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Olanzapine Diabetes Reversible

Medicationinduced Diabetes Mellitus

Medicationinduced Diabetes Mellitus

Department of Pediatrics, University of Virginia, Charlottesville Corresponding Author: David R. Repaske, Department of Pediatrics, University of Virginia, Charlottesville, VA ( Department of Pediatrics, University of Virginia, Charlottesville Corresponding Author: David R. Repaske, Department of Pediatrics, University of Virginia, Charlottesville, VA ( Please review our Terms and Conditions of Use and check box below to share full-text version of article. I have read and accept the Wiley Online Library Terms and Conditions of Use. Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. Epidemiological studies and case reports have demonstrated an increased rate of development of diabetes mellitus consequent to taking diverse types of medication. This review explores this evidence linking these medications and development of diabetes and presents postulated mechanisms by which the medications might cause diabetes. Some medications are associated with a reduction in insulin production, some with reduction in insulin sensitivity, and some appear to be associated with both reduction in insulin production and insulin sensitivity. A variety of medications have been associated with development of diabetes. Establishing a precise cause and effect relationship between a medication and development of diabetes is challenging for several reasons. Side effects of most medications are rare and clinical studies of medications typically evaluate effectiveness and are not powered to evaluate side effects. Diabetes is a common disease and there is always a question of whether it would have developed if the person had not taken the medication in question. Patients are often taking multiple medications and so it is hard to determine w Continue reading >>

Diabetic Control And Atypical Antipsychotics: A Case Report

Diabetic Control And Atypical Antipsychotics: A Case Report

Gaston et al; licensee BioMed Central Ltd.2008 People with schizophrenia are at increased risk of developing metabolic disturbances. This risk may be further exacerbated by the use of antipsychotic agents. Research is still ongoing to determine the metabolic impact of antipsychotics on glucose regulation. In this case report we review some of the possible mechanisms of action of antipsychotic medication on glucose regulation. We present the case of a 50-year-old man diagnosed with paranoid schizophrenia who developed type 2 diabetes mellitus whilst on treatment with second generation antipsychotics (SGA). His diabetes was controlled by a combination of antidiabetic drugs that were associated with his psychotropic treatment. Due to deterioration in his mental state, the patient was admitted on two occasions to a psychiatric unit during which his prescribed medication (olanzapine and risperidone) was discontinued and changed to aripiprazole. On both occasions, the patient suffered hypoglycaemic episodes and his antidiabetic treatment had to be adjusted accordingly. The patient did not require any antidiabetic treatment whilst on aripiprazole during the follow up period. Clinicians face regular dilemmas in trying to find the right balance between achieving control over a patient's mental illness and reducing any adverse effects associated with the prescribed medication. In patients receiving concomitant antidiabetic therapy, caution should be exercised when changing from one SGA to another. Whilst more longitudinal data are required, a trial of alternative SGAs, including aripiprazole in those developing type 2 diabetes and impaired glucose tolerance may be a worthwhile therapeutic option. MetforminClozapineRisperidoneOlanzapineAripiprazole Second generation antipsychotic Continue reading >>

Which Atypical Antipsychotics Carry The Highest Risk For Diabetes?

Which Atypical Antipsychotics Carry The Highest Risk For Diabetes?

Which Atypical Antipsychotics Carry the Highest Risk for Diabetes? If you are unfamiliar with antipsychotics, my article, Psychosis 101 , has a detailed description of the medications and how they work. The following information on diabetes risk in antipsychotic medications comes from two papers from the Journal of Clinical Psychiatry: Antipsychotic Medications: Metabolic and Cardiovascular Risk by Dr. John W. Newcomer and Switching Antipsychotics as a Treatment Strategy for Antipsychotic-Induced Weight Gain by Dr. Peter J. Weiden. Both researchers show conclusive evidence that the risk of diabetes from certain antipsychotics is high and must be addressed immediately within the entire healthcare community. There are six atypical antipsychotics in use today: (a newer antipsychotic called Saphris was not a part of the metabolic syndrome studies cited in the article.) Numerous and well-documented studies have shown a serious and potentially dangerous connection between certain second generation antipsychotics and the risk of diabetes because of their connection to metabolic syndrome. Those atypical antipsychotics with the highest risk for developing diabetes are: In a major NIMH study (the CATIE project), Zyprexa was associated with relatively severe metabolic effects. Subjects taking Zyprexa showed a major weight gain problem and increases in glucose, cholesterol, and triglycerides. The average weight gain over the 18-month study period was 44 pounds. Abilify and Geodon do not have a significant risk of metabolic syndrome and thus are not considered a diabetes risk (although the FDA has ordered all makers of antipsychotic drugs to include a warning about a possible link with diabetes on their product label). The term high-risk antipsychotics used throughout this article Continue reading >>

