From alcohol, to over-the-counter meds and herbal supplements, find out what substances and scenarios people with diabetes need to be aware of.
If you have diabetes, you probably know all about how food affects your blood sugar, including what, when, how often and how much you eat. Skipping meals, for example, can be a clear recipe for disaster, and overdoing starchy foods can cause glucose to soar. There are several other substances and scenarios that you may not be aware can cause dangerous dips or spikes in your glucose levels. Some experts weigh in so you can learn more about these risks and make sure you don’t end up in any danger.
1. Over-the-counter meds. While most OTC drugs are generally safe for use with diabetes medications, there are a few that can pose risks. Aspirin can lower blood sugar, though it typically takes quite a large quantity to have that effect, and other OTC meds can drive glucose up.
“The most common offenders are the allergy and decongestion products, which include pseudoephedrine or other decongestants that can increase a diabetic patient’s blood sugar level,” according to Kevin M. Pantalone, DO, a staff endocrinologist and director of clinical research at the Cleveland Clinic. Some cough syrups can also boost glucose because they contain sugar. Again, standard doses are unlikely to make a big difference, but “if this is a real concern for a particular patient, a sugar-free cough syrup could be purchased instead.
2. Other prescription drugs. “The medications that patients really need be concerned about raising their blood sugar levels are steroids such as prednisone,” says Pantalone. “It is not unusual for patients to receive an injection of steroid into a joint for pain relief, for example, only to then notice their blood sugar levels spiraling out of control a few days later.”
The injectable and oral varieties tend to have the largest impact, but inhaled and topical steroids can also have glucose-raising effects. Steroids are typically prescribed to treat conditions including asthma, inflammatory bowel disease (Crohn’s disease, ulcerative colitis) and joint/muscle diseases, such as rheumatoid arthritis. To avoid a potential emergency, alert your physician if you have been or will be prescribed steroids. Also, antibiotics, especially the class called fluoroquinolones (e.g., Cipro/ciprofloxacin), can cause significant glucose fluctuations in either direction, leading to hypoglycemia in some people and hyperglycemia in others.
3. Dieting. Diabetes meds reduce blood sugar regardless of how much or little food a patient is eating at a given time, explains Pantalone. During times of decreased appetite or limiting food intake by choice, a person taking such drugs may experience drops in glucose that can cause levels to become dangerously low when combined with the medication. Don’t attempt to tweak your dosage on your own, though.
“Patients should review with their doctors which medications need to be adjusted, if any, prior to making any self-adjustments,” he recommends. “Patients with insulin-dependent diabetes cannot simply skip doses of long-acting basal insulin, as doing so could result in an emergency situation, and maintenance medications usually need to be continued, albeit often times at a lower dose.”
4. Illness. While a cold medicine can raise blood sugar, the “cold itself is likely to increase glucose levels too,” says Matthew Freeby, MD, director of the Gonda Diabetes Center at David Geffen UCLA School of Medicine. People taking diabetes drugs might require a higher dosage when experiencing bodily stress caused by illness.
The disease-fighting hormones your body releases in response to the stress of illness can boost glucose and interfere with your medication. In type 1 diabetes, this can lead to a life-threatening condition called ketoacidosis, and may result in diabetic coma. Though less likely to affect individuals with type 2 diabetes, illness may still lead to excessive blood glucose levels in both groups.
Alternatively, some patients may need a lower dosage of diabetes medication while sick because of decreased appetite.
Talk to your doc or diabetes educator about creating a “sick-day plan,” so you’ll know exactly what to do in case of illness.
5. Herbal supplements. “Most patients don’t think to tell their clinician or pharmacist that they’re using herbal supplements because they appear ‘safe’ and natural,” notes Amy Gustafson, PharmD, manager of ambulatory pharmacy at the Cleveland Clinic Twinsburg Family Health Center. But many natural products can decrease blood sugar and lead to too-low levels when combined with diabetes meds, she says, including garlic, ginseng, fenugreek and cinnamon. No need to worry about the herbs when used as spices, the concern is the concentrated amounts found in supplements.
“Other agents that could interact with diabetes drugs are aloe vera, andrographis paniculata, karela (Momordica charantia), Lycium, St. John’s wort, and herbs with glucosamines, isoflavones or levocarnitine,” adds Mohamed A. Jalloh, PharmD, assistant professor at Touro University California College of Pharmacy and a spokesman for the American Pharmacists Association. “St. John’s wort and ginseng are the worst because they induce the same enzyme that processes most diabetes drugs” and therefore decrease their effectiveness.
6. Alcohol. Hitting the sauce can mess with your meds and your glucose, though maybe not in the way you would expect. It is well-known that alcohol can increase blood sugar in small amounts, but in larger doses, it “can increase the risk of hypoglycemia by reducing the liver’s natural glucose production — and alcohol plus medication can add up to a low glucose level,” explains Freeby. “Therefore, patients taking diabetes medications should be cautious with alcohol intake and need to consult their doctor” regarding safe limits for their specific situation.
In many cases, people with diabetes can drink alcohol in moderation, but you should never do so on an empty stomach or when you know your blood sugar is already low. People taking insulin or sulfonylureas are especially vulnerable to the glucose-lowering effects of alcohol.
How to Stay Safe
One of the most important ways to minimize such risks is to keep close track of all drugs you are taking, including OTC drugs and natural supplements, advises Jeff McClusky, BS, RPH, a hospital pharmacy manager and American Pharmacists Association spokesperson in Houston, Texas. “Verify that both your physician and pharmacist have these details, and ask them first if you are looking to change any OTC or medication practices,” he says.
It is best to use just one pharmacy so that they can maintain up-to-date and accurate records, and this helps the pharmacist get to know you as a patient and fully understand the various medications you may be taking. “Having all of these details in one place allows them to provide comprehensive medication reviews every time you visit them,” McClusky adds.