Cold and flu season comes upon us with a vengeance, at this time of year. Dealing with aches and pains, fevers, sore throats and runny noses is hard enough. Add a few more challenges like diabetes, and perhaps it's complications such as cardiovascular disease and high blood pressure, and there can be a real concern about which over-the-counter (OTC) medications to use.

There are so many brands of cold and flu medications to choose from. You can buy single symptom medicines that treat just coughs, or just nasal congestion. Or you can buy a product that will help with several symptoms at once.

People who have diabetes have to be careful which OTC medicines they use. With so many options, how do you know which ones are OK to take?

The trick is to know what ingredients are in the medications that you buy, and how they will affect your diabetes. Ingredients on the labels fall under two categories: inactive and active. Inactive ingredients don't have medicinal value. They are typically fillers, flavorings, colorings and substances that help with consistency. Active ingredients are the drugs that actually treat the symptoms.

Inactive ingredients that may affect diabetes:

Alcohol or sugar are non-pharmacological ingredients that may be in the cold and flu medicine you are taking. They may be listed under "inactive ingredients" on the label. Both alcohol and sugar will affect your blood glucose levels.

Active ingredients that may affect diabetes:

Pain and fever reducers: acetaminophen is used in cold and flu medications for minor aches and fevers.

• Acetaminophen can be toxic to liver and kidneys. People with diabetes who also have kidney complications should check with their doctor before using acetaminophen.

NSAIDS: (Non-steroidal anti-inflammatory drugs) are used to treat aches, pains and fevers associated with colds and flu.

• Ibuprofen should be used cautiously by people with liver and kidney problems. It also increases the hypoglycemic effect of insulin and oral diabetes medications.
• Naproxen should not be used for people with severe cardiovascular disease, or kidney or liver problems. It may also increase the risk of hypoglycemia with insulin and oral diabetes medications

Cough medications:

• Dextromethorphan is an ingredient in many cough preparations and at recommended doses is safe for people with diabetes.
• Guaifenesin is an ingredient that loosens mucus and makes it easier to cough it up. There are no warnings about guaifenesin and diabetes.

Decongestants:

• Epinephrine, phenylephrine, and pseudoephedrine are usually found in nasal sprays, but also some oral cold medicines. They work by drying up secretions in the nasal passages. It is possible that they could decrease the effects of insulin or oral diabetes medications. They can also increase blood pressure and should be used cautiously in people with high blood pressure.
• Phenylpropanolamine (PPA) is a decongestant that has been recalled by the FDA as of 2005, due to an increased risk of strokes.

Antihistimines:

• Brompheniramine, chlorpheniramine, and doxylamine are used in combination with other active ingredients. These antihistimines do not affect diabetes directly, but elderly people may be more susceptible to side effects. Diphenhydramine is used alone (marketed as Benedryl) or in combination with other drugs. It can cause low blood pressure in some people.
• Loratadine is a second generation antihistamine that has recently gone OTC. It does not cause the sedation associated with the older antihistimines. It does not appear to cause problems in people with diabetes.

Navigating the cold and flu aisle at your drug store can be challenging because of all the different brands and combinations of drugs available. Remember that these medications will not cure a cold or a flu; they only temporarily ease the symptoms.

It's best to ask your doctor or your pharmacist which of these medications is right for you.

OTC cold and flu medications are not recommended for children under the age of two.