Engaging in physical activity is one of the most important steps a person suffering from diabetes can take to help regulate their blood glucose.

For people who suffer from diabetes, it wouldn’t be an exaggeration to say that exercise truly is medicine. Representing one-third of the triad of interventions (diet, exercise and medications) needed to control blood glucose (BG) levels, it can lower BG without the need for pills or insulin. Since glucose continues to be utilized by muscle cells 24 to 48 hours after exercising, people with diabetes can reap the benefits of lower BG levels long after they have stopped actively working out.

In addition to improving glucose levels, exercise builds muscle mass/strength, flexibility and endurance. It also improves cardiovascular fitness, including blood pressure. A very important benefit, since people with diabetes are at high risk for heart disease. Bone health, sleep and mood are some of the other advantages of exercise.

Remember to warm up and stretch for about 5 minutes before starting any vigorous exercise activity. Before starting any exercise plan, you should consult your physician to help create a schedule and plan that’s right for you.

However, for exercise to be truly effective, it has to be done regularly. The American Diabetes Association recommends at least 150 minutes a week of moderate to vigorous aerobic exercise over at least three days, with no more than two consecutive days between exercising. People who need to lose weight should also be engaging in 60 minutes of exercise several days of the week, although you don’t have to complete 30 or 60 minutes all at once. Short bouts of aerobic activity throughout the day can be just as beneficial as a half-hour at a time. Aerobic exercise such as running, walking, bicycling and swimming improves cardiovascular function and generally lowers glucose levels.

Resistance training is a major component in a comprehensive exercise program. With aging, muscle mass declines and glucose isn’t utilized as well in the body, so including resistance training at least twice a week on non-consecutive days is also recommended. This can include lifting hand weights or using weight machines, resistance bands or your own body weight. Resistance training improves strength and endurance; it can also lead to transitory increases in blood glucose due to an imbalance between the output of glucose from the liver needed to meet the high energy demands of this type of exercise and the body’s available insulin. Combined resistance training with aerobic exercise burns more calories and can aid in weight loss.

To prevent low glucose levels as the body burns it during exercise, extra carbohydrates or a reduction in medication is often needed to prevent hypoglycemia, an abnormally low-level of blood sugar. A good rule of thumb is to consume between 15 and 30 grams of carbohydrates for each hour of moderate activity. Protein should be included if activity is going to be sustained over an hour. Fruit, sports bars, drinks and glucose formulations can provide needed glucose.

In addition to improving glucose levels, exercise builds muscle mass/strength, flexibility and endurance.

Since exercise can lower BG levels, it can also lead to hypoglycemia in those who take insulin or oral medications that cause the pancreas to secrete insulin. To prevent or reduce the possibility of hypoglycemia, starting and ending your exercise session at a safe glucose level is important. The Joslin Diabetes Center recommends pre- and post-exercise BG levels of 110 mg/dL for those who take insulin and 90 mg/dL for those who use oral medications.

Always speak with your health care provider before starting an exercise program. Choose something you like that is also safe for you so you’ll stay with it; don’t overdo it in the beginning, and track your results. You will be surprised how much a little exercise can do for your life.

Jaqueline Shahar, M.ED, RCEP, CDE is the manager of the exercise physiology department at the Joslin Diabetes Center. A clinical exercise physiologist and certified diabetes educator, she has worked individually and in groups with overweight, obese patients who have diabetes, including developing the exercise component in the Why WAIT? Program, a diabetes and weight management curriculum at the Joslin clinic. In addition, Shahar has worked with athletes toward improving their sports performance while managing their diabetes.