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Managing Diabetes Magazine - diabetes

Your Medicine Cabinet
Do you have everything you need?

Your medicine cupboard may be the first place you go to when you are not feeling well. It may contain supplies for first aid, pain or cold relief. Organizing a medicine cupboard takes a little time, but it is handy to have your supplies in one place when you are sick or hurt.

The first step is to organize your medicine cupboard and medications. Remember the following:

Do not store medicine in the bathroom, because of the temperature changes and humidity. Medicines keep better in a dry, cool place.
Keep medications in their original containers so you know what the drug is and how to take it.
Go through your medicine cupboard and check for medications that are past the expiry date. Replace those that are too old. Remove medication you no longer use.
Check if the medicine has changed in appearance, texture, consistency, colour, or smell. If there has been a change, it should be replaced even if it has not expired.
If you have medications that are no longer useful, take them to your pharmacy for proper disposal. Medicine should not be thrown in the garbage or flushed down the toilet.
All medicines should be stored out of sight and reach if you have children, or if children come to your home.

Treatment Tips

Wound Care
The best method for cleaning a simple wound is to wash the cut with soap and water, or flush gently with normal saline or tap water. The pressure when flushing to cleanse a wound should be gentle, no stronger than what you would use for eye rinsing. This is to prevent damaging the new skin cells that are trying to close the wound. Hydrogen peroxide and other antiseptic solutions can slow healing time and are no longer recommended. People with diabetes need to be careful how they care for a wound or ulcer, as small wounds can soon become large. Good blood glucose control will assist in wound healing. If healing is delayed or the wound has changed, contact your doctor.

Foot Care
You must maintain proper foot care to avoid foot problems. Protect your feet from injury by wearing shoes that fit well, and checking daily inside the shoe for foreign objects or tears. Do not go barefoot. Wear clean socks everyday, and align your socks and any seams carefully over your foot. Get into a routine of checking your feet each day. Inspect and feel the top and bottom of your feet and in between your toes. What are you looking for? Check for anything that is different or injured: blisters, cuts, redness, hard skin, scratches, breaks in the skin, and hot or cold spots. Pay close attention to any blister or cut. Contact your doctor if there is redness, pain or swelling, or an area that is not healing properly. Proper fitting shoes and foot powder for drying feet may make them less prone to blisters. If a blister does form, use moleskin or cushioning donuts to keep the pressure off the blister until it heals. Once a day, wash your feet in tepid water, avoiding extreme water temperatures. Dry carefully, especially between the toes. Look at and treat any dryness with a moisture restoring cream or lotion. Avoid getting lotion between toes, as this may cause skin to tear away, putting you at risk for an infection. The area between the toes is a haven for developing athlete's foot.

Skin Care
A suggestion may be to bathe or shower in warm water, as hot water can further dry out your skin. Gently pat your skin dry right away instead of letting water evaporate and dry out your skin. You can use gentle cleansers, and mild or moisturizing soaps. Moisturizers are applied to the skin to reduce dryness and irritation, making the skin surface appear smoother and softer. A good time to use moisturizers is after a bath or shower when
the skin is slightly damp.

Illness or Injury
Blood sugar levels can rise during an illness. You may not be eating regularly if you are not feeling well. It is important, during a stressful time of being ill or injured, to check your blood glucose levels more often than usual. You may also need to check your ketones if your blood glucose levels are high. Please refer to your Sick Day Management Guide, available from your diabetes educator.

Items for Everyone’s Medicine Cupboard

Medications
Over-the-counter items you may consider keeping with your supplies in the medicine cupboard are:

medicine to relieve pain or fever such as acetaminophen, or to relieve inflammation like ibuprofen or aspirin: please note that aspirin should not be given to children or teenagers because of the risk of Reye's syndrome
antihistamine for allergy relief.
calamine lotion or hydrocortisone cream 0.5% to relieve itching
sun screen
sun burn remedy
anti-diarrhea medicine, or antacids (check with your doctor or pharmacist).

In the cough and cold section, choose a product that will treat your current symptoms. Do not choose a product that contains many ingredients to treat many symptoms. Always read the label to find out what symptom the product treats. Check the safety information for side effects, problems mixing with other drugs you may be taking, or health problems that are a concern with this drug. Avoid cough and cold medicines that contain alcohol. Do not use medicines that contain sugar, such as sucrose, maltose, dextrose or fructose. With sugar-free products, you do not need to account for their carbohydrate value. Sugar-free products containing sorbitol can cause diarrhea.

Decongestants can relieve your stuffy nose, but those you take by mouth can increase your blood glucose levels. Nasal decongestant sprays or drops should be used for no more than five days. After that they tend to worsen nasal stuffiness instead of helping. A saline nasal spray may help to relieve congestion without affecting blood sugar levels and can be used for an unlimited time. To ease a sore throat, sugarless throat lozenges or gargling with warm salt water may be helpful.

If your cough has no mucus, a cough suppressant like dextromethorphan may be helpful. If your cough does have mucus, an expectorant (which helps loosen mucus) like guaifenesin may help. Again, choose a product that is alcohol and sugar-free.

