It's November and with the holidays around the corner, lots of people are preempting those big family meals by working out; but for those with diabetes, working out can be a tricky undertaking. Believe it or not, too much physical activity is among the leading causes of low blood glucose levels. For up to 24 hours following a moderate to intense workout, blood glucose levels may drop into a hypoglycemic state. This post-exercise period is often referred to as the "lag effect."

For those without diabetes, the object of working out before the holidays is to cut fat in anticipation of turkey dinners and pie. To fuel the workout, our bodies rely on two different sources of energy, sugar and free fatty acids (in that order). The sugar is stored in the liver and muscle in a form called glycogen. During the first 15 minutes of exercise, most of the sugar for fuel comes from either the blood stream or the muscle glycogen, which is converted back to sugar. After 15 minutes of exercise however, the fuel starts to come more from the glycogen stored in the liver. After 30 minutes of exercise, the body begins to get more of its energy from the free fatty acids. As a result, exercise strenuous enough to begin burning fat can deplete sugar levels and glycogen stores.

Following the workout, the body will replace these glycogen stores but this process may take 4 to 6 hours, or even 12 to 24 hours with more intense activity. During this rebuilding of glycogen stores, a person with diabetes can be at higher risk for hypoglycemia. Here are tips for safe exercising:

• Check your blood sugar before working out; make sure you have sufficient blood glucose levels. If they are a little low, eat a snack!
• Avoid exercising during the peak period of your insulin action. There are different types of insulin and depending on which you take, the period of time it is most active will vary.
• Time your exercise to allow yourself at least two hours between the workout and your bedtime.
• Chances of hypoglycemia go up with the number of workouts in your day. Try to limit yourself to 1 or 2.
• Avoid hot tubs, steam rooms or saunas immediately following your workout. The high temperatures maintain a high heart rate and continue to lower your blood glucose level.
• Even if you're not diabetic, avoid alcohol prior to, and following, a workout.
• Keep a close eye on your glucose level after you're done. Check your blood sugar immediately following the workout, and again 2-4 hours later.
• Wear compression socks during periods of activity and recovery from exercise. By applying a light graduated compression to your legs, you will increase your circulation and prevent soreness.

Diabetes is a tricky disease that requires meticulous attention to various facets to your life. By keeping a good balance between diet and exercise, you will begin to find that the symptoms are easier to manage. Remember, it is all about having support from your friends and loved ones; No one should deal with it alone!