Nonprescription Products and Diabetic Patients

Diabetic patients should be made aware of the availability of specialized nonprescription products for diabetics and guided in the proper selection and use of these products.

Pharmacists are likely to encounter patients seeking medical advice regarding which nonprescription medications are appropriate for use in diabetic patients. Some patients may not be aware that a host of nonprescription medications are on the market.

These products are formulated to meet the specific needs of diabetic patients, ensuring that their condition is not exacerbated by products that contain sugar or other ingredients that may elevate or decrease their blood glucose levels. Nonprescription products marketed specifically for the diabetic population include products for managing and treating allergies, cough, cold, and flu; multivitamin supplements; topical products for skin care; and oral care products (Table 1). Many of the allergy and cough/cold products that are marketed for diabetic patients are formulated to be free of sugar, alcohol, dextrose, sucrose, sorbitol, sodium, fructose, glycerin, and dyes. In addition, various nonprescription products that are marketed for the general population are free of sugar and alcohol. Pharmacists can be instrumental in assisting diabetic patients by making them aware of the availability of specialized nonprescription products for diabetics and guiding patients in the proper selection and use of these products.

Patients should be reminded to always seek the advice of their primary health care provider or a pharmacist prior to using any nonprescription products, including alternative/complementary medications or supplements, especially if they are unsure about the appropriateness of use. Patients should be advised to be cautious when using certain medications because they may cause hyperglycemia or hypoglycemia. For example, the hypoglycemic effect of insulin and some oral hypoglycemic agents may be enhanced by taking large doses of aspirin, and the use of decongestants such as pseudoephedrine may elevate the blood glucose level.^1,2 To avoid this effect, diabetic-specific allergy, cough, and cold products such as Diabetic Tussin products (Health Care Products) are formulated without decongestants.

Prior to recommending the use of any nonprescription products to diabetics, pharmacists should assess the appropriateness of self-care and screen for potential drug—drug interactions and/or contraindications. During counseling, pharmacists should ensure that patients understand the proper use of these products and remind patients about the importance of adhering to the directions and warnings on the product’s label. When possible, patients should avoid the use of medications that contain sugar or alcohol or multi-ingredient formulations of allergy and cough/cold medications to avoid therapeutic duplications or unnecessary use of medications. According to the American Diabetes Association (ADA), patients should always read the medication label to check the inactive ingredients and determine if there is a form of sugar or alcohol in the medication that may adversely affect the blood glucose level.² In addition, patients should always adhere to manufacturer warnings on medication labels.

Because being sick can affect one’s blood glucose level, patients should be reminded to monitor their blood glucose levels more frequently when feeling ill—at least every 3 to 4 hours or as directed by their primary health care provider. Diabetic patients should also be advised to call their primary health care provider if their blood glucose levels are elevated or too low, if exhibiting signs of dehydration, if they have a fever higher than 101°F, if experiencing excessive diarrhea and vomiting, or if they have large amounts of ketones in their urine.^2-5 Patients should also be encouraged to discuss any health concerns with their primary health care provider, especially when feeling ill. The ADA and the National Institutes of Health’s National Diabetes Information Clearinghouse websites list several suggestions for helping diabetic patients avoid complications when they are sick. During counseling, pharmacists can remind patients of these suggestions (Online Table 2).

Table 2: Questions Diabetic Patients Should Ask Their Primary Health Care Provider When Feeling Ill

• How many times per day should my blood glucose level be monitored?

• Should I test for ketones in my blood or urine?

• Should I change my usual dose of diabetes medications?

• What types of foods and drinks should I consume when ill?

• When should I contact my primary health care provider?

Reasons why a health care provider may instruct a patient to seek medical care immediately^3-6:

• The blood glucose level is >240 mg/dL, even though diabetes medications have been taken as usual.

• The urine or blood ketone level is above normal.

• The patient is experiencing excessive vomiting or diarrhea.

• The patient is having trouble breathing.

• The patient has a fever above 101°F.

• The patient is feeling sluggish or drowsy.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

• Scolaro K. Disorders related to colds and allergy. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.
• Gebel E. Common cold remedies. Diabetes Forecast Online. http://forecast.diabetes.org/colds-nov2012?loc=ContentPage-when-youre-sick. Accessed August 25, 2013.
• When you’re sick. The American Diabetes Association website. www.diabetes.org/living-with-diabetes/treatment-and-care/who-is-on-your-healthcare-team/when-youre-sick.html. Accessed August 25, 2013.
• What to do when you’re sick. Life Scan Inc website. www.onetouch.com/articles/sickplan. Accessed August 24, 2013.
• Sick days and diabetes. The BD Diabetes Learning Center website. www.bd.com/us/diabetes/page.aspx?cat=7001&id=7347. Accessed August 27, 2013.
• Diabetes: When you’re sick. National Diabetes Information Clearinghouse website. http://diabetes.niddk.nih.gov/dm/pubs/type1and2/specialtimes.aspx#sick. Accessed August 27, 2013.