Medication and Exercise Interactions: Considering and Managing Hypoglycemia Risk

Abstract

Exercise, as part of lifestyle modification, is known to be the first line of therapy for patients with type 2 diabetes (1), and, dating back as far as 1000 AD, Greek physicians prescribed exercise as a way to improve health (2). Regular exercise provides many physiological and psychological benefits, including improvements in glycemic control (in most individuals), insulin sensitivity, blood pressure, lipid profile, muscular strength, and bone mineral density. In addition, exercise reduces total daily insulin requirements in people on insulin therapy, risk for coronary artery disease, body weight, percentage of body fat, stress, and depression and improves individuals’ sense of well-being and quality of life (3–5). Given all the health benefits it provides, exercise truly can be considered “medicine.” Despite being advised to participate in exercise as an essential part of diabetes management, only 39% of adults with diabetes are physically active (6), and many face barriers to becoming and staying physically active. Brazeau et al. (7) found four main barriers to physical activity in patients with type 1 diabetes: fear of hypoglycemia, work schedule, loss of control over diabetes, and low fitness level. Fear of hypoglycemia is the major barrier and biggest challenge for people treated with insulin. Exercise can cause profound changes in glucose homeostasis and may lead to hypoglycemia. Some hypoglycemia symptoms such as sweating and fatigue are similar to the physical sensations of normal exertion, which can make it difficult for patients to distinguish between the two (7). Given that an excessive decrease in blood glucose is a primary clinical concern and barrier to being physically active for people with diabetes, it is important to consider potential interactions between antihyperglycemic medications and exercise to minimize the risk of hypoglycemia. This article provides a brief overview of medication management considerations in people with …