It’s that time of year again. Stuffy noses, scratchy throats, upset tummies, and splitting headaches can send even the most stoic among us to the local drugstore for a magic pill to take away the pain. The fluorescent aisles of brightly colored bottles promising fast relief can seem daunting. Are all over-the-counter cold and flu meds safe for people with diabetes? 

Many over-the-counter cough, cold, and flu remedies list diabetes as an underlying condition that may indicate you should leave the medication on the shelf. The warnings are clear: “Ask a doctor before use if you have: heart disease, high blood pressure, diabetes.” Unfortunately, your doctor is not along for the trip to the pharmacy.

Most experts agree that most people with diabetes can feel free to select whatever over-the-counter (OTC) product works best for them, so long as the medication is taken as directed. At the same time, everyone is different so it’s important to shop smartly to ensure a quick and safe recovery from this season’s infections.  Because illness causes your body to release stress hormones that naturally raise blood glucose, you’ll want to be sure that over-the-counter medications won’t increase blood glucose levels, too.

Ask the Pharmacist

Don’t just wander around the drugstore dazed and confused. “When making these choices, this is a time to utilize a pharmacist…This is what they are trained for…Tell the pharmacist all your symptoms, what other medicines you are taking,” says Jerry Meece, RPh, FACA, CDE, director of clinical services at the Plaza Pharmacy and Wellness Center in Gainesville, Texas.”

Meter/Monitor Accuracy

There’s been concern that certain OTC medications can cause false blood glucose readings. “Ten years ago, as companies were changing the process by which they monitor glucose, several meters used a system that could be impacted by acetaminophen [the pain reliever in Tylenol and other medications], so they worried about that,” says Keith Campbell, RPh, FASHP, FAPhA, CDE, a professor at Washington State University.  “I was on a couple of committees to look at that. The amount it changed wasn’t clinically significant.” So while OTC medications may cause meter measurements to be slightly off, in most people it’s not enough to make a significant difference. Makers of continuous glucose monitors warn that acetaminophen may affect the devices’ performance. Talk to your doctor if you have questions or concerns about your blood glucose readings.”

Test, Test, Test

While you’re ill, follow sick-day rules such as testing for ketones, checking blood glucose often, and getting lots of fluids (8 ounces per hour). Campbell says it’s important to keep in mind that some medications, such as antihistamines, can increase drowsiness, which may make it more difficult to drink enough fluids or test. Dehydration can drive up blood glucose levels, he says, so he encourages drinking water or sugar-free electrolyte beverages. Campbell also recommends keeping extra testing supplies at home, so that when a sick day comes, you’re ready.”

Simple Is Best for Cold Medicines

Keep it simple by choosing an over-the-counter medication based on the types of ingredients proven to relieve your particular symptoms. Often a medication with just one ingredient is all you need to treat your symptoms rather than agents with multiple ingredients. 

Oral cold and flu pills are often a better choice than syrups with the same ingredients because the pills may contain no carbohydrate. If you decide to use a syrup, look for one that is sugar-free. If you can’t find one, the small amount of sugar in a syrup will likely affect your blood sugar less than the illness itself, Meece says.

Various over-the-counter medications are designed to treat specific symptoms. Many pharmacists recommend these products for people with diabetes.

Symptom: Cough
Best option: Anti-tussive dextromethorphan (Delsym, Diabetic Tussin NT [includes acetaminophen, diphenhydramine])

Symptoms: Congestion, mucus in sinus passages
Best options: Decongestant pseudoephedrine (Sudafed); phenylephrine; phenylpropalamine

Symptoms: Phlegm, mucus in respiratory tract
Best option: Expectorant guaifenesin (Mucinex, Robitussin)

Symptoms: Runny nose, itchy eyes
Best option: Antihistamine
Less-sedating options: certirizine (Zyrtec); loratadine (Claritin) 
More-sedating options: chlorpheniramine (Chlortrimeton); diphenhydramine (Benadryl)

For a stuffy nose, oral decongestants (pseudoephedrine, phenylephrine, phenylpropalamine) can increase both blood glucose and blood pressure and therefore are not usually recommended. “The occasional use of a decongestant should be the rule,” says Robert Busch, M.D., an endocrinologist from Albany, New York. You’ll have to sign the pharmacy register for over-the-counter remedies containing pseudoephedrine. Federal law limits pseudoephedrine purchases because the drug can be used to make illegal methamphetamine.

All oral antihistamines are effective for sneezing, runny nose, nasal or eye itching, postnasal discharge, conjunctivitis, and allergic rhinitis.

Symptoms: Pain and/or fever
Best options: Analgesic acetaminophen (Tylenol); aspirin

For fever and pain relief, look to analgesics, including aspirin and acetaminophen. Both are safe for most people and commonly available. The analgesic class of nonsteroidal anti-inflammatory drugs (NSAIDS), which includes ibuprofen and naproxen, may increase blood pressure and is not a good choice for people with kidney problems. Note: Be sure to call your doctor if your temperature rises. 

By Elise Swenson RPh, MS, MAOM, CDE
Cecelia Health Certified Diabetes Educator