4. Guidelines for a sound exercise program

If the blood glucose level is less than 100 mg/dl or greater than 250 mg/dl, do not exercise.

It is recommended to exercise indoor instead of outdoor to minimize the risk of integumentary and musculoskeletal trauma. It is also helpful for the patient to have an immediate access to necessary things to address hypoglycemia, hyperglycemia or diabetic ketoacidosis.

When patients plan to come out of their house to go somewhere else, they are highly advised to wear the medical tag for diabetics.

During prolonged exercise duration, 10–15 g of carbohydrate snack is recommended for every 30 minutes.

They are recommended to have a carbohydrate snack such as a glass of orange juice or milk at every exercise session. Exercising in a comfortable temperature is worthwhile. Never exercise in extreme temperatures.

For type 1 (insulin-dependent) patients, it is not allowed to exercise during the peak times of insulin. Before a physiotherapist asks a patient to do exercise, he should coordinate with the referring physician or nurse in charge for the patient regarding the stability of the patient and the type of insulin administered.

Type 2 diabetics are advised to have an average of 30 minutes of exercise duration per session.

Always wear proper footwear and exercise in a safe environment.

Menstruating women should have to boost insulin during menses, especially if they are not active.

It is not reasonable to inject insulin close to the muscles to be exercised within 1 hour of exercise.

Patients ought to eat 2 hours before they go for exercise. If they plan to exercise after meal, they should have to wait 1 hour prior to start. They should always bring their own portable blood glucose monitor. They should keep an eye on their glucose levels before and after exercise.

It is also important to drink adequate amount of fluid before exercise. If blood glucose level is between 70 and 100 mg/dl, the physical therapist can be allowed to provide carbohydrate snack and then reassess the glucose level after 15 minutes.

Make sure exercise does not contribute an unnecessary stress to the patient. Stress increases insulin requirements. A gradual progression from aerobic and resistance exercises is the key.

Avoid exercising late at night. Thus, exercising five times a week as maintenance is preferred. Any known DM patient must not exercise alone as much as possible so as to call someone to help in unexpected situations.
