Some over-the-counter (OTC) medications may interfere with diabetes management. How can a parent know which are okay for a child with diabetes?
When your child is sick, you want to do everything you can to help him or her feel better. The cold-and-flu aisle can be a minefield for parents of children with Type 1 or Type 2 diabetes. Labels on some over-the-counter (OTC) medications say they may interfere with diabetes and blood sugars; others may not. How can a parent navigate this minefield?
One of the nice things about OTC medicine labels is they recommend to “ask your doctor before taking this medicine.” Here are some of the reasons why your endocrinologist may suggest one medicine over another for your child, or why they may say “no” for any of the following:
- Nonsteroidal anti-inflammatory medicines (NSAIDS)
- Cough and cold products such as decongestants
- Liquid medications
- Herbs and supplements
Nonsteroidal anti-inflammatory drugs (NSAIDS)
This includes medicines such as ibuprofen, naproxen, and aspirin. The reason these medicines are so effective at preventing pain and reducing inflammation is that they prevent the creation of prostaglandins, chemicals in the body that cause swelling and inflammation. Prostaglandins also help with blood flow to the kidneys (renal blood flow). These medicines can affect the kidneys by lowering blood flow to them. If your child with diabetes is sick, he or she may already have decreased renal blood flow because of dehydration, and taking these medications could increase the risk of acute kidney injury.
But if you’re 5 years old, and not feeling well, and you can’t have ibuprofen because it could hurt your kidneys, what can you take?
Well, you could take some acetaminophen. But this can pose an issue, too, because acetaminophen can interfere with continuous glucose monitoring –– you may have heard it can throw off your readings, depending on the monitor. Why is this?
Many early continuous glucose monitors (CGMs), including Dexcom G4, Dexcom G5, and Medtronic CGMs, can’t always tell the difference between acetaminophen and blood glucose.
This is because part of acetaminophen’s molecule is a phenol. When phenols become oxidized (a chemical reaction), the chemical structure is similar to glucose (blood sugar). This means that when your child takes acetaminophen, some CGMs may be tricked into thinking they are seeing more glucose than is actually in your child’s blood. It’s been shown that these monitors may read between 20 to 60 glucose points higher than a child’s actual blood glucose reading. The biggest difference in a reading would likely occur one hour to 90 minutes after taking acetaminophen. Some monitors, including Dexacom G6 and implantable CGMs are not affected by this “phantom glucose.”
So does that mean acetaminophen is off the table for treating your sick kiddo? Not necessarily. Giving acetaminophen is fine, but know that, depending on the CGM your child has, you’ll need to use finger sticks for blood sugar monitoring while your child is taking this medicine.
These are commonly used for cough, colds, and allergies. They have a chemical structure similar to amphetamines. Amphetamines can create a “fight or flight” response, also called sympathomimetic stimulation. This is when your body kicks into high gear and your adrenal glands begin producing hormones that cause increased blood glucose to fuel your muscles. It’s fine to give your child a decongestant, but remember that the blood sugar levels may be elevated while taking the medication.
Younger kids may not like to or be able to take medicines in pill form. Liquid medicines can help. But like the song says, a spoonful of sugar helps the medicine go down, and sugar can affect our children with Type 1 diabetes. Depending on the type, a tablespoon of liquid medication can have a sugar content between 1 to 12 calories per 5 milliliters, which means that a child could have 1 to 9 grams of carbohydrates per tablespoon. This may not seem like a lot, but if your child is older and needs higher doses of insulin for carbohydrates, he or she could be missing out on several units of insulin if this type of medicine is used without accounting for the carbohydrates. So, if your child takes a cough medicine, pay attention to the serving size and sugar content, as this is an added source of carbohydrates.
Many liquid medications, including those for children, contain alcohol. Many cough syrups have up to 10% alcohol content. This can cause CGM values to be less reliable due to the alcohol, and finger sticks may give lower readings when a child is taking a medication that has some alcohol content.
Wendy Novak Diabetes Center
UofL Physicians – Pediatric Endocrinology
Type 1 and Type 2 diabetes care
Herbs and supplements
There are many herbs and supplements that people read about that claim to benefit blood sugar and diabetes. Two that have been studied include glucosamine and cinnamon.
People sometimes take glucosamine for joint pain, and some wonder whether it might be helpful for diabetes. The typical recommended dose for joint pain is 1500 milligrams. The doses studied around diabetes management were five to 10 times higher than the 1500 milligram dose. A high-powered microscope showed pancreatic cell death at these high dosages. Additionally, glucosamine use did not show any benefit for blood glucose, glucose metabolism, or insulin sensitivity in people with diabetes, or in the control group without diabetes.
Cinnamon is another popular supplement studied in diabetes, however there is no evidence that show that this spice has any benefit in children and teens with Type 2 diabetes or Type 1 diabetes patients.
Lisal J. Folsom, M.D., M.S., is an adult & pediatric endocrinologist with UofL Physicians – Pediatric Endocrinology & Adult Endocrinology, and an assistant professor of pediatric and adult endocrinology at the University of Louisville School of Medicine.