Wil Dubois

Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

This week, Wil answers questions about the mix of exercise and metformin, and addresses what you can do when glucose testing and insulin-dosing seem like just too much... Read on.Ask-DMine_button

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Robert, type 2 from Louisiana, asks: Can too much exercise and metformin be harmful?

Wil@Ask D’Mine answers: Absolutely! Too much of anything is harmful. If you exercise too much you’ll pull a muscle, get dehydrated, or drop dead from a heart attack. Each of which sucks exponentially more than the previous.

OK, I apologize if it sounds like I’m making fun of you, your question is actually an excellent one.

Quite a few diabetes medications don’t play well with exercise, most notably pills in the sulfonylurea class, and all insulins. For background, the sulfonylureas work by grabbing your pancreas and wringing it out like a sponge. If you’re on the right dose for your normal activity and you step it up with a new exercise program, these pills can trigger some spectacular lows. This is also true of insulin, and for the same reason: Muscles in action use more sugar than muscles sitting in front of the TV. If you’ve been mainly sitting in front of the TV and your hard-working doctor has finally got your medication doses right to control your diabetes, and then you start working out, you’ll suddenly have more medicine in your blood than sugar, and that’s the recipe for hypoglycemia.

The bottom line here is that if you decide to start exercising too much, or even much more than you did before, your meds will need adjuMetforminTabletssting. At least in most cases. Metformin, however, is an exception to this rule. That’s because met doesn’t operate on the insulin end of diabetes control: It has more to do with carb uptake and the liver’s release of sugar during the day and night. Low blood sugars are very rare in people taking metformin alone, regardless of activity, so I don’t see that you’ll have any issues in that department. In fact, this study found that combining exercise and metformin actually made insulin resistance a tiny bit worse, which would lower the risk of hypoglycemia even more. So if metformin is all you take for your diabetes, adding exercise doesn’t pose any risk. At least on the diabetes medication side of your world.

Of course, there’s more to think about than your diabetes pills when it comes to stepping up your exercise. Do you take other meds? People who take beta blockers tend to get fatigued easily, folks on pain pills sometimes injure themselves by missing the early warning signs of muscle strain, and people on antihistamines have been known to get drowsy and drop barbells on their heads. 

OK, I made up the part about the barbells. 

But there’s more to exercise than just meds. How’s your heart? Are you in good enough cardiac shape to hit the gym hard? How are your lungs? Any asthma to worry about?

Any time any of us D-folks are looking to add some serious exercise, it’s a good idea check with our doc before we call our trainer.


Josef, type 2 from Florida, writes: As a T2 who was recently diagnosed with prostate cancer, and will soon be undergoing radiation treatment for it, I am starting to suffer a little burnout. I normally test 3x a day, but I’ve dropped that to 2x and generally forget or don’t care to take my regular Humalog at lunch. Is this a bad thing?

Wil@Ask D’Mine answers: Yes. This is a bad thing. But let’s be clear about the fact that this does not make you a bad person. One of the problems with diabetes is that life gets in the way of it sometimes. I mean, hey, diabetes is a hell of a lot of work, and when other things in life start to become overwhelming—like a cancer diagnosis and impending treatment—sometimes diabetes drops to the wayside

But here’s the problem: You are about to engage in a fight for your life. Literally. Do you really want to go into that in less than fighting form? Radiation is going to kick you in one side of your ass, and kick you hard. You don’t want to let the diabetes kick you in the other side of your ass, do you?

I think that of the two things you’ve slacked off on, the lack of testing bothers me less than slacking on taking insulin. No. Wait. That’s a lie. You’ve actually done the thing that drives me most crazy of anything in the world (from a clinical perspective). You’ve stopped both your meds and your testing at the same freakin’ time.

Excuse me while I go bang my head on the wall...

OK. I’m back. Now, let’s consider this for a moment. If you just stopped your meds, but kept testing your sugar, at least you’d know how badly your decision was impacting your body. On the flip side, if you kept taking your meds but dropped the testing, odds are you’d be fine, or would at least maintain the status quo. That would be the better choice so long as you aren’t prone to lows and can feel them OK. 

But, like anything else that rocks the blood sugar boat, radiation treatment can make your blood sugar do the funky chicken dance. Plus, a cancer is not unlike an infection. In this case for you, it’s more like a long-term low-grade infection, but as the radiation kills it, you can expect some changes in your blood sugars. I’d expect that in the long run you’ll need lower doses of your meds to control your diabetes (but likely need higher doses during treatment), and if you're not on the ball on your testing during this up and down progression you’ll end up first under-medicated and then over-medicated.

Now, when I talked about burnout the other day, we focused on ways to lighten the burden by taking a break as the key to fighting burnout. But you, Sir, can ill afford to take a break. At this point, a break might break you. Instead, I think we need to focus on an additive therapy instead of trying to lighten your load. What do I mean by that? We need to add something to your life that will suck some of the burnout out of your blood.


You need some diabetes stress relief.DiabetesStressRelief

What do you love? Is there something that used to bring you joy that you no longer do? Did you used to fly radio-controlled airplanes, plant flowers, or volunteer at the animal shelter? Is there something you always wanted to do but never got around to doing? Did you always long to build a tree house, paint a landscape, or take ballroom dance classes?

On the verge of burnout, taking on something new sounds, well, crazy-stupid, but it really isn’t. What you need is a pressure relief valve. In your case, I really don’t think you dare let up on what’s burning you out, but I do think a dose of joy could be the next best thing to a break. It will change the balance of stress in your life. It will give you an outlet.

If you don’t have the energy for any of those, one other therapy that helps many people is ST, or Shopping Therapy. Personally, it does wonders for my soul, although I was a bit shocked when I wandered into the Eddie Bauer factory outlet store last night (wearing an Eddie Bauer shirt, Eddie Bauer jeans, Eddie Bauer jacket, and carrying my diabetes supplies in an Eddie Bauer bag) and the whole staff shouted, “Hi, Wil!”

Hey, their clothes happen to look great on me, and they’re really well made. But when everyone knows your name, and you’re not in the Cheers bar, you are probably spending too much money there.

Sorry, I got sidetracked.

Of course, OLST, or On Line Shopping Therapy, while not as good in the exercise department, can also be good for the soul and takes very little energy if the radiation leaves you too pooped. Plus waiting for the FedEx and UPS drivers to arrive can be fun, too. And while eBay has just become one giant boring mall with everyone selling the same stuff, art sites like Etsy are filled with amazing, one-of-a-kind finds. That adds the "thrill of the find" to the shopping experience.

So, yes, I think what you are doing is a bad thing. So snap out of it, get it together, and add a dose of fun to keep the burnout blues at bay.


Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.