This article is an excerpt from the book Living Well with Diabetes from the Cleveland Clinic Foundation. Unlimited Diabetic Supplies and shop4diabetics.com are publishing articles such as this as a health resource for diabetics and to provide useful information on the self management of diabetes. Topics ranging from medication and monitoring to exercise and nutrition will be covered.

Unlimited Diabetic Supplies is a Medicare Participating Provider of diabetic supplies for Medicare and private insurance members. If you are a diabetic on Medicare or have private insurance, please visit shop4diabetics and complete the enrollment form to find out if you are eligible to receive no-cost diabetic supplies delivered to your home. Shop4diabetics carries a full range of diabetic testing supplies to help monitor your blood sugar. Arthritis heating pads and impotence devices are also available at no cost to qualified Medicare and private insurance members.

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Exercise is very important in managing diabetes. Combining diet, exercise and medication (when prescribed) will help control your weight and blood glucose levels.

Benefits of exercise

• Improves your body's use of insulin
  
  
• Helps burn excess body fat, helping to decrease and control weight
  
  
• Improves muscle strength
  
  
• Increases bone density and strength
  
  
• Decreases blood pressure
  
  
• Helps protect against heart and blood vessel disease (by lowering cholesterol)
  
  
• Improves circulation and reduces your risk of a heart attack
  
  
• Increases energy level and enhances work capacity
  
  
• Reduces stress, promotes relaxation, and releases tension and anxiety
  
  
• Improves physical appearance
  
  
• May raise HDL or 'good' cholesterol

How exercise Affects Blood Glucose Levels

Insulin is released when the concentration of glucose in the body increases, such as after eating. Insulin stimulates muscle and fat cells to absorb the glucose they use as fuel for their activities.

Muscles store excess glucose in the form of a starch called glycogen. During exercise, muscles use stored glycogen as the first source of energy. Your body burns glycogen for energy during short bursts of exercise, such as a quick sprint to catch the bus. As the exercise continues, your muscles take up glucose at almost 20 times the normal rate.

In a person whose blood glucose is controlled, exercise may lower blood glucose levels. In the person whose blood glucose is poorly controlled (particularity for people with type 1 diabetes) exercise may increase glucose levels.

Is Blood Glucose Ever Too High to Exercise?

Yes. In some cases, you should hold off on exercising if your blood glucose is very high. The American Diabetes Association offers this basic guideline: if you find that your blood glucose level is high8 just before exercise [300 mg/dl (milligrams of glucose per deciliter of blood) or higher], you should consult with your health care team and wait until your blood glucose is under control before exercising.

General Exercise Guidelines and Precautions

1. Check with your doctor before you begin an exercise program. Tell your doctor what kind of exercise you want to do so adjustments can be made to your medication schedule or meal plan, if necessary.

2. Start slowly and gradually increase your endurance.

3. Choose an activity that you enjoy-you'll be more likely to stick with a program if you enjoy the activity. Make exercise a lifetime commitment.

4. Exercise at least three to four times per week for 20-40 minutes each session. Ideally, you should exercise every day.  

5. Wear good shoes and practice good foot care.

6. Consider a water exercise program. Some other exercise options include walking, riding a stationary bicycle, swimming or muscle stretching.

7. A good exercise program should include a 5-10 minute warmup and 15 to 30 minutes of continuous aerobic exercise (walking, biking) or muscle stretching exercises, followed by a 5-minute cool down.

8. To reduce the risk for hypoglycemia, the best time to exercise is ½ to 1 hour after eating. Follow a regular routine of exercising, eating your meals and taking your medications at the same time each day.

9. Prolonged or strenuous exercise can stimulate the production of adrenaline and other hormones that ca counteract the effects of insulin and cause blood glucose to rise. If you are participation in strenuous exercise (exercising at your maximum capacity) or prolonged exercise (lasting for several hours or more), your insulin and/or oral diabetic medication may need to be changed. Talk to your health care provider about how to adjust your medication.

10. Be careful exercising when your medication is reaching its peak effect.

11. Do not ignore pain-discontinue any exercise that causes unexpected pain. If you continue to perform the activity while you are in pain, you mayu cause unnecessary stress or damage to your joints.

12. Drink water before, during, and after exercise to prevent dehydration.

13. Test your blood glucose before and after you exercise. If your blood glucose is 120 mg/dl or higher before exercising, do not exercise.

14. If you are taking insulin or an oral diabetes medication, always carry a sugar source with you while exercising.

15. Exercise with someone who knows what to do if you have a low blood glucose reaction.

16. Wear a medical identification tag or carry an identification card that states you have diabetes.