Living with Diabetes

Itching can often be a symptom of a complication of diabetes such as a fungal infection, dry skin or poor circulation, which may lead to a condition called neuropathy. 

Fungal infections can create itchy rashes which occur most often in warm, moist folds of the skin.  Common fungal infections include jock itch, athlete's foot, ringworm, and vaginal (yeast) infections. If you think you have a yeast or fungal infection, we recommend contacting your physician. Treatment may require a prescription medication.

If the itching is related to dry skin, limit how often you bathe and use a mild soap.  After bathing, dry your feet and use a thin layer of either plain petroleum jelly, or an unscented hand cream to help seal in moisture.  Do not put oils or creams between your toes because this could lead to an infection.

When poor circulation is the cause of itching, the itchiest areas may be the lower parts of the legs. Poor circulation could lead to nerve damage (or neuropathy). Please report this to your physician since the treatment for neuropathy is individualized and based on specific symptoms.

Additional skin problems that can occur mostly in people with diabetes include diabetic dermopathy, necrobiosis  lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis.  You can read more about these conditions at http://www.diabetes.org/living-with-diabetes/complications/skin-complications.html.

Since you have developed blisters on your skin, we suggest consulting with your physician to determine the cause of your itching and the appropriate treatment.  An antibiotic may be needed to prevent infection.

Anti-diuretic hormone, also known as vasopressin, is a prescription medication that is available in the following forms: subcutaneous (injected under the skin), intramuscular (injected in the muscle) or nasal spray.  Vasopressin is given to help prevent or control polyuria (excessive urination), polydipsia (excessive thirst), and dehydration in patients with central diabetes insipidus. Dosages for each of these products are based on individual response.  Please consult with your mother’s physician for instructions on how to use this medication. 

There are no prenatal vitamins specifically made for patients with diabetes.  It is up to your physician to determine which product would be suitable.  According to our references, chromium is “possibly effective” in decreasing blood glucose levels; however, not all evidence regarding the use of chromium in diabetes is consistent due to small study sizes, small number of trials, and inconsistent patient populations. Theoretically, chromium may increase the risk of hypoglycemia if used with other diabetes medications. If your physician approves the use of chromium, you should monitor your blood glucose levels closely. Dosage adjustments to your diabetes medications could be necessary.

There are numerous over the counter and prescription medications on the market today, many of which may be contraindicated or need to be used with caution by people with diabetes.  Please resubmit your question through our “Ask the Pharmacist” service at www.riteaid.com with a list of the medications you are currently taking and what you would like to take so that we may best answer your question.

Unlike pharmaceuticals, "natural" products, such as celery seed, are not required to undergo the FDA (Food and Drug Administration) approval process to demonstrate their safety and effectiveness.  The FDA only regulates the package labeling, prohibiting a product from making claims that it is intended to diagnose, treat, cure, or prevent a disease. We could not find any information indicating that celery seed should not be used in patients with diabetes.  When celery oil or seeds are consumed in amounts commonly found in foods it is generally recognized as safe in the United States; however, there is insufficient reliable information on the effectiveness of celery for most uses besides dysmenorrheal (menstrual cramps). Please check with your physician before adding any product to your current drug regimen.

According to Bayer, the manufacturer of One a Day® Women’s Multivitamin Supplement, there are 0.5 grams of carbohydrates and 0.008 grams of sugar in each tablet. As with any medication, if you have a medical condition such as diabetes, you should contact your physician before using this product.

Special supplements for specific groups, such as patients with diabetes, are manufactured by some companies. However, it is up to the manufacturer to determine what goes into them. There are no regulations nor are there standard formulations. As a result, these formulations may not be complete and may not provide any additional benefits to the groups they are targeting. We suggest contacting your physician and/or a registered dietitian to help determine if you are receiving adequate amounts of vitamins and minerals through your diet and to determine if supplements are needed.

Before selecting a product, it is important to check the inactive ingredients of cough and cold medications.  Many formulations contain some form of sugar which can increase blood glucose levels.  Additionally, many contain alcohol which can cause either increases or decreases in blood glucose levels.  It is best to look for a sugar-free and alcohol-free preparation to minimize the impact on blood glucose levels.

