Just a Spoonful of Sugar Helps the Medicine Go Down…

Or does it?  Yes, a cute song from our favorite nanny Mary Poppins might be just the trick for remembering the benefits of a positive attitude (or for making it more fun to clean up the nursery!), but the words really don’t fit with diabetes, do they?  We always think that medicine is supposed to help us feel better, but sometimes the medicines we choose can do more harm than good!

If you are like many of my patients, you have been fighting colds and the flu for the past few weeks.  And if you’ve taken a trip down the cough and cold aisle of your local pharmacy, you know how confusing it is.  Have you seen how many different Robitussin products there are on the shelf??  And if you look on any of the boxes, they all say “talk to your doctor before taking this medicine if you have diabetes.”  It is no wonder why I am asked many times a day what is safe to take if you are a diabetic.

You may ask, “why does it matter which medication I choose?”  Well, it all comes down to sugar (doesn’t it always!).  Many of the liquid medicines that we sell for colds contain some sugar because, let’s face it, medicine really can be a bitter pill to swallow.  It might not seem like much, especially when you only have to take a teaspoon or two of the medicine per dose, but that little amount of sugar can affect your blood sugar in a very big way.  Even some medicines that don’t contain sugar can affect your blood sugar.  The last thing you want to be worried about when you are fighting a cold is your blood sugars going too high.

The most important thing to remember when choosing a cold medication is: keep it simple. There are many products out there that contain a combination of various ingredients for cough, chest congestion, head congestion, runny nose, stuffy nose, and body aches.  Vicks DayQuil and NyQuil and Tylenol Cold and Flu are a few examples of these.  Many times you only need one or two of the ingredients to treat your symptoms.  And when you remember that some medications can affect your blood sugar, why would you want to risk that by taking an entire list of medications?  When in doubt, tell your pharmacist your symptoms and remind them that you are diabetic, and they will help you choose the right medicine for you (and maybe even save you some money – those combination medicines can be expensive!).

As a general guide, I’m going to discuss some of the most common medications that I recommend to my diabetic patients, based on symptoms.

Cough: When you have a cough the first thing to think about is, what kind of cough is it?  I’m talking about thick and congested in the chest, productive, or dry and non-productive.  These things will make a difference as to which medication we choose.  Essentially there are two main things that we use to fix a cough: a cough suppressant (something that stops that nagging need-to-cough feeling) and an expectorant (something that makes it easier for you to cough).

As a general rule, if the nagging cough is the thing that is bothering you the most, and possibly keeping you up at night, I recommend the cough suppressant.  The main ingredient that I like to use is dextromethorphan.  This ingredient is available by itself in a product called Delsym.  Unfortunately, Delsym is not sugar-free in liquid form, but there is a sugar-free cough drop from Delsym with dextromethorphan that also contains some menthol to soothe the throat (Delsym Cough Relief Plus Soothing Action – SUGAR FREE Cherry).  This would be safe for a diabetic.

If your cough is very thick, especially in the chest, and you are having a tough time coughing things up, I like to use the expectorant guaifenesin.  There is a sugar free product called Diabetic Tussin that I like to use for patients with a very thick cough and lots of “gunk” in the throat and chest.  This is safe for diabetics and contains the expectorant as well as sometimes the cough suppressant (in Diabetic Tussin DM).  Also, Mucinex is a pill that contains guaifenesin and will not affect your sugars.  A helpful hint: “DM”stands for dextromethorphan, the cough suppressant – any product with DM in the name contains that cough suppressant.  Don’t confuse this with “D” (like Mucinex-D or Claritin-D) which stands for something else that I’ll talk about in a bit.

Sinus headache and congestion in the head or nose: I decided the “D” versus “DM” conversation was a good lead-in for this next topic.  Products that are used to treat congestion in the head or nose are called decongestants (hence the “D”).  The one that you are probably most familiar with is Sudafed.  You will be able to recognize these products easily because they are the ones that must be purchased with a government ID and usually paid for right at the pharmacy.  A few years ago the federal government started regulating any products containing pseudoephedrine (the decongestant in Sudafed) because people use it to make methamphetamine.  Most of the time you will have to ask your pharmacy for these products behind the counter because they are no longer kept on the shelves.

