Diabetes Drugs: Exercise

Editor’s Note: This is the eleventh post in our miniseries about diabetes drugs.


Thus far, this series has been focused on pharmacological methods for treating diabetes. Today, we turn to exercise, which research has shown to be very effective for both preventing and treating this condition.

Several large studies have demonstrated that a program comprised of a healthful diet and physical activity significantly reduces the risk of developing diabetes in people with impaired glucose tolerance. In these studies, dietary modifications have included reduced calorie consumption, a decrease in the consumption of total and saturated fat, a decreased intake of cholesterol, and an increase in the consumption of fiber, whole grains, fruits, and vegetables. The exercise has consisted of an additional 150–240 minutes of moderate-intensity physical activity per week. These lifestyle changes resulted in an average reduction of 5% to 10% of body weight in participants.

Additionally, in each of these studies, the groups that exercised experienced an approximately 50% reduction in their risk of developing diabetes. In the Diabetes Prevention Program Trial (DPPT), a diet and exercise regimen was shown to be better than metformin at preventing diabetes. So it is clear that diet and exercise can significantly reduce the risk of developing diabetes in people with impaired glucose tolerance who are at a high risk for developing diabetes.

But what is the role of exercise in treating people who already have diabetes? This depends on a number of factors, including a person’s type of diabetes, his level of diabetes control, the type of medicines he is taking, what other diseases he has, what other diabetes complications he has, and the type of exercise that he is doing. For people with Type 1 diabetes, exercise can improve cholesterol levels, lower blood pressure, improve insulin sensitivity, and decrease body fat, among other benefits. Exercise also has a wide variety of benefits for people with Type 2 diabetes, including reducing HbA1c (a measure of blood glucose control over the previous 2–3 months) levels between 0.66% and 1.5%, improving the body’s use of insulin, helping control weight, decreasing blood pressure, increasing bone density, and reducing the risk of heart disease.

While there are many benefits to exercise for people with diabetes, it should be noted that there are several potential risks as well, including a worsening of eye complications in people with conditions such as proliferative retinopathy when doing specific exercises (such as weight lifting), hypoglycemia (low blood glucose), and hyperglycemia (high blood glucose). To help ensure a person is healthy enough to begin an exercise program, a thorough evaluation should be conducted by a person’s doctor beforehand.

It is a good idea for people with diabetes to check their blood glucose levels before, during, and after exercise. If blood glucose is less than 100 mg/dl prior to exercise, a small, carbohydrate-containing snack should be eaten. People whose blood glucose level is greater than 300 mg/dl but who do not have ketones (potentially toxic by-products of fat breakdown) present in the blood or urine should use caution when deciding whether to exercise. Those whose blood glucose levels are greater than 250 mg/dl with ketones present should avoid exercise. While every person reacts differently to exercise, with time, people develop a familiarity with their own responses to physical activity and can modify how they monitor their blood glucose accordingly.

Both aerobic exercises, such as walking, running, cycling, or swimming, and resistance exercises, such as weight lifting and using resistance bands, have beneficial effects for people with diabetes. Most health groups recommend a minimum of 30 minutes of moderate-intensity aerobic activity done five times a week, along with two to three resistance exercise workouts each week that include all the major muscle groups.

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  • Bob

    Thanks for a good article, I absolutely agree.

    I know several people who taking up exercising and have found it helpful. Obviously, it will benefit non-diabetes people too. It seems moderate intensity workouts are best, for example biking or swimming and perhaps running (if you can run more than 30 minutes at at time).


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  • Shane

    Amazing information on this site. I will share this post! Thanks so much.

  • Carolyn Rountree

    Hi, I a using Metformin for my diebeties and I am only borderline. Like to know what you think. Thank you

  • Mark T. Marino

    Metformin is the drug of choice as the first line therapy for people with Type 2 diabetes in conjunction with diet and exercise as outlined in the ADA/EASD guidelines (Diabetes Care 32:193-203, January 2009).

  • Gloria Santiago

    I have been taking “METFORMIN for 3 years once a day every 3 months I go for a check up nothing drops down my sugar is always high 140-180 now I take the pills twice a day i also have high CHOLESTEROL could that be a problem with taking “SIMVASTATIN” and the other pill for my sugar too?

  • Mark T. Marino

    Metformin is not metabolized by the liver but simply eliminated in the urine. Simvastatin is metabolized by the liver (specifically by an enzyme called CYP450 3A4) and its metabolism can be altered by drugs that interact with CYP450 3A4. It is therefore unlikely is that the two drugs are interacting. I could find no reports in the literature that interference is likely to occur. It may simply be that you either need a higher dose of metformin or the addition of another agent to control your blood glucose.

  • Greg

    I have alergy and I started to look around for a solution. I found a book on amazon, called the The Allergy and Asthma Cure. I found a very interesting thing in the book. Lots of health problems are coming from ‘food intolerance’, which is invisible itself, but it come out in an other form, like alergy, asthma, acne and even diabetes. I suggest to make a food intolerance test, probably your doctors will find out some interesting thing for you.

  • ram

    in fact its a very helpfull advice for health and a well balanced program for diabeties thanks