Table 2

Acute exercise interactions with diabetes medications (adapted from Nagi and Gallen;18 Eckstein et al)19

MedicineEffect on glucoseExtra CHO with exercise
Biguanides
(eg, metformin)
In people with T2DM, metformin can reduce the decline in blood glucose during acute aerobic exercise but the glycaemic effects of metformin while performing exercise in people at risk of or with T2DM appear transient and minorNo
Sulphonylureas (eg, glibenclamide or glimepiride)
/ glinides (eg, nateglinide)
Sulphonylureas should be taken with caution during acute exercise as the combined influence of both can rapidly decrease blood glucose levels and lead to hypoglycaemia.
There is little evidence to detail the impact of glinides on physical exercise and metabolic outcomes.
Check glucose with exercise and take extra CHO during exercise
Thiazolidinediones (eg, pioglitazone)No noted effect on blood glucose with acute exerciseNo
Sodium glucose like transporter inhibitors (eg, empagliflozin or canagliflozin)Largely unknown, studies neededUnknown
Incretin-based therapies
GLP1-RA: liraglutide
DPP-4 inhibitors: sitagliptin or saxagliptin
GLP1-RA: No noted effects on blood glucose with acute exercise
DPP-4 inhibitors: unknown
No
Insulin (eg, Tresiba or aspart)Promote hypoglycaemia with exercise; may need to reduce dose before planned exerciseCheck glucose before, during and after exercise and take extra CHO if needed during exercise
  • CHO, carbohydrate; T2DM, type 2 diabetes mellitus.