Helpful Hints on OTC Medications

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

It is certainly winter in New England. Who doesn’t love wooly mittens, ice skating on the Frog Pond, or curling up with hot tea and a big book? Unfortunately, there is a flip side to these happy scenes:  people get sick. Illness can occur at any time of year but there seems to be an increase in illness in winter.  People with diabetes have a few more challenges in their self-care, so I want to highlight a few points about over the counter medications to consider as you try to stay healthy this winter and all year long.

Over the counter medications (or OTCs) are available without a prescription, but this doesn’t mean they’re harmless.  Tell your healthcare provider about any OTCs you are taking.  Many medications have a combination of the ingredients listed below, so read the label and follow the directions carefully.  You can always ask your pharmacist for help or to check if any OTCs will interact with other medications you’re taking.

  • Non-steroidal anti-inflammatory medications (NSAIDS) are used to lower fever and relieve pain. You may be more familiar with ibuprofen (Motrin, Advil) or naproxen (Aleve, Naprosyn).  You should not use these medications if you are allergic to aspirin, have kidney disease, trouble with your stomach or a bleeding disorder.  NSAIDS can raise blood pressure, so check with your healthcare provider before taking.
  • Acetaminophen (Tylenol) is also used to lower fever and relieve pain. If you have liver disease, use with caution or avoid altogether.
  • Antihistamines are used to relieve allergic symptoms and nasal congestion, and may be combined with other medications. They can make you feel sleepy, jittery, and/or have a dry mouth. Talk to your healthcare provider before taking these medications if you have high blood pressure, thyroid disease, glaucoma, or prostate problems.
  • Pseudoephedrine (Sudafed) is a decongestant used to relieve nasal congestion and sinus pain. This medication can make you feel anxious, increase heart rate, and/or interfere with sleep.  It can also interact with many other medications.  Do not use if you take medications for high blood pressure, thyroid medications, or some psychiatric medications until discussing with your healthcare provider.  Pseudoephedrine can also raise blood sugar, so if you have high blood sugar while taking this medicine it’s best to avoid it.
  • Dextromethorphan is a cough suppressant and a common ingredient in many cold medications. Cough suppressants help reduce coughing.  It can be taken any time during the day, but it is  best taken at night. The potential side affects are drowsiness, dizziness, anxiety, and upset stomach. Medications with the initials DM at the end of the name have this ingredient.
  • Guaifenesin (Mucinex) is an expectorant found in many cold medications or combined with other medications mentioned above, though it can also be taken by itself. Expectorants help break up mucus so you can cough it out.  This medication may cause upset stomach and dizziness, but it is not known to interact with other medications.

Many of the medications discussed here are available in pill and liquid form.  The liquid types are syrups made with sugar.  Sugar free versions may not be easily available, but these medications are taken in small amounts for a short period so the impact on blood sugar may not be too hard to manage.  However, it is best to avoid products that contain sucrose, dextrose, fructose, lactose, and honey whenever possible.

If you are looking for sugar free cough and cold medications, these are ones that are available:

  • Chlor-Trometon tablets
  • Dimetapp Elixir
  • Scot-Tussin DM Liquid
  • Cerose-DM Liquid

I hope this information clarifies the best medications to have in your sick day tool box. Please check with your pharmacist and health care provider with any questions.  I truly hope that you won’t need to use any of these suggestions and your winter remains cozy and healthy.

Guest Post, Health

The Flu: An Overview

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

It seems like every year come winter we’re inundated with health care providers’ recommendations and public service campaigns to get the flu vaccine. But what exactly is the flu and why is it such a big deal? ‘Flu’ is short for influenza, an infectious disease caused by a small group of viruses – namely influenza virus A, influenza virus B and influenza virus C. These viruses target and infect the respiratory tract (nose, throat and lungs) causing the illness we call the flu. People with the flu experience a combination of high fever, chills, sore throat, significant fatigue, muscle aches, headache, and cough. True, many of these same symptoms are associated with the common cold, but colds are caused by a different set of viruses and these symptoms are much less severe (and much shorter in duration) than with the flu.

One reason there is so much public attention given to the flu is its potential to cause large-scale outbreaks. In fact in 1918 a particularly lethal flu pandemic spread through many parts of the world, resulting in an estimated 500 million deaths. Though we have not seen as high a fatality rate from the flu in recent memory, and even though most healthy individuals will completely recover from the flu in about one to two weeks, it’s still a highly contagious illness that has the potential to turn particularly severe (and potentially deadly) in certain populations. The CDC estimates that approximately 3,000 to 49, 000 people have died from the flu each year over the past 30 years. This is the driving force behind the recommendation for the flu vaccine.

The Flu Vaccine

Each year the World Health Organization researches and identifies the strains of influenza viruses they predict will cause the bulk of the flu illness for the upcoming season.  Based on these predictions vaccine manufacturers develop the seasonal flu vaccine, which is made available to the public starting in the fall.  Why does a brand new vaccine need to be developed each year? The influenza viruses, influenza A in particular, have a high rate of mutation. This means that they’re able to change a component of themselves, one of their viral “body parts” as it were, to such a degree that the immune system is unable to remember prior versions of the virus. Put another way, someone who had the flu last year may build up immune defenses against the strain of virus that caused their illness, but those defenses may not recognize a new or different version of the virus this year. Thus, the flu vaccine given this season is no longer protective for the next.  This is also why some individuals may still get the flu despite having gotten a flu shot:  they may have gotten infected with a strain of the virus that was not included in the vaccine.  There are two forms of influenza vaccine available: an injectable version commonly known as the “flu shot” and a nasal vaccine which is sprayed into the nose.  You cannot get the flu illness from either of these vaccines themselves. The virus used to make the injectable vaccine is inactivated or killed while the virus used to make the nasal version is attenuated or weakened.