Antihistamines may help in drying and relieving your congestion. These products are available over the counter (OTC) and include diphenhydramine, chlorpheniramine, brompheniramine, loratadine, cetirizine, and fexofenadine. (Please note: brompheniramine is available OTC only in combination products and as a single agent by prescription).  Diphenhydramine, chlorpheniramine, brompheniramine, and cetirizine when taken by mouth may affect blood pressure and should be used with caution. Loratadine and fexofenadine, when taken by mouth, are not expected to affect the blood pressure. None of the OTC antihistamines are known to cause a problem with blood glucose levels.                                                                                                                     

Analgesics such as acetaminophen, ibuprofen, naproxen or aspirin may provide relief from sore throat pain and fever associated with the common cold.  Ibuprofen, naproxen, and aspirin may cause fluid retention in some patients and interfere with the beneficial effects of blood pressure lowering medications.  In addition, when taken in high dosages (i.e. prescription strengths) ibuprofen, naproxen, and aspirin have been reported, rarely, to cause hypoglycemia (low blood glucose levels) in patients with diabetes.  Additionally, naproxen and aspirin have caused hyperglycemia (high blood glucose levels) rarely in some people.  If your physician approves the use of these products, we recommend that you monitor your blood glucose levels closely and notify your physician of any significant changes.

Please consult with your physician before adding any medication to your current drug therapy.  Also be sure to monitor blood glucose levels closely for fluctuations.

In order to control your blood glucose (sugar) using oral medication, your body must be able to produce enough insulin on its own.  There may be some instances where this could occur.  For example, if insulin was given during an acute illness to help when glucose levels can be high and the illness has subsided, oral medications could possibly be restarted.  Also, individuals that have lost a lot of weight may be able to reduce their dose of insulin or control their diabetes with oral medication. 

It would be best to consult with your physician regarding your concerns.   Treatment of diabetes is customized to each individual patient and many factors are taken into account when a physician initiates a treatment plan. Insulin therapy is usually reserved for patients that have type 1 diabetes or type 2 patients that have failed lifestyle modification such as diet and exercise and other oral medications.

Depo-provera (medroxyprogesterone) should be used cautiously in patients with diabetes. This product can decrease the actions of anti-diabetes medications and increase blood glucose levels. If your physician approves the use of Depo-Provera with your current medication therapy, make sure to monitor your blood glucose closely.

Iron deficiency is common among women and we were not able to locate much research on this and it’s relation to high blood glucose levels. We were able to find one study regarding the association between iron deficiency and A1C levels among adults without diabetes in the National Health and Nutrition Examination Survey (1999–2006) which concluded that further research is needed to examine whether iron deficiency is associated with shifts toward higher A1C levels.

Please report the changes you are experiencing to your physician; dosage adjustments in your current diabetes therapy may be warranted.

We have found many available over-the-counter (OTC) medications for symptom relief of cough, cold, flu and pain.  However, some of these medications may interfere with diabetes.          

Decongestants containing pseudoephedrine or phenylephrine can worsen diabetes control and should not be used unless directed to do so by a physician. As an alternative, saline nasal spray may be used to help break up and clear nasal congestion.

Antihistamines may help in drying and relieving congestion.  These products are available OTC and include diphenhydramine, chlorpheniramine, brompheniramine, loratadine, cetirizine, and fexofenadine.  (Please note: brompheniramine is available OTC only in combination products and as a single agent by prescription).  None of the OTC antihistamines are known to cause a problem with blood glucose control.      

Guaifenesin is an expectorant available OTC for facilitating the thinning and removal of bronchial secretions.  Guaifenesin is not known to affect diabetes and is useful for productive coughs (a cough in which you bring up phlegm).                                                                                          

Dextromethorphan is a cough suppressant available OTC for the relief of a dry, hacking cough.  This product should not be given for a productive cough, unless the cough is disrupting sleep at night.  This product is not expected to interfere with diabetes. 

