Diabetes. The word almost every trainer fears when scrolling through a client's medical history. With it come insulin, low blood sugar, diabetic comas, neuropathy, and even death. Not your ideal client right? A little scary?

Unfortunately, this fear is deliriously overblown. In fact, it's keeping a lot of trainers from making a lot of money. This market is huge, easy to break into, and is a referral generating machine.

5 Reasons Why I Love the Diabetic Market (and you should too)

1. It's HUGE

It's no longer a niche -- it's an epidemic. In 2012, 29.1 million Americans, 9.3% of the population, had diabetes. Yes, that's almost 1 in 10 Americans. Another 86 million Americans had pre-diabetes. Considering only 45 million Americans had gym memberships in 2012 (Yes, diabetics are twice the size of your current market), a savvy trainer would spend more time visiting local physicians and hospitals than even their own gym. Each year this market is getting bigger and bigger (2).

It's not just an epidemic in the U.S., either. According to the World Health Organization, there are 347 million people worldwide with diabetes. Not impressed? That number was only 153 million in 1980. Yes, that means the number of diabetics have literally doubled in just 3 decades (1). This represents both a serious problem and a serious opportunity.

Over the 6 years I've spent working with diabetics, I've seen exercise go from a quick 2 minute recommendation during the initial physician workup to a 5 minute lecture during every visit. I work with several diabetic educators, and they recommend exercise to all their diabetic patients. Thus, not only is the market huge, but it's well aware of the benefits of your services. It's just waiting for you to introduce yourself!

2. The Clients are motivated

They say fear can motivate even the least motivated. Trust me, diabetics have plenty to fear. Just the thought of insulin and administering subcutaneous shots daily sends a shiver down the spine of almost every newly diagnosed type II diabetic.

A patient will literally try to do whatever he possibly can if it means avoiding insulin, and the good news is that exercise can help. With the right diet and mix of oral prescription medications, exercise can help prevent the need to add insulin to the patient's regimen. I've even had patients get off of insulin after a significant weight loss from diet and exercise. Once you have one testimonial like that, you'll be a god in the diabetic world.

The fear doesn't just stop with newly diagnosed diabetics. Long time diabetics are at serious risk for toe and leg amputations. Fact is, over the last 2 months two of my patients have had one of their legs removed. Could an exercise regimen have prevented those amputations? Absolutely if started early enough.

Whether the patient fears insulin or just wants to be able to be able to play with his grandkids, motivating them won't be hard. A few simple reminders are all he'll need to make sure he shows up 4 days per week.

3. Half the Battle is already won thanks to your TEAM

Diet -- it's the trainer's worst enemy. There's nothing more frustrating than seeing your client bust his butt in the gym all week only to completely obliterate it at the kitchen table because your client won't follow nutrition advice. When you only see the client 4-5 out of the 168 hours during a week, it's hard to create healthy eating and exercising habits. Making matters worse, at times, it feels like you're the only one reinforcing these good habits. Not so with diabetics.

Diabetics tend to have a much larger, more influential support group. It's not just you anymore. It's the client's physician, nurses, optometrist, podiatrist, support group, family, and friends. Because of the severity of the situation, the client has an entire team behind him, and that makes habits much easier to change. Your job simply is to figure out how you fit into the equation, and to reinforce everything else his team is telling him. Moving from the minority to the majority makes your job much easier and a lot less stressful.

4. Getting clients is easy

Once you have success with one diabetic client, word will travel fast. You'll get so many referrals you won't be able to keep up. Why? Because they travel in herds. They're usually just 3 or 4 key players that handle 30, 40, or even 50 potential clients. Thus, marketing is easy and cheap.

Once you help one diabetic client, he'll mention you at his monthly support meeting. The client's physician will tell all his patients about the work you've done. The hospital will mention you to all of its diabetic patients on discharge. You'll quickly create a referral generating machine from just one client and it won't cost you a dime.

5. It's not snake oil

When your product works, it's much easier to sell. The bottom line is that exercise is an extremely effective treatment/prevention modality for diabetes. It even offers benefits if your client doesn't lose a single pound. There isn't a medication on the planet that has as many beneficial effects as exercise, and thankfully, physicians, nurses, and pharmacists are finally starting to realize it.

Exercise has been shown to:

  • Increase glucose uptake in skeletal muscle via an insulin-dependent mechanism and an insulin-independent mechanism
  • Lower fasting blood sugar acutely and chronically
  • Improves fat oxidation and storage in muscle
  • Slightly reduce systolic blood pressure and LDL cholesterol levels
  • Improve depression and quality of life
  • Lower hemoglobin A1C levels
  • Reduce cardiovascular morbidity and mortality (3)

Impressive isn't it? The only question is who is the go-to trainer in your area for diabetics?

Creating a Referral Network in 3 Steps

Because there are just a few gate keepers in your local diabetic climate, an elaborate, expensive marketing plan isn't needed. All you need is a phone, a flyer, and a Facebook account. $30-50 will be more than enough to jumpstart your diabetic program

1. Create a Facebook Ad

Don't get cute. Simply create an ad using your market's zip code and extend it by 10-25 miles. Don't narrow the demographics down too much. The only change I make is the age - 25 or over.

The majority of referrals I've received from Facebook ads for my diabetic program haven't come from diabetics. Their friend, family member, or nurse saw the ad, and contacted me directly or had the patient contact me. If I was too specific and only targeting diabetics, I wouldn't have gotten those clients.

2. Create a flyer and a name

Remember, you're not training diabetic clients. That doesn't scream expert -- that's just a trainer that also happens to train a few diabetic patients. You are creating a diabetic exercise program. Thus, you are the trainer for diabetics because you have a specific program created just for diabetics. Trust me, the marketing will be much easier and resonate more clearly if you have a program. We called our program The DiaBeat-It Exercise Program.

