Many of us don’t even think about our blood sugar levels when we’re scrabbling through the medicine cabinet, looking for a pain reliever. We just want to make the pain disappear—stat. But people with diabetes do need to take that matter into consideration when they’re taking any medication. If you have type 2 diabetes, your doctor or diabetes educator has probably warned you to be vigilant about the effects that that your diet, your activity level, and any other medication you take on a regular basis can have on your blood sugar levels. You also need to be careful about any pain relieving medication that you take, even if it’s just on an occasional basis, because certain types of pain killers can lower or raise your blood sugar levels. NSAIDs There are times when you can easily treat pain with an over-the counter pain reliever. You may take a low dose of aspirin or a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen to relieve the occasional headache or muscle pain. A regular dose is unlikely to affect your blood sugar levels, but a higher-than-usual dose may lower your blood sugar level. Talk to your doctor about what’s an appropriate dose for your occasional aches and pains so you don’t accidentally cause an episode of hypoglycemia. Another word of caution. You might have settled on an effective dose of a particular pain reliever that won’t drastically alter your blood sugar levels. But your diabetes puts you at elevated risk for certain other health conditions. So you may have other medical conditions you need to manage—and you will need to watch out for the effect any pain killers you take can have on those. For example, NSAIDS like ibuprofen and naproxen can increase your blood pressure. And they can affect your kidneys, too, which is problematic because diabetes is a leading cause of kidney failure. Salsalate If you have arthritis or other joint pain issues, your doctor might recommend that you take the prescription anti-inflammatory drug known as salsalate. Research has shown that this drug can also lower blood glucose levels, although the Food and Drug Administration (FDA) hasn’t given an official green light to salsalate for this purpose. In fact, experts are considering whether it might make a useful drug for people with type 2 diabetes who need help lowering their blood sugar levels. However, that means that anyone who is already taking it to relieve pain should be aware of this effect—and take any necessary steps to address it. Other Prescription Pain-Relieving Drugs Depending on the type of pain that you experience, your doctor may decide you need something stronger than an NSAID. But it’s still critical to know how that medication may affect your blood sugar levels—and if it might interact with another drug you’re already taking that could also affect your blood sugar levels. A few examples: Duloxetine. The antidepressant duloxetine is one of two drugs approved by the FDA for the relief of pain associated with the painful nerve damage known as diabetic neuropathy. Many people who have had diabetes for many years experience diabetic neuropathy. Keeping good control of your blood sugar levels—keeping them in your target range—is the best strategy you can embrace to reduce the development of diabetic neuropathy. Duloxetine medication can also raise your blood sugar levels, so you will want to closely monitor your levels if your doctor prescribes this for you. Pregabalin. The other med with specific FDA approval for diabetic neuropathy is the anticonvulsant pregabalin. But if you’re taking a drug like thiazolidinedione to lower your blood sugar levels, your doctor will likely not want you to take pregabalin, because they can interact or cause your body to retain extra fluid, putting extra strain on your heart. Opioids. Opioids can be very effective in knocking out moderate to severe pain. But there can be downsides to that relief. Recent research in JAMA Internal Medicine warned that an opioid painkiller known as tramadol may be more likely to cause your blood sugar levels to drop dangerously low, causing hypoglycemia. The bottom line is that everyone should exercise caution when taking any medication to relieve pain. You should familiarize yourself with common side effects and possible drug interactions. Clearly identify all of your other medications to any doctor prescribing pain relief. And that advice is especially critical for people with diabetes, since they must be vigilant about maintaining good control over their blood sugar levels.