OTC Diabetes Products: Helping Patients with Selection

Patients with diabetes may not know about OTC products formulated to meet their specific needs.

According to the Centers for Disease Control and Prevention, more than 29 million individuals in the United States have diabetes. Of these, 1 in 4 are not even aware they have the disease.¹ Another 86 million adults are considered prediabetic; without interventions such as weight loss and dietary changes, many of these individuals will develop type 2 diabetes mellitus within 5 years.¹

The Pharmacist’s Role

Pharmacists are in a pivotal position to increase awareness about the importance of preventing and managing diabetes and are likely to encounter patients with diabetes seeking counsel regarding the appropriate use of nonprescription medications. Many of these patients may not be aware that a host of nonprescription medications have been formulated to meet their specific needs by excluding sugar or other ingredients that could increase or decrease blood glucose levels. Pharmacists can be instrumental in assisting diabetic patients by making them aware of the availability of specialized nonprescription products and by guiding them in the proper selection and use of these products.

Among the many nonprescription products marketed specifically for the diabetic population are products to manage and treat allergic conditions, cough/ cold and flu symptoms, and dermatologic conditions, as well as multivitamin supplements and oral care products (Online Table 1). Many of the cough/cold products marketed for patients with diabetes are formulated to be free of sugar, alcohol, dextrose, sucrose, sorbitol, sodium, fructose, glycerin, and dyes. A number of nonprescription products marketed for the general population are also sugar-free and alcohol-free.

TABLE 1: EXAMPLES OF OTC PRODUCTS MARKETED FOR PATIENTS WITH DIABETES

Product

Manufacturer

Cough and Cold Medications

Diabetic Tussin DM Cough Suppressant & Expectorant

Diabetic Tussin DM Maximum Strength Cough Suppressant & Expectorant

Diabetic Tussin Nighttime Cold & Flu

Health Care Products

Fisherman’s Friend Sugar Free Cough Suppressant Lozenges

Lofthouse’s

Hall’s Sugar Free Cough Suppressant Drops & Lozenges

Hall’s Breezers Sugar Free Cough Suppressant Drops & Lozenges

Cadbury Adams

N’ICE Sugar Free Cough Suppressant Lozenges

Insight Pharmaceuticals Inc

Robitussin Sugar Free Cough + Congestion DM

Wyeth Consumer

Ricola Sugar Free Cough Suppressant Throat Drops

Ricola Sugar Free Cough Drops

Ricola USA

Safetussin PM Night Time Cough Relief

Safetussin DM

Kramer Labs

Scot-Tussin DM Cough Suppressant & Cold Relief

Scot-Tussin Expectorant Cough

Scot-Tussin Diabetes CF Cough Suppressant

Scot-Tussin Senior Cough Suppressant & Expectorant

Scot-Tussin Original Multi-Symptom Cold and Allergy Relief

Scot-Tussin Pharmacal

Dermatologic Products

Anastasia Diapedic Foot and Leg Treatment Cream

Ames Walker

DiabetAid Pain and Tingling Relief Lotion

Insight Pharmaceuticals Inc

DiabetiDerm Foot Rejuvenating Cream

DiabetiDerm Heel and Toe Cream

DiabetiDerm Antifungal Cream

DiabetiDerm Hand and Body Lotion

Healthcare Products

Diabetic Basics Healthy Foot & Body Lotion

Woodward Labs

Diabet-X Callus Treatment

Diabet-X Moisturizing Body Wash

Diabet-X Skin Therapeutic Body Lotion

Diabet-X Hair and Scalp Therapy Shampoo

Diabet-X Hair and Scalp Therapy Conditioner

Diabet-X Daily Prevention Skin Therapy

FNC Medical Corp

Flexitol Diabetic Foot Balm

LaCorium Health

Neoteric Oxygenated Advanced Healing Cream

Neoteric Diabetic Shampoo and Scalp Care

Neoteric Cosmetics Inc

ReliOn Callus Treatment

ReliOn Antifungal Cream

Walmart Pharmacies

Zim's Crack Creme, Diabetic Formula

Perfecta Products Inc

Oral Care Product

GUM Diabetes Oral Care Kit

Sunstar Americas

Patient Counseling

Pharmacists should always assess the appropriateness of self-care and screen for potential drug—drug interactions and/or contraindications before recommending any nonprescription products. During counseling, pharmacists should remind patients to always consult their primary health care provider or a pharmacist before using any nonprescription products, including alternative or complementary medications or supplements, especially if they are unsure about the appropriate use of these products.

Patients with diabetes should also be advised to use caution when taking certain medications that may affect blood glucose levels by causing hyperglycemia or hypoglycemia. For example, the hypoglycemic effect of insulin and some oral hypoglycemic agents may be increased when taking large doses of aspirin, and the use of decongestants such as pseudoephedrine may elevate blood glucose levels.^2,3 Cough/cold products such as Diabetic Tussin (Health Care Products) are formulated without decongestants to avoid this issue.

Patients should be educated about the importance of adhering to the manufacturer’s instructions and warnings on the product’s label. The American Diabetes Association (ADA) recommends that patients always read the medication label before taking any medication to check for inactive ingredients such as some form of sugar or alcohol that may adversely affect blood glucose levels.³

Because illness itself can adversely affect an individual’s blood glucose level, pharmacists should stress the importance of monitoring blood glucose levels more frequently during sickness—at least every 3 to 4 hours or as directed by their physician. Patients with diabetes should also be advised to call their physician if their blood glucose levels are elevated or decreased or if they exhibit signs of dehydration, have a fever higher than 101°F, experience excessive diarrhea or vomiting, and/or have large amounts of ketones in the urine.^3-9 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 offer several recommendations that may aid diabetic patients in the management of their disease when they are sick (Table 2).^3-9 Pharmacists should also seize this opportunity to remind patients with diabetes about receiving their annual flu vaccination when appropriate as well as the importance of adhering to medication and diet recommendations, maintaining tight glycemic control to reduce or prevent diabetic complications, and conducting routine skin and foot care as well as oral care.

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

References

• More than 29 million Americans have diabetes; 1 in 4 doesn't know [press release]. Atlanta, GA: Centers for Disease Control and Prevention; June 10, 2014. www.cdc.gov/media/releases/2014/p0610-diabetes-report.html. Accessed September 18, 2014.
• 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 website. http://forecast.diabetes.org/colds-nov2012?loc=ContentPage-when-youre-sick. Updated November 2012. Accessed September 18, 2014.
• Sick days. American Diabetes Association website. www.diabetes.org/living-with-diabetes/parents-and-kids/everyday-life/sick-days.html. Updated October 28, 2013. Accessed September 18, 2014.
• When you’re sick. American Diabetes Association website. www.diabetes.org/living-with-diabetes/treatment-and-care/whos-on-your-health-care-team/when-youre-sick.html. Updated April 1, 2014. Accessed September 18, 2014.
• Diabetes - when you are sick. Medline Plus website. www.nlm.nih.gov/medlineplus/ency/patientinstructions/000079.htm. Updated September 4, 2012. Accessed September 18, 2014.
• What to do when you’re sick. Life Scan Inc website. www.onetouch.com/articles/sickplan. Accessed September 18, 2014.
• Sick days and diabetes. The BD Diabetes Learning Center website. www.bd.com/us/diabetes/page.aspx?cat=7001&id=7347. Accessed September 18, 2014.
• Diabetes: When you’re sick. National Diabetes Information Clearinghouse website. http://diabetes.niddk.nih.gov/dm/pubs/type1and2/specialtimes.aspx#when. Updated February 12, 2014. Accessed September 18, 2014.