First Aid

You should keep the following first aid items in a first aid kit or in your medicine cupboard:

first aid manual
gauze roll and individually packaged gauze pads
non-allergenic tape to hold gauze in place (won’t cause an allergic reaction)
various sizes of adhesive bandages
sterile cotton balls and swabs
tweezers
sterile eyewash and eye wash cup
eyedropper
antiseptic cream or ointment to prevent infection (use only with your doctor’s approval)
cold/hot packs, regular or instantly activated (use these with caution . . . ask your pharmacist)
elastic bandage to wrap a sprained joint
safety pins
blunt tipped scissors
latex gloves
thermometer
card with the phone number of your doctor, poison control centre and local emergency numbers

The Poison Centre suggests that stocking syrup of ipecac and activated charcoal is not necessary, as these are no longer recommended for treating home poisoning.

Diabetes Supplies

Some supplies for diabetes which you may store in your medicine cupboard (if they are not already with your diabetes supplies) are:

products to treat hypoglycemia (low blood sugar reactions), such as glucose tablets, glucose gel, or Glucagon Emergency Kit™.
reactive strips to test urine for ketones if glucose levels are high.

Foot Care
Some products in the foot care section can be dangerous for people with diabetes. If you develop corns, calluses, or warts, do not treat them yourself at home. Do not cut corns or calluses, as this can lead to foot injuries. Do not use over-the-counter chemicals to remove these foot problems. Check with your doctor or a podiatrist to have these assessed and treated.

Skin Care

To reduce the evaporation of moisture from the outer layer of skin, moisturizers contain ingredients called occlusive agents. They give skin a look and feel that is soft and smooth. Some occlusive agents are yellow or white petrolatum, lanolin, eucarin, wheat germ oil, olive oil, cocoa butter, simethicone, and dimethicone, to name a few. The occlusive agents usually are listed at the beginning of the ingredient label.

Other ingredients called humectants can be added to the softening and soothing or moisturizing base. These agents draw water to the top layer of the skin to hydrate the skin. Examples of these agents include glycerin, propylene glycol, urea, butylene glycol, lactic acid, and lecithin. Other ingredients can be added to the moisturizer, which may not help increase the moisture on your skin. Examples of these are collagen, elastin, amino acids, proteins, aloe vera, allantoin, and liptosomes.

Moisturizers come in a wide selection of lotions, creams or ointments. Many of these are either oil in water or water in oil preparations. The oil in water mixture can produce a cooling effect to relieve itching. The water in oil combination has a higher oil content, and less drying occurs through evaporation, but may feel greasy.

Vitamin and Mineral Supplements
Vitamins and minerals are available from eating a well balanced diet rich in complex carbohydrates, fruits and vegetables. If you have diabetes, your vitamin and mineral supplement needs may differ from a person without diabetes. People with poor glucose control may pass their urine often. This can lead to a loss of water soluble nutrients, and may warrant use of a vitamin-mineral supplement.

It is safe to take a daily multiple vitamin-mineral supplement that contains no higher than 100 per cent of the recommended daily allowances. If you choose to take a supplement, remember to continue to eat in a healthy manner. As well, with vitamins and minerals more is not necessarily better. Check with a health professional if you are considering taking supplement doses which exceed the recommended daily allowance.

There is a lot of interest in the antioxidant vitamins, which include beta-carotene (a form of vitamin A), Vitamin C, Vitamin E, and selenium. It is thought that high blood glucose levels can cause the production of free radicals, which can damage body cells. Antioxidants may help. However, more research needs to be done before a dosage specifically for a person with diabetes can be recommended. Discuss this with your doctor. Meanwhile, good sources of antioxidants are dark green and orange vegetables and fruits.

Vitamins should be protected from excessive heat, light and moisture. House brand names are usually as good as advertised brand names, and often less expensive. Some synthetic vitamins, which are less costly, are thought to be as good as those from natural sources. Check with your healthcare provider about which product would be best for you.

Herbal Products
There is a growing number of herbal products on the market. You may wonder if these products are safe and effective. There are some concerns with a few. 'Natural' does not necessarily mean 'safe.' Herbal products can cause side effects, react with medication you may be taking, or cause a problem with diseases including diabetes.

Glucosamine may increase blood glucose levels by increasing insulin resistance or decreasing insulin production.
The effect of Ginseng, either Panax or Siberian, in diabetes is unpredictable and may cause hypoglycemia.
Garlic, high doses of ginger, fenugreek, devil's claw, licorice root, burdock, chromium, and guar gum can affect blood glucose control. Blood glucose levels should be monitored closely with more frequent testing, or the herbal product should be avoided.
Alpha lipoic acid may reduce the amount of insulin or oral diabetic medication required, so close monitoring of blood sugar levels is recommended.
Gotu kola can elevate blood glucose levels.

These are some of the known reactions. Other herbal products may be safe to use. You should consult your doctor or pharmacist before taking an herbal product and let your doctor know if you are taking one. It is very important to continue taking your prescription medications as advised by your doctor. Before making any changes or additions to your medications, check with your doctor.

In the over-the-counter section of your pharmacy, there are many products available for home health care. When choosing a product for self-medication or stocking a medicine cupboard, it is important to read the label carefully. Check to see if the new product reacts with any medicine that you are taking. Be sure it is safe for your diabetes, or for any other medical condition you may have. If you have any concerns or questions, always ask your pharmacist or doctor for assistance. As well, before purchasing any non-prescription medications or vitamin or herbal supplements, always check with your doctor or pharmacist.