3 Schizophrenia Drugs May Raise Diabetes Risk, Study Says

3 Schizophrenia Drugs May Raise Diabetes Risk, Study Says

U.S. |3 Schizophrenia Drugs May Raise Diabetes Risk, Study Says Three drugs commonly prescribed for schizophrenia and other psychotic illnesses increased patients' risk of developing diabetes when compared with older antipsychotic medications, researchers said yesterday, presenting the results from a long-awaited study of patients treated at veterans hospitals and clinics across the country. The drugs -- Zyprexa, made by Eli Lilly, Risperdal, made by Jannsen Pharmaceutica, and Seroquel, made by AstraZeneca -- were associated with higher rates of diabetes than older generation drugs for schizophrenia like Haldol, the study found. But the increased risk was statistically significant only for Zyprexa and Risperdal, the researchers said, possibly because of the smaller number of subjects who took Seroquel. Younger patients, under age 54, who took Zyprexa or Risperdal showed the highest risk of developing diabetes, the study, led by Francesca Cunningham of the Department of Veterans Affairs at the University of Illinois at Chicago, found. The results add to a growing number of reports linking Type 2 diabetes to some drugs in the class of antipsychotics known as atypicals. ''These findings are absolutely consistent with everything we've looked at and seen,'' said Robert Rosenheck, a professor of psychiatry and public health at Yale and an author of an earlier study that found an increased risk of diabetes with Zyprexa, Risperdal, Seroquel and Clozaril, made by Novartis. Experts said the new findings underscored the need for patients who take the drugs and doctors who prescribe them to be alert for the symptoms of diabetes, including increased thirst, frequent urination, increased appetite and rapid weight gain. Atypical antipsychotics, studies indicate, are less likely than Continue reading >>

Antipsychotics Inhibit Glucose Transport: Determination Of Olanzapine Binding Site In Staphylococcus Epidermidis Glucose/h+ Symporter

Antipsychotics Inhibit Glucose Transport: Determination Of Olanzapine Binding Site In Staphylococcus Epidermidis Glucose/h+ Symporter

The antipsychotic drug olanzapine inhibits the glucose transport of a GLUT4 homologue. Olanzapine binds in a newly discovered site at the cytosolic side of the glucose transporter. Olanzapine inhibits the glucose transporter by locking it in the inward-facing conformation. The antipsychotic drug olanzapine is widely prescribed to treat schizophrenia and other psychotic disorders. However, it often causes unwanted side effects, including diabetes, due to disruption of insulin-dependant glucose metabolism through a mechanism yet to be elucidated. To determine if olanzapine can affect the first step in glucose metabolism glucose transport inside cells we investigated the effect of this drug on the transport activity of a model glucose transporter. The glucose transporter from Staphylococcus epidermidis (GlcPSe) is specific for glucose, inhibited by various human glucose transporter (GLUT) inhibitors, has high sequence and structure homology to GLUTs, and is readily amenable to transport assay, mutagenesis, and computational modeling. We found that olanzapine inhibits glucose transport of GlcPSe with an IC50 0.90.1mM. Computational docking of olanzapine to the GlcPSe structure revealed potential binding sites that were further examined through mutagenesis and transport assay to identify residues important for olanzapine inhibition. These investigations suggest that olanzapine binds in a polar region of the cytosolic part of the transporter, and interacts with residues R129, strictly conserved in all GLUTs, and N136, conserved in only a few GLUTs, including the insulin-responsive GLUT4. We propose that olanzapine inhibits GlcPSe by impeding the alternating opening and closing of the substrate cavity necessary for glucose transport. It accomplishes this by disrupting a key s Continue reading >>