Once you've created a name for the program, create a flyer for it, add a page on your website about it, and post an article on Facebook about it. If you live in a smaller community, the local newspaper will often run an article about it for free. As cheap as business cards are now, I'd even create a specific business card for it. Don't just focus on the internet. It will never entirely replace face-to-face marketing.

3. Call your local physicians, pharmacies, and optometrists

Now it's time to create your referral network. Start with your local pharmacies. Although I may be biased, pharmacies tend to be at the center of the healthcare provider network. They know the physicians, diabetic educators, optometrists, and nurses. Best of all, you can literally walk right in without an appointment and talk to them. I'd suggest stopping by your local independent pharmacies first. Never visit during the busy times - Monday and Friday. Saturday afternoons are usually painfully slow, so they'll be more than happy to help you.

Here's what you'll need to say:

"Hi my name is. T.J., a trainer at the local gym. Do you have a quick minute or two? I was wondering if you offered a diabetes program at the pharmacy? {The answer doesn't matter} Good. I'm starting an exercise program at my gym that's specifically for diabetics. I was wondering if I could leave a few flyers at your pharmacy? If you don't mind, I'd love to tell my diabetic clients about your program.

Do you have a flyer or business card I could give them? Also, one more thing, what other healthcare providers in the area do you think I should contact {Get their names and phone numbers}. Thank you so much. You've been a huge help. Here's my business card. If you ever need anything, please do not hesitate to call or e-mail me."

Once you get the list of names of healthcare providers, mail them a letter with your flyer first. Address it specifically to the person the pharmacy mentioned. Wait a few days, and then call them. Simply ask for the specific person, and if you get them on the phone, ask if they have any questions about your program. If they seem interested, ask if they'd like to meet to discuss it in further detail.

If they're not interested, don't pursue that option just yet. If there's one thing a nurse/physician hates, it's a pushy salesperson. Trust me, they get that enough from drug reps. A much better method is to initially work with the physicians that are excited about the program, get results with their clients, and then send a follow-up letter/ phone call to the physicians that were on the fence about it with the results from your current diabetic clients.

Perform the same sequence with diabetic educators, optometrists, and podiatrists in your area.

Setting up a Diabetic Program

Here's a list of information you need to include on your initial assessment that are specific for diabetics:

  • Diabetic history - How long have they had diabetes? Is it relatively controlled? Are they on insulin? Do they have neuropathy (any reduced feeling in their feet/legs)?
  • Diabetic medications - What diabetic medications are they on? Some medications are more likely to cause low blood sugar episodes than others. This is the perfect opportunity to consult with your local pharmacy and create a symbiotic relationship.
  • Low blood sugar episodes: How many low blood sugar episodes have they had in the last 30 days? Have they had to use a glucagon pen? How comfortable are they with recognizing their low blood sugar signs and symptoms? What are those signs and symptoms? What kind of snack do they usually eat/drink to raise their blood sugar?
  • A letter from their physician stating they are healthy and stable enough to exercise
  • An emergency phone number.

I always keep on hand a banana, a sports drink, a bottle of orange juice, and glucose tablets. Funny enough, this is similar to what Jon kept in his now-famous personal trainer desk.

Side note: In the U.S., health information is highly protected via HIPAA. Thus, once you start getting into medications, lab tests such as HbA1c and fasting blood glucose, the rules slightly change. If you're uncomfortable about the rules/regulations regarding HIPAA, simply ask the client if he is on any medications that can cause low blood sugar. A simple yes/no question along with a letter from the physician should suffice and keep you out of any trouble with HIPAA.

Creating the Program

I usually train my diabetic clients just like I do my normal clients with two possible exceptions:

1. If they have some kind of neuropathy in their lower body, pay special attention to standing exercises. If they have a significant balance problem because they've lost so much feeling in their feet, I keep the standing exercises simple and progress slowly.
2. Three of the major signs/symptoms of low blood sugar are:

  1. increased heart rate
  2. increased sweating
  3.  tremors.

As you can imagine during a tough workout, those may also be consequences from the workout. Thus you must be able to differentiate between the two. I do a little more conversational talking with my diabetic clients because that's usually my low blood sugar gauge.

If they start acting confused or have trouble understanding my questions, I immediately know they're having a low blood sugar episode. Before training, I also ask them if they've eaten yet, if they have taken their medication yet, and if they measured their blood sugar. Those answers help me determine if I can ramp things up or keep it light.

For a more in-depth look at exercise and type II diabetics, check out the joint position statement from American Diabetes Association and the American College of Sports Medicine (free access here).

Client Charts, aka the referral machine

Hopefully you allow the client to take his assessment and workout charts home. If not, definitely start doing it. I tell all of my clients to take their charts with them to their physician appointments. Even if the physician has no idea about exercise and has never shown interest in the program, eventually he may change his mind once he sees how organized and professional you are, as well as the results you're getting. This will be your biggest marketing tool. The nurses, physicians, and even other patients will talk about it.

We're at the point now where we create branded binder for the client, and put the sheets in it before he leaves the gym. The client can then take the binder to the appointment and everything is there. Best of all, while they're carrying it around, everyone sees our logo for our diabetes program. We even throw a couple of business cards in it for the client to hand out if anyone asks about the program.

Are you convinced this niche is right for you? Or are you still nervous about training diabetics? Don't be.


  1. http://online.wsj.com/news/articles/SB10001424052702304231204576405783420390772
  2. http://www.diabetes.org/diabetes-basics/statistics/