Analgesics may provide relief from aches, pains, and fever associated with the common cold.  Acetaminophen, ibuprofen, naproxen, and aspirin are all available OTC. When taken in the amount recommended on the OTC package, these products should not pose a problem. However, when taken in higher amounts (i.e. prescription strengths) ibuprofen, naproxen, and aspirin have been reported to cause hypoglycemia (low blood glucose levels) rarely in patients with diabetes.  Additionally, naproxen and aspirin have rarely caused hyperglycemia (high blood glucose levels) in some people.  If using these products, we recommend that you monitor your blood glucose levels closely and notify your physician of any significant changes.

Make sure your father checks the inactive ingredients of cough and cold medications before he purchases something.  Many products contain some form of sugar which can increase blood glucose levels.  In addition, many contain alcohol which can cause either increases or decreases in blood glucose levels.  Have your father look for a sugar-free and an alcohol-free preparation to minimize the impact on the blood glucose level.  He should check with his physician before adding any medication to his current drug regimen. His local Rite Aid pharmacist can help with specific product selection and to check for any drug interactions.

There are a number of generic medications available to help in the treatment of diabetes.  It is up to your physician to determine your next course of therapy since you are unable to take metformin.  Please contact your physician to see what medications they are considering and resubmit your question at www.riteaid.com (click the “Ask the Pharmacist” icon) with the names of the products and we will be happy to check for adverse effects to the kidneys for you.

Victoza (liraglutide) is an injectable prescription medicine that may improve blood sugar in adult patients with type 2 diabetes when used along with diet and exercise. This product is not recommended as the first medication to treat diabetes and is not for people with type 1 diabetes or people with diabetic ketoacidosis (accumulation of ketones in the blood and urine). This product is not a substitute for insulin if you currently require insulin treatment.

For detailed information on this product visit www.victoza.com or check out our Rite Advice Patient Education Monograph at www.riteaid.com/pharmacy/monographs/.

Preliminary research raised some concerns that glucosamine may increase blood glucose (sugar) levels in people with diabetes. However, more reliable clinical studies show that glucosamine does not appear to significantly influence the control of blood glucose in people with type 2 diabetes. Glucosamine, along with routine monitoring of blood glucose levels, seems to be safe for most people with diabetes.

We would not expect glucosamine or chondroitin to interact with your current medications; however, it is important to remember that unlike pharmaceuticals, "natural" products are not required to undergo the FDA (Food and Drug Administration) approval process to demonstrate their safety and effectiveness.  The FDA only regulates the package labeling, prohibiting a product from making claims that it is intended to diagnose, treat, cure, or prevent a disease. Please consult with your physician before adding any product to your current drug regimen and make sure to check you blood sugar levels regularly.

According to our references, animal data shows that monoamine oxidase inhibitors (MAOIs) may stimulate insulin secretion. In addition, inhibitors of MAO type A have been shown to prolong the hypoglycemic response to insulin and oral sulfonylurea medications. It is recommended to monitor serum glucose closely when adding a MAOIs to any anti-diabetes drug therapy.

Beta-blockers have been shown to prolong or enhance hypoglycemia and can occasionally cause hyperglycemia. Selective beta-blockers (i.e. acebutolol, atenolol, metoprolol) may cause less problems with blood glucose regulation in patients with diabetes; however, they can mask the symptoms of hypoglycemia. Patients receiving beta-blockers and anti-diabetes medications together should be monitored closely.

Salicylates have been shown to indirectly increase insulin secretion, thereby decreasing blood glucose levels. If someone suffers from an acute overdose, salicylates can cause either hypo- or hyperglycemia. Dosage adjustment to anti-diabetes therapy may be necessary when salicylates are added or removed from a patient’s course of therapy. Careful monitoring is recommended.

We also found that tetracycline may increase the hypoglycemic effects insulin, Humulin N specifically.

Please contact your physician if you are concerned about any drug interactions or adverse effects with your current treatment regimen.

The timing of medications depends on what type of insulin you are taking (i.e. short-acting vs. long-acting or both) in addition to which oral medications are prescribed.  Some medications are given once daily, others are given before meals and some may be given at bedtime.  Please resubmit your question through our “Ask the Pharmacist” service at www.riteaid.com with the names of the products you are currently prescribed and we can help you set up a dosage schedule.