yogurt
• Beans and lentils
• Tofu

If you have kidney disease, talk to your doctor before increasing or reducing your protein intake. A registered dietitian can help tailor recommendations to your needs.

Keep Control Over Your Blood Sugar

Consistently managing your diabetes reduces inflammation and risk of complications, while promoting healthier muscle metabolism. With exercise, people with prediabetes can often improve their A1c and blood sugar control so they are no longer classified as having prediabetes. Other strategies include:

• Following your medication plan
• Monitoring glucose regularly
• Staying physically active
• Managing stress

Researchers are still studying how different diabetes medications affect body composition. Some treatments may influence weight and muscle differently. Since evidence is still evolving, make sure to discuss medication changes with your clinician.

Is Loss of Muscle Mass Reversible?

In many cases, yes — muscle that’s lost can be built back up.

Doctors suggest that consistent resistance training combined with adequate protein can increase muscle mass even in older adults and those with diabetes. However, progress may be slower if blood sugar remains uncontrolled or complications are advanced.

The key is starting early and staying consistent.

When To Talk to Your Doctor

Bring up muscle concerns with your healthcare team if you notice:

• Rapid decline in strength
• Frequent falls
• Significant unintended weight loss
• Difficulty performing daily activities

Your diabetes care team may evaluate you for sarcopenia or other causes of weakness. Muscle loss shouldn’t be dismissed as “just aging” or “just diabetes.” It’s a medical issue with practical solutions. Building up your muscle strength can improve your diabetes, wellness, and overall quality of life.

Join the Conversation

On DiabetesTeam, people share their experiences with diabetes, get advice, and find support from others who understand.

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