Your respiratory tract is made up of an upper section (mouth, throat, nose, sinuses and vocal cords) and a lower respiratory tract (bronchi or breathing tubes and lungs). Viruses and bacteria may infect both. Upper respiratory tract infections (URTI) can cause a congested or runny nose, sore throat, sinus pain, headache and hoarseness. A lower respiratory tract infection is bronchitis (infection in the bronchi) or pneumonia (an inflammation of your lung tissue caused by an infection).

There is no objective evidence why we get more viral infections in winter, but speculation includes:

• Our internal body temperature falls after exposure to cold air, and so too does the immune system’s ability to resist viruses and bacteria.
• We spend more time indoors and in closer proximity to one another. Closer proximity promotes viral spread through shared air and frequently touched surfaces. You may have noticed that we had fewer respiratory infections during our past COVID-19 isolation times.

A rise in blood glucose levels

When you become infected, your immune system releases hormones such as cortisol which prevent your body’s insulin from working well. Insulin works to use and store glucose and when the insulin is not working well, glucose builds up in your body.

The first you know about an infection starting may be a rise in blood glucose levels. Living with diabetes means your body does not compensate for the build-up of glucose in your body. 

As your blood glucose levels rise, you may notice symptoms such as:

• Tiredness
• Frequent urination and thirst
• Blurred vision
• Dehydration.

Do you have a plan for those days when you don’t feel well? You may need to consider what medications and actions to take during sick days. If you are very unwell, one or more diabetes medications may need to be temporarily stopped. Your doctor and diabetes educator can make you an individualised plan for your sick days.

Read more on sick day planning

Medications for respiratory tract infections

Antibiotics

Getting better with respiratory tract infections is less likely to include antibiotic treatments. Antibiotics will act only on bacterial infections by killing or slowing bacterial growth, allowing your immune system to clean up and mend. If you have a respiratory tract infection, it is often viral and not able to be treated with antibiotics. For a viral infection, antibiotics will not help you get better faster, stop an illness from getting worse, or prevent spreading a virus. 

Using antibiotics when you don’t need them may lead to antibiotic resistance, so your doctor will not prescribe antibiotics at first. Antibiotic resistance may mean that if you have a severe infection in the future, such as bacterial pneumonia, antibiotics may not work as well for you. If you are prescribed antibiotics, follow your doctor’s directions on when, how, and how long to take them. Don’t be tempted to share antibiotics with someone else. Always return any leftover antibiotics to your pharmacy.

Pain and fever medications

• Paracetamol and ibuprofen are common ingredients in cold and flu medicines available without a prescription. If you are already taking pain medication, check you are not doubling up. 
• An important point is paracetamol slow release 665mg is often taken for osteoarthritis at the highest allowable dose. If this applies to you, do not add extra paracetamol in any other preparation. 
• Ibuprofen or aspirin may not be suitable if you have stomach issues, kidney damage, or if using a prescription anti-inflammatory or blood thinner. Check this with your pharmacist.

Decongestants

• Pseudoephedrine and phenylephrine will raise blood glucose levels and increase blood pressure. Our Australian medication supervisor, the Therapeutic Goods Administration (TGA), suggests caution for use in people living with diabetes.
• Nasal sprays work directly on the nasal cells with very little absorbed into your bloodstream – only a small amount of drug is required for a direct local effect. Nasal sprays will have little or no effect on your blood glucose levels. Nasal sprays may contain decongestants such as oxymetazoline and ipratropium, which can be used for three to five days. Ongoing use is not recommended due to rebound congestion. Hayfever symptoms may require steroid sprays for short or long periods. Saline sprays (salt water) are an option for congestion with or without other sprays or oral medications.
• Antihistamines may be helpful in tablet form or as nasal sprays. Some of the sedating antihistamines could be useful at night for their drying effect and hayfever symptoms. Non-sedating antihistamines may be an alternative to using phenylephedrine if you only have hayfever symtoms.

Cough preparations

• Cough syrups, tablets or lozenges may contain ingredients such as guaiphenesin, dextromethorphan, ivy leaf, senega and ammonia. These ingredients will not directly affect your blood glucose levels. Mixtures may contain sugar or honey, natural sugar sources. Consider how much sugar is in a dose, it is often minimal. If you use a sugary mixture or lozenge, please consider brushing your teeth more often. Prolonged exposure to sugar can increase dental carries and gum disease risk. Many of the currently available mixtures and lozenges are sugar-free.
• Herbal preparations in liquid or lozenge formulation may not directly affect your symptoms. They may assist in reducing the duration of illness; however, they often do not have reliable proof to recommend their use. Whether chemical or herbal, all ingredients must be considered drugs. All preparations can have serious interactions with your medications. Please check with your pharmacist that they are suitable for you before use. 

Old fashioned remedies

Old-fashioned remedies are often the best. Consider using chest rubs and inhalations or nasal rinses to clear congestion. Ask your pharmacist for recommendations on how to use these effectively. It would be best to rest and drink plenty of water and non-alcoholic fluids. Avoid smoking and exposure to cigarette smoke.

You can help soothe a sore throat by gargling with warm salty water or sucking on an ice cube or a non-medicated throat lozenge. Hot water with honey and lemon may also help.

Please check what is suitable for you before taking any non-prescription medications, especially if you are pregnant, taking blood thinners or sedating medications, have a heart condition, kidney damage or liver damage. Taking the wrong medication, even when it is from the supermarket aisle, can damage your overall health. 

By Donna Itzstein, Pharmacist and Credentialled Diabetes Educator