So, can a diabetic take a decongestant?  Well…sort of.  Generally pseudoephedrine is safe on a short-term basis, for the length of your cold.  However, you do need to be aware that your blood sugars might run higher if you are taking this medicine.  Occasional use is the rule.  If you need it, take it, but watch your blood sugars very carefully.  As a side note, if you have high blood pressure you should not take pseudoephedrine because it can raise your blood pressure.

What are some other options out there for head congestion?  There are many nose sprays that are listed as nasal decongestants that are available without a prescription.  Nasal decongestants help for stuffy noses.  These have less of a chance of raising your blood sugars.  However, the bad thing about nasal decongestants is that they can only be used for three days in a row – after that they can actually make your nose more stuffy!

Another product that you might see on the shelf is a pill with the drug phenylephrine in it.  The most common name you will see that contains this is Sudafed-PE.  When Sudafed went “behind the counter” because people were using it to make meth, the makers of Sudafed decided to make an alternative product that could still be sold outside of the pharmacy.  This is where Sudafed-PE came from.  However, in studies I have seen, phenylephrine (Sudafed-PE) does not work as well as pseudoephedrine (Sudafed).  Also, phenylephrine can affect your blood sugars just like pseudoephedrine does, so it is not a better alternative.

Another product that is safe for diabetics is a nasal rinse or nasal irrigation system.  There are many types of these available in pharmacies.  The cheapest option is nasal saline, which is basically just salt water that you spray up your nose to help open it up for better breathing.  A newer product that gained it’s fame from being advertised by Oprah and Dr. Oz is called a Neti Pot.  This is a plastic teacup-shaped cup that you fill with a solution of a special powder mixed in distilled or filtered water.  The water is then poured into your nose and it flushes out all the “gunk”.  Pretty gross, huh?  But, many of my patients swear by it, and it is a safe option for a diabetic to use.

Runny nose, watery eyes, sneezing, allergies: I have listed these three symptoms together because the products we use to treat them are all the same.  For these, you will be looking for an anti-allergy medicine called an antihistamine.  Even if you don’t have allergies, these medications can help with the other problems I listed.  There are two different types of antihistamines – the kind that make you tired and the kind that don’t.

Benadryl (drug name diphenhydramine) is one of the antihistamines that causes drowsiness.  It is a good medicine to use for just a few days, while you are sick.  But, I would not choose this medicine if you need to be out and driving and alert, because it will make you very tired. At night you can take this one because it will help you sleep.  And, it should not affect your blood sugars.

Chlor-Trimeton (drug name chlorpheniramine) is another antihistamine that can make you tired.  It is similar to Benadryl, but sometimes causes less tiredness, so it might be an option for you to use during the day.  I still recommend that you try it at night to see how tired it makes you before taking it during the day.  It should not raise your blood sugars.

Claritin, Zyrtec, and Allegra (drug names loratadine, cetirizine, and fexofenadine) are the antihistamines that do not make you tired.  These are the medicines that I recommend for patients with allergies, because you can take them every day for a long time.  They are safe to take any time a day, and many times only have to be taken once a day.  They should not affect your blood sugars, so they are safe for diabetics.

Fever, body aches:  For fevers and body aches we use pain relievers.  These are names that people are very familiar with: aspirin, Tylenol (acetaminophen), Advil or Motrin (ibuprofen), or Aleve (naproxen).  The most important thing for you to know as a diabetic is that Advil, Motrin, and Aleve (ibuprofen or naproxen) can raise your blood sugars.  The safest choice for you is Tylenol, or acetaminophen.  Aspirin is safe to use as well, at low doses.  Many of you are already taking aspirin for your heart.  But at high doses, it might cause a decrease in blood sugar, so be very careful so that it doesn’t go too low.

These are the most common cold symptoms that I get asked about this time of year.  I hope this will be a good quick reference for you when you need to choose a cold medication.

As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions.  However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs.  Remember to always check with your medical provider and pharmacist before stopping or starting any new medications.  My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health.  Please consult with your doctor and pharmacist about anything regarding your health.

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