Story by: Lisal J. Folsom, M.D., M.S. on February 24, 2020
When your child is sick, you want to do everything you can to help them feel better, but choosing cold medicine for kids with diabetes can be like a minefield for parents.
One of the nice things about over-the-counter (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:
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, they already may 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 there is 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 likely would occur one hour to 90 minutes after taking acetaminophen. Some monitors, including Dexcom G6 and implantable CGMs, are not affected by this “phantom glucose.”
So does that mean acetaminophen is off the table for treating your sick child? Not necessarily. Giving acetaminophen is fine, but know that depending on the CGM your child has, you may need to use finger sticks for blood sugar monitoring while your child is taking this medicine.
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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 many have sugar that would affect 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, they could be missing out on several units of insulin if this type of medicine is used without accounting for the carbohydrates. 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, also 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.
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 1,500 milligrams. The doses studied around diabetes management were five to 10 times higher than the 1,500-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 supports benefits for children and teens with Type 1 or Type 2 diabetes.
Lisal J. Folsom, M.D., M.S., is an endocrinologist with Norton Children’s Endocrinology, affiliated with the UofL School of Medicine, and an assistant professor of pediatric and adult endocrinology at the University of Louisville School of Medicine.[templatera id=”304707″]