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Managing Diabetes Magazine - diabetes

Diabetes and over-the-counter medications
Check with the pharmacist before you buy

You have the sniffles, so you head to the store to pick up something to ease your symptoms. If you have a chronic disease or take prescription medication, it is wise to check with the pharmacist before you buy. Why the caution?

We tend to think of health care products that can be picked up at any store as harmless. Though they are easily available, over-the-counter (OTC) products are still medications. They include vitamins, supplements, herbal and homeopathic remedies. Many are used to self-treat minor illness. Although you can buy them without a prescription, OTCs can affect existing conditions or react with your current medications.

To avoid problems, keep a record of all your regular prescriptions and OTC medications. Share this information with your healthcare providers.

Sick day strategies

The best time to discuss sick day strategies with your doctor is before you get sick.

People with diabetes often find their blood glucose elevates when they become ill. For this reason, frequent checks are important when you are sick. If your blood glucose is over 14 mmol/L, check your ketones.

Frequent diarrhea, vomiting or inability to drink fluids can dehydrate you. In this case, you may need to stop taking some of your current medications until you are well. Check the Canadian Diabetes Association’s sick day medication list.

The following table shows OTC medications commonly used by adults to self-treat minor illness. Always read the label, as many OTCs contain multiple ingredients including added sugar. Sugar includes sucrose, lactose, dextrose, glucose and fructose. The guide also explains when you should seek medical attention.

When in doubt about whether or not to take an OTC product, always check with your pharmacist. This simple precaution helps to protect your health.

After meal glucose level


Weight loss

0.7% Less than or equal to 4 kg
Dapagliflozin 0.5% 2 to 3 kg


Quick Guide to Using Over-The-Counter Medications

Symptoms and Conditions

Treatment and Medications


Pain and fever

Check with your doctor if you:

  • fever is associated with a stiff neck or seizures
  • temperature is greater than 40 C (104 F)
  • fever continues for longer than three days
  • pain continues for longer than 10 days.
Acetaminophen (Tylenol, Excedrin)
  • 325 to 650 mg every four to six hours when needed, maximum 4000 mg of acetaminophen
    per day (12 of 325 mg regular strength tablets, or eight 500 mg extra strength tablets)
  • No effect on blood glucose
  • Check labels, as many products contain acetaminophen
  • Add up all the milligrams (mg) of acetaminophen from all medications (prescription and non-prescription)
  • Use caution if you have liver disease, or consume excess alcohol

Acetylsalicylic acid, known as ASA (Aspirin, Bufferin, Entrophen)

  • 325 to 650 mg every four to six hours when needed
  • *Daily low dose ASA (81 to 162 mg) is often taken to reduce cardiovascular (heart and blood vessel) risk - check with your doctor to see if this applies to you.
  • Safe in low doses
  • Taking 3000 mg daily can cause low blood glucose
  • Should not be used by anyone under
    18 years of age
  • Increases the risk of gastrointestinal
    (digestive tract) bleeding

NSAIDS (non-steroidal anti-inflammatory drugs)
Ibuprofen (Advil, Motrin)

  • 200 to 400 mg every four to six hours when needed, maximum 1200 mg/day

Naproxen sodium (Aleve) -

  • 220 mg every eight to 12 hours, maximum 440 mg/day
  • No effect on blood glucose
  • Increases risk of gastrointestinal bleeding
  • May increase blood pressure
  • Can decrease renal function, especially with
    long-term use
  • Do not take if you are dehydrated.

Upset stomach and indigestion

Check with your doctor if you have:

  • symptoms that last longer than two weeks
  • trouble or pain when you swallow
  • bloody vomit or stools
  • stomach pain that is ongoing
  • chest pain, shoulder pain or pain that spreads to your arms, neck or shoulders with shortness of breath
  • weight loss for no reason
  • nausea or vomiting.

Aluminum hydroxide
Magnesium hydroxide
Calcium carbonate
Simethicone for gas (Gas-X)

  • These ingredients are found in various combinations and concentrations.
  • Sugar-free products include Diovol, Maalox, Gaviscon regular liquid and Gelusil regular liquid.
  • No effect on blood glucose
  • Check label for dosage, as this varies with the strength of the medication
  • Antacids can interact with many other
    medications - check with your pharmacist
  • Do not take within two hours of other medication
  • Aluminum and calcium antacids can cause constipation
  • Magnesium antacids can cause diarrhea

H-2 antagonists
Famotidine (Pepcid AC)

  • 10 to 20 mg twice daily, maximum 40 mg per day

Ranitidine (Zantac)

  • 150 mg when needed,
    maximum 300 mg per day
  • No effect on blood glucose
  • Prevents indigestion
  • Take famotidine 10 to 15 minutes, or ranitidine 30 to 60 minutes before eating
  • If you require calcium supplements, use calcium citrate when taking H-2 antagonists.

Proton-pump inhibitor (PPI)
Omeprazole (Olex)

  • 20 mg once daily, for up to four days to treat frequent heartburn.
  • If symptoms last longer than 14 days, see your doctor.
  • No effect on blood glucose
  • If you require calcium supplements, use calcium citrate if taking a PPI

Allergies and hay fever

Check with your doctor if you have tried appropriate medication for two weeks without relief.

