Exercise for people with diabetes is crucial for good glycemic control. Type Is can reduce their insulin doses and type 2s can reduce the risk of numerous complications. But exercise for people with diabetes also requires special attention because it has special risks. The following list of recommendations should help you avoid any unnecessary risk when it comes to all forms of exercise - from dancing to jogging.

1. All persons taking medications for their diabetes should always keep on hand:
• A fast-acting carbohydrate while exercising
• Some current form of identification
• Quarters, in case there is a need to make a phone call
2. Blood glucose monitoring, both before and after exercise, will give you feedback about how the exercise is affecting your blood glucose levels. Understanding this relationship is the key to safe exercising.
3. Exercise of long duration or intensity should be accompanied with additional intake of carbohydrates to replenish used glycogen.
4. If you don't reduce your insulin dose, have a pre-exercise snack or drink consisting of 10-15 grams of carbohydrate for every 30 minutes of physical activity.
5. If you are prone to low blood glucose episodes, check with your doctor about adjusting your pre-exercise insulin dose.
6. Vigorous exercise should be avoided if the environment is extremely hot, humid, smoggy or cold. Often feelings of being too hot or too cold can be confused with signs and symptoms of hypoglycemia.
7. To reduce the likelihood of injury, persons with diabetes should have proper equipment and properly fitting exercise shoes.
8. All workouts should include warm-up and cool-down sessions. In addition, stretching exercises are recommended to enhance flexibility and prevent injury.
9. Be aware that certain medications can mask symptoms of hypoglycemia.
10. Keep plenty of water handy. In other words, maintain hydration while exercising. For longer events (more than 40 minutes) make sure to start drinking liquids well before you feel thirsty.
11. You should stop exercising if you feel faint or experience pain or a pronounced shortness of breath.

Paula Harper a diabetes exercise specialist from the International Diabetic Athletes Association (IDAA), adds: "Individuals with diabetes need to adjust their insulin therapy on the basis of their personal experiences in order to avoid exercise-induced hypoglycemia. Testing remains the person's primary yardstick for managing how to effectively and safely participate in sports and games."

It is also important to test frequently, with a meter, to avoid inaccurate blood sugar estimates, says Harper. "Because it was such a hassle to stop and explain to others that I needed to test, I would estimate. I thought I knew what my blood sugar reading was, but I was wrong."

She also advises to check your body symptoms for hypoglycemia every 15 minutes. "It is so easy to get caught up in the beauty of immediate surroundings. But it is critical that you regularly do a reality check on potential low blood sugar signs and symptoms."

Neil Scheffler, DPM, from the Baltimore Podiatry Group in Baltimore, Maryland, says that exercise is the best way to avoid many of the deadliest complications associated with diabetes - heart disease, stroke and other problems such as leg amputations caused by clogged arteries. He adds that exercise has direct links to reducing lipid profiles (HDL/LDL/total Cholesterol).

Weight reduction from exercise may also benefit people with diabetes because reducing weight on the feet and legs decreases the pain of various lower extremity problems. A visit to a podiatrist to evaluate risks to feet and to get suggestions for shoes, socks and inserts for protection and shock-absorbency, is also recommended.

He warns that people with diabetes that have complications may need to custom-tailor their exercise program. "People with eye or nerve damage may need to do low-impact exercises," he says.

The benefits are more than diabetes-specific, he adds. "You may have an improved self-image and quality of life as well."

The above guidelines (1-11) are from the IDAA newsletter, The Challenge. The IDAA is a non-profit organization dedicated to physical fitness for individuals with diabetes. The IDAA will be holding its 1997 North American meeting, "Diabetes and Exercise: Practical Approaches for the Long Run," in Scotts Valley, Calif., on the weekend of May 9-11, 1997. For more information, call (800) 898-4322.