A daily exercise program is an important part of a healthy pregnancy. Daily exercise helps you feel better and reduces stress. In addition, being physically fit protects against back pain, and maintains muscle tone, strength, and endurance. For women with gestational diabetes, exercise is especially important.

Regular exercise increases the efficiency or potency of your body's own insulin. This may allow you to keep your blood sugar levels in the normal range while using less insulin.

Moderate exercise also helps blunt your appetite, helping you to keep your weight gain down to normal levels. Maintaining the correct weight gain is very important in preventing high blood sugar levels.

Talk with your doctor about what exercise program is right for you. Your doctor can advise you about limitations, warning signs, and any special considerations. Generally, you can continue any exercise program or sport you participated in prior to pregnancy. Use caution, however, and avoid sports or exercises where you might fall, or that involve jolting. Pre-pregnancy bicycling, jogging, and cross-country skiing are good exercises to continue during pregnancy.

If you plan to start an exercise program during pregnancy, talk to your doctor before beginning and start slowly. Vigorous walking is good for women who need to start exercising and have not been active before pregnancy.

Exercising frequently, 4 to 5 days per week, is necessary to get the ?blood sugar lowering? advantages of an exercise program. Don't omit a warmup period of 5 to 10 minutes and a cool-down period of 5 to 10 minutes. Always stop exercising if you feel pain, dizziness, shortness of breath, faintness, palpitations, back or pelvic pain, or experience vaginal bleeding. Also, avoid vigorous exercise in hot, humid weather or if you have a fever. It is important to prevent dehydration during exercise, especially during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends drinking fluids prior to and after exercise, and if necessary, during the activity to prevent dehydration.

An ACOG report* issued in 1985, warned that target heart rates for pregnant and postpartum women should be set approximately 25 to 30 percent lower than rates for non-pregnant women. It may be that exercising too vigorously will direct blood flow away from the uterus and fetus. ACOG recommends that pregnant women measure their heart rate during activity and that maternal heart rate not exceed 140 beats per minute.

If you need to be on insulin during your pregnancy, take a few precautions. Because both insulin and exercise lower blood sugar levels, the combination can result in hypoglycemia or low blood sugar You need to be aware that this is a potential problem, and you should be familiar with the symptoms of hypoglycemia (confusion, extreme hunger, blurry vision, shakiness, sweating). When exercising, take along sugar in the form of hard, sugar-sweetened candies just in case your blood sugar becomes too low. When on insulin, you should always carry some form of sugar for potential episodes of hypoglycemia.

It may be necessary for you to eat small snacks between meals if the exercise results in low blood sugar levels.

One serving of fruit will keep blood sugars normal for most shortterm activities (approximately 30 minutes).

One serving of fruit plus a serving of starch will be enough for activities that last longer (60 minutes or more).

If you exercise right after a meal, eat the snack after the exercise. If the exercise is 2 hours or more after a meal, eat the snack before the exercise.

What happens if diet and exercise
fail to control my blood sugars?

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If your blood sugars tend to go over the acceptable levels (105 mg/dl or below for fasting, 120 mg/dl or below 2 hours after a meal) you may need to take insulin injections. Insulin is a protein and would be digested like any other protein in food if it were given orally. The needles used to inject insulin are extremely fine, so there is little discomfort. If insulin injections are necessary, you will be taught how to fill the syringe and how to do the injections yourself.

Your physician will calculate the amount of insulin needed to keep blood sugar levels within the normal range. It is very likely that the amount or dosage of insulin needed to keep your levels of blood sugar normal will increase as your pregnancy advances. This does not mean your gestational diabetes is getting worse. As any healthy pregnancy progresses, the placenta will grow and produce progressively higher levels of contra-insulin hormones. As a result you will likely need to inject more insulin to overcome their effect. Some women may even require two injections each day. This does not imply anything about the severity of the problem or the outcome of the pregnancy. The goal is to maintain normal blood sugar levels with whatever dosage of insulin is needed.

Can my blood sugar level go too
low, and if so, what do I do?

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Occasionally, your blood sugar level may get too low if you are taking insulin. This can happen if you delay a meal or exercise more than usual, especially at the time your insulin is working at its peak. This low blood sugar is called ?hypoglycemia? or an ?insulin reaction.? This is a medical emergency and should be promptly treated, never ignored.

The symptoms of insulin reaction vary from sweating, shakiness, or dizziness to feeling faint, disoriented, or a tingling sensation. Remember, if you take insulin injections, you need to keep some form of sugar-sweetened candy in your purse, at home, at work, and in your car. In case of an episode of hypoglycemia, you will be prepared to treat it immediately. Be sure to eat something more substantial afterward. Also, report any insulin reactions or high blood sugar levels to your doctor right away in case an adjustment in your treatment needs to be made.

As you can see from reading this article, extra care, work, and commitment on the part of you and your spouse or partner are required to provide the special medical care necessary. Don't worry if you occasionally go off your diet or miss a planned exercise program. Your doctor and other health care professionals will work along with you to make sure you receive the specialized care that has resulted in dramatically improved pregnancy outcome.

An ounce of prevention is worth a pound of cure! Eat as directed. Exercise as directed. Monitor as directed. Do these things and you are doing your part toward a happy, healthy pregnancy.

A Practical Guide to a Healthy Pregnancy; U.S. Department of Health and Human Services