Sedating antihistamines
Chlorpheniramine (Chlor-Tripolon)

  • 4 mg every four to six hours
    Diphenhydramine (Benadryl) -
    25 to 50 mg every six to eight hours
  • No effect on blood glucose
  • May cause drowsiness - avoid alcohol and use caution if operating machinery
  • Avoid this medication and check with your doctor if you have glaucoma, thyroid or prostate problems

Non-sedating antihistamines

  • Cetirizine (Reactine) – 5 to 10 mg daily
  • Loratadine (Claritin) – 10 mg daily
  • Desloratadine (Aerius) – 10 mg daily
  • No effect on blood glucose
  • Cetirizine may cause drowsiness in five per cent of people

Sodium cromoglycate
Cromolyn Eye Drops (Opticrom)

  • one to two drops in affected eye up to four times daily

Nasal Spray (Cromolyn)

  • one spray in each nostril up to six times daily
  • No effect on blood glucose
  • Works by reducing allergic response
  • Discard bottles 30 days after opening


See Pain and fever section (above) and Cough and Sore throat sections (below).

Check with your doctor if you have:

  • difficulty breathing
  • a history of respiratory disease
  • a fever of greater than 38.5 C (101.3 F)
    for longer than 24 hours
  • severe throat pain
  • prolonged nasal congestion with purulent (yellow or green) discharge
  • severe headache or neck pain.



  • 2.5 to 10 mg every four to six hours


  • 30 to 60 mg every four to six hours
  • Products containing oral decongestants increase blood glucose and blood pressure
  • Avoid or use with caution if you have heart disease, high blood pressure, kidney disease, glaucoma, thyroid disease, diabetes or prostate problems

Long-acting nasal
decongestant sprays

Oxymetazoline (Dristan Long Lasting, Drixoral Nasal Spray)

Xylometazoline (Otrivin)

  • Use as labelled
  • Do not use longer than five days to avoid rebound congestion

Saline nasal solutions

  • use as labelled
  • Safe to use to soothe a stuffy nose and loosen mucus

Cough – dry

Check with your doctor if your cough:

  • lasts longer than seven days
  • is accompanied by a high fever or severe sore throat, as above for colds.

Dextromethorphan, known as DM (Benylin DM, Robitussin DM, and multi-ingredient products)

  • 10 to 20 mg every four hours or 30 mg every six to eight hours, maximum 120 mg/day
  • No effect on blood glucose
  • Dose varies with formulation so check label


  • 7.5 mg every four to six hours

Tylenol #1 or generic
– Also contains acetaminophen and caffeine

  • One to two tablets every four to six hours
  • Note: cough syrups with codeine usually
    contain sugar in the formulation.
  • No effect on blood glucose
  • May cause drowsiness and constipation

Cough - loose

Check with your doctor if your cough:

  • lasts longer than seven days
  • is accompanied by a high fever or severe sore throat, as above for colds.


  • 200 to 400 mg every four hours,maximum of 2400 mg/day
  • Sugar-free liquid versions include Benylin E and Robitussin.
  • No effect on blood glucose
  • Drink plenty of liquid
  • If the cough is not disturbing your sleep, use a product without additional dextromethorphan; this allows the cough to clear your chest of the phlegm that has been thinned by the guaifenesin

Sore throat

Check with your doctor if your sore throat:

  • is severe and lasts longer than two days
  • is accompanied by a high fever, headache, nausea or vomiting.
  • Any lozenge will bring moisture to the throat and relieve a dry irritated throat. Cough drops containing menthol may help with nasal stuffiness.
  • Sugar-free products include Halls Sugar Free, Bentasil, and Fisherman’s Friend Sugar Free.
Suitable for occasional use if you get no relief from gargling with salt water


Check with your doctor if you have:

  • diarrhea lasting longer than two days
  • diarrhea that is accompanied by a fever over 38.5 C (101.3 F)
  • bloody or black stool
  • signs of dehydration – increased thirst, decreased passing of urine, feel weak or light-headed, a dry mouth and tongue.

Loperamide (Imodium)

Two tablets (4 mg) to start, then one tablet after each loose bowel movement, maximum of eight tablets (16 mg) per 24 hours

  • No effect on blood glucose

Attapulgite (Kaopectate)

  • One dose is two tablets or two tablespoons
  • Recommended maximum of seven doses of regular strength, or six doses of extra strength
  • No effect on blood glucose
  • Do not take within two hours of other medication

Nausea and vomiting

Check with your doctor if you have:

  • nausea and vomiting that has lasted longer than two days without a known cause
  • significant weight loss
  • signs of dehydration (see diarrhea)
  • blood in the vomit
  • a recent history of head trauma
  • altered level of consciousness (decreased alertness).

Dimenhydrinate (Gravol)

  • 50 to 100 mg every four to six hours as needed
  • No effect on blood glucose
  • Takes 30 minutes to work
  • May cause drowsiness; avoid alcohol and use caution if operating machinery
  • May cause constipation and blurred vision


Prevention is important.
Regular exercise, increasing dietary fibre, and drinking plenty of fluids daily can relieve constipation naturally.
Check with your doctor if:

  • you have rectal pain or bleeding
  • you have blood in the stool
  • the constipation is accompanied by fever, abdominal pain, nausea or vomiting
  • the constipation lasts longer than two weeks, or is recurring over a period of three months or longer

Psyllium (Metamucil)

  • 2.6 to 7.5 gm in eight ounces
    (850 mL) of water
    Maximum 30 gm per day
  • No effect on blood glucose
  • This bulk (fibre) forming agent usually works overnight
  • Do not take within two hours of other medications
  • Take with at least 250 mL of water

Sennosides (Senokot)

  • 8 to 15 mg, once per day
  • No effect on blood glucose
  • This stimulant laxative usually works overnight

Docusate sodium (Colace)

  • 50 to 500 mg per day at bedtime
  • No effect on blood glucose
  • Do not take within two hours of other medications
  • Works by bringing water into the bowel, softening
    the stool and making it easier to pass
  • May take up to three days to work.

Check the Canadian Diabetes Association’s sick day medication list

FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1 [DI_MDss16]
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