Diabetes mellitus has reached epidemic proportions and can be prevented and controlled with diet, exercise and lifestyle changes. Regular physical exercise (especially aerobic physical activity) has a great role to play in the management of diabetes mellitus, both for type-1 diabetes as well as for type-2 diabetes.

The ADA (American Diabetes Association) recommends 150 minutes of aerobic physical activity per week, which should be distributed over at least 3 days a week. In addition patients with type-2 diabetes resistance training should be included in the exercise regimen.

There are several positive benefits of exercise in diabetes. The multiple positive benefits of regular aerobic physical activity in diabetes are reduction in the risk of cardiovascular diseases, reduced blood pressure, maintenance of muscle mass, reduction in body fat, and weight loss. All of these have positive impact in diabetes management. Exercise is useful for lowering plasma glucose (during and following exercise) as well as for increasing insulin sensitivity, both in type-1 and type-2 diabetes individuals.

Although the benefits of exercise for diabetes individuals is unequivocal, exercise pose a challenge among diabetes patients, as indiscriminate exercise can cause several problems in diabetics, especially in type-1 diabetes patients, because they lack the normal glucoregulatory mechanisms, which is fall in insulin level and rise in glucagon during exercise. During exercise skeletal muscles utilize glucose without insulin. Skeletal muscles are major sites for metabolic fuel consumption during resting state, but increased muscle activity during aerobic exercise greatly increases glucose requirements. Individuals with type-1 diabetes are prone to either hyperglycemia or hypoglycemia during exercise depending on the plasma glucose, the circulating insulin level, before exercise and the level of exercise-induced catecholamines (adrenalin, nor-adrenalin and dopamine). If pre-exercise insulin level is low, the exercise-induced rise in catecholamines may cause increase in plasma glucose excessively; promote ketone body formation, which may lead to ketoacidosis. Conversely, if the circulating pre-exercise insulin level is high (relative hyperinsulinemia) this may reduce glucose production in liver due to decreased glycogenolysis and decreased gluconeogenesis, and there is increase glucose entry into muscle (occurs without requirement of insulin) during exercise which may lead to hypoglycemia.

What Precautions should be taken before exercise?

To overcome exercise-related hyperglycemia or hypoglycemia by diabetic individuals, especially by type-1 diabetes individuals, certain precautions can be helpful in reducing or preventing problems that may arise due to aerobic exercise. The precautions are:

· Monitor blood (plasma) glucose before exercise, during exercise and after exercise.

· Postpone or delay exercise if blood (plasma) glucose level is more than 250 mg/100 ml of blood or more than 14 mmol/liter.

· If blood glucose is less than 100 mg/100 ml of blood or less than 5.6 mmol/liter, consume glucose before exercise.

· Reduce the dose of insulin based on your previous experience, before starting exercise and inject the insulin to a non exercising area of body.

So make sure to take the above precautions if you are a diabetic patient, especially type -1 diabetic and ensure that no complications arise in trying to remain fit and reduce long term complications.