From Houston, Texas, USA:
I have Type 1 diabetes and am aware of the many warnings placed on over the counter drugs (such as decongestants). Could you explain what effects the medications have on blood glucose, and if you are familiar with any types of related cold medicines which do not, or have a lesser effect on blood glucose than the more common medications? For those with Type 2, could the warnings also be placed there because of drug interactions?
This question was referred to several members of the Diabetes Team, who have each given an answer:
Answer from Dr. O'Brien:
As you say, many Over The Counter (OTC) decongestants and cough medicines have a base that may contain glucose, sucrose or corn syrup. Many tablets use lactose as an excipient and of course some pediatric medicines are made palatable with a syrup; some also contain alcohol. The amount of carbohydrate added with a usual dose is too small to affect diabetic control to a significant degree.
Most pharmacists have lists of cough and cold preparations that are sugar and decongestant free and have minimal alcohol content. Sosufree Cough Mixture has no decongestant, no sugar and no alcohol. Spen-cold Pediatric Cough Syrup contains a decongestant; but no alcohol or sugar and there are many more.
In general the active ingredients of these products have little effect on glucose metabolism although phenylephrine and other ephedrine derivatives are usually quoted as possibly raising blood sugars and aspirin as lowering blood sugar. In any case the stress of the underlying condition is likely to have much more effect on blood sugar than the medication.
Some OTC medications have advice to diabetics on the label. This is due to the sugar content of the product; but usual doses minimally distort diet patterns.
Answer from Dr. Lebinger:Many cough and cold medicines contain decongestants that can increase the blood sugar and produce ketones independent of the sugar content. I usually advise patients that if they need a decongestant to use a nasal spray such as Afrin or phenylephrine that will relieve nasal congestion and have little effect on the blood sugar as opposed to an oral decongestant.
Antihistamines, cough suppressants, and expectorants have little effect on blood sugar or ketone production. If you must use an oral decongestant, keep in mind that your blood sugar may even be higher than it would be from the illness itself alone, and you may need more extra insulin.
[Editor's comment: The same comments apply to Type 2 diabetes as well as to Type 1. Drug interactions would be some concern for anyone on other medications, but I think the points made above are extremely relevant for all people with diabetes who take OTC medications. WWQ]
Original posting 13 Dec 96
Last Updated: Tuesday April 06, 2010 15:08:52
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