Potential Complications, Treatment and Prevention

So how does a virus that causes sore throat, muscle ache, fever, chills, headache and cough become deadly? Well, some individuals can develop an infection of the lung or pneumonia caused by the influenza virus itself, or by bacteria that began growing in the lungs while the immune system was busy dealing with the flu virus.  Babies under the age of 2, pregnant women, and people over 65 are most susceptible to this complication.  People who are immunocompromised (have a weakened or no immune system) from another illness, who smoke, or have a chronic illness such as asthma, diabetes, lung or heart disease are also at risk for severe complications.

What happens when someone gets the flu?  Depending on the severity of symptoms and any complicating medical conditions, healthcare providers may prescribe an oral antiviral medication. Though these medications do not cure the flu, they may decrease the severity and duration of symptoms as well as the chance of developing complications.  The CDC recommends such treatment for specific populations, including hospitalized patients and people at high risk for complications including children under 2; adults over 65; pregnant or postpartum women; residents of nursing homes; immunosuppressed individuals; and those with chronic illnesses.  For anyone not included in the above populations, flu symptoms can be effectively treated with some over the counter medications. Acetaminophen or ibuprofen can help to reduce fever, headache and muscle aches.  Aspirin or other salicylates should be avoided, especially in children under 18, as it has been associated with Reye syndrome. In addition, people with the flu should drink plenty of fluids and get a good amount of rest. Flu symptoms may last for one week or more.

As with anything, prevention is the best course of action.  Flu viruses are highly contagious through contact with contaminated surfaces and through the air, so habits such as hand washing with soap and water, covering one’s mouth when coughing or sneezing, and avoiding touching the eyes, nose and mouth limit its spread and transmission.  Good hygiene and annual vaccination are the best defenses against the flu.


Managing Sick Days and Diabetes

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

Although anyone can get sick at any time of year, it seems that as we approach fall and winter the chances for illness are greater. When you have Diabetes and get sick— to use a pop culture catch phrase— it’s complicated.

When people living with Diabetes talk about sick days, they’re referring to how they’ll take care of their Diabetes when they get a cold or flu. Illness puts additional stress on the body and your blood sugar levels can increase (or be hard to manage in general). But when you’re sick, the last thing you want to do is figure out how to control the fluctuations in your blood sugar!  Things can get very dangerous very quickly if you don’t know what to look for and how to prepare. That’s why it’s important to plan ahead for when you’re sick so you can try to avoid any additional complications, and why it’s a good idea to discuss sick day management with your provider at your next scheduled appointment (before you get sick).

Some common conditions that can require you to use your sick day plan include (but aren’t limited to) colds, flu, stomach bugs, urinary tract infections, and/or skin infections like an ingrown toenail.  Any illness with fever or gastrointestinal symptoms such as vomiting and diarrhea need special attention—even a mild case of any of these illnesses cans cause challenges with your blood sugar regulation.

I want to review a few key points to help you feel confident with your sick day management.  The first thing is you’ll need to check your blood sugar regularly.  At a minimum you should check before meals and bedtime, and you may need to check more often (especially if you’re using insulin).  Next, you’ll need to keep your dietary intake as close to normal as possible.  This may be difficult, especially if you aren’t feeling well enough to eat, but you need to try to keep your carbohydrate intake stable to help with glucose control.  I’ve included a list from the American Diabetes Association website to help you with some food choices (these foods contain between 10 and 15 grams of carbohydrates):


1 double-stick Popsicle
1 cup Gatorade
1 cup milk
1 cup soup
1/2 cup fruit juice
1/2 cup regular soft drink (not diet)


6 saltines
5 vanilla wafers
4 Lifesavers
3 graham crackers
1 slice dry toast (not light bread)
1/2 cup cooked cereal
1/3 cup frozen yogurt
1/2 cup regular ice cream
1/2 cup sugar-free pudding
1/2 cup regular (not sugar-free) Jell-O
1/2 cup custard
1/2 cup mashed potatoes
1/4 cup sherbet
1/4 cup regular pudding

It’s imperative that you continue to take your medications—however adjustments may need to be made. Dosages of sulfonylureas and basal and bolus insulin may need tweaking based on your intake and glucose values to avoid any hypoglycemia. Over the counter medications can be tricky and since many have added sugar in them, it’s always best to check with the pharmacist first (although there are sugar free cough medications and lozenges available).

It isn’t always necessary to call your provider when you’re sick, but it’s best to call them and let them know what’s going on if:

*You aren’t getting better after a couple of days

*You’re having persistent diarrhea or vomiting and can’t keep any fluids down

*You have a fever above 100.5°F that’s not coming down to normal

*You have ketones in your urine

*Your blood sugar readings are consistently above 240 mg/dl after checking twice over a few hours

The biggest thing about good Diabetes management is being as prepared as possible. Many things that may be required during illness are not the things that people with Diabetes might normally keep on hand. I suggest starting a “Sick Day Tackle Box” that has everything you’ll need so when you are sick, you don’t have to try to gather everything when you feel miserable.  Some items to keep in there include testing supplies (extra glucometer, batteries, test strips and lancets, ketone strips), glucose tablets and a thermometer; as well as some regular jello, juice boxes and small cans of regular soda.  Write an inventory list with the contents of you box and any expiration dates and review it every 6 months.  Also, keep an updated list of phone numbers with your health care provider, local emergency room, and family contact numbers on hand.

Living with Diabetes takes a lot of planning, but that planning can keep you healthier and able to enjoy your life to the fullest. Here’s hoping these suggestions are rarely ever needed and we all have a healthy fall and winter.