The Last Psychiatrist

The Last Psychiatrist

Why Zyprexa (And Other Atypical Antipsychotics) Make You Fat this post does not apply to her, she only eats apples Strange finding : Zyprexa makes free fatty acids level go down. II. Zyprexa's effects on glucose and insulin are bad. In a rat study of rats, using rats, Zyprexa raised glucose levels by 20%, both in fed and fasting states. It didn't much increase insulin in fed states (already high) but it kept insulin high even in fasting states: at 14h post meal, it was 140% higher than it should have been. All that exposure to insulin, for so long. At the coffee cart, we doctors would call that bad. III. Zyprexa's effect on triglycerides is... weird. Zyprexa made circulating triglyceride levels fall-- it promoted the uptake of free fatty acids by various tissues: All those tissues taking up fatty acids-- what did they do with it? IV. Zyprexa Makes Your Body Use Fat, Not Carbs, As Fuel Normally, after eating, your body uses carbohydrate as the main energy source. After a long time hungry, it switches to fat. Zyprexa made the body use fat all the time: RER (respiratory exchange ratio) tells you what's being used: 1= carbs, 0.85= carb/fat mix, and .7 is all fat. You eat, and your body uses carbs. After a few hours, your body switches to fat utilization. In graph A, in the first 3 hours the body should have been using carbs and fat; but with Zyprexa, it was preferring mostly fat. In graph B, every time you got a Zyprexa dose, your body switched to fat utilization instead of carbs. V. Wait a second, why would increased utilization of fat be a bad thing? If the body is churning through the fat, what do you think it is doing with all the sugar? Answer: turning your arteries into Twizzlers. Yum! The typical thinking is that hyperglycemia leads to insulin resistance leads to in Continue reading >>

Olanzapine - Wikipedia

Olanzapine - Wikipedia

Urine (57%; 7% as unchanged drug), faeces (30%) [3] [4] Olanzapine (originally branded Zyprexa) is an antipsychotic medication used to treat schizophrenia and bipolar disorder . It is usually classed with the atypical antipsychotics , the newer generation of antipsychotics. [5] It appears to have slightly greater effectiveness in treating schizophrenia (especially the negative symptoms ) and a lower risk of causing movement disorders than typical antipsychotics . [6] Olanzapine, however, has a higher risk of causing metabolic side effects like weight gain and type 2 diabetes than the typical antipsychotics. [5] [6] Olanzapine is believed to work by blocking, or antagonizing, the dopamine D2 receptor , an effect it shares with most antipsychotics. [7] Like most other atypical antipsychotics, olanzapine also strongly antagonizes the 5-HT2A receptor , which may partially underpin its reduced propensity for causing movement disorders. [7] Olanzapine was first patented in 1971. [8] The drug became generic in 2011. Sales of Zyprexa in 2008 were $2.2 billion in the US , and $4.7 billion worldwide. [9] The first-line psychiatric treatment for schizophrenia is antipsychotic medication; olanzapine is one such medication. [10] Olanzapine appears to be effective in reducing symptoms of schizophrenia, treating acute exacerbations, and treating early-onset schizophrenia. [6] [11] [12] [13] The usefulness of maintenance therapy, however, is difficult to determine as more than half of people in trials quit before the six-week completion date. [14] Treatment with olanzapine (like clozapine ) may result in increased weight gain and increased glucose and cholesterol levels when compared to most other second-generation antipsychotic drugs used to treat schizophrenia. [15] [11] National In Continue reading >>

Drug Induced Diabetes

Drug Induced Diabetes

Tweet A number of medications have side effects which include the raising of blood glucose levels. Drug induced diabetes is when use of a specific medication has lead to the development of diabetes. In some cases the development of diabetes may be reversible if use of the medication is discontinued, but in other cases drug-induced diabetes may be permanent. Drug induced diabetes is a form of secondary diabetes, in other words diabetes that is a consequence of having another health condition. Which drugs can induce diabetes? A number of drugs have been linked with an increased risk development of type 2 diabetes. Corticosteroids Thiazide diuretics Beta-blockers Antipsychotics Is diabetes permanent? Diabetes may not be permanent but this can depend on other health factors. With some medications, blood glucose levels may return back to normal once the medication is stopped but, in some cases, the development of diabetes may be permanent. Managing drug induced diabetes If you need to continue taking the medication that has brought on diabetes, it may make your diabetes more difficult to control than would otherwise be the case. If you are able to stop the course of medication, you may find your blood glucose levels become slightly easier to manage. Following a healthy diet and meeting the recommended exercise guidelines will help to improve your chances of managing your blood glucose levels. Can drug induced diabetes be prevented? It may be possible to reduce the risk of developing diabetes by ensuring you to keep to a healthy lifestyle whilst you are on the medication. Being on smaller doses of the medication or shorter periods of time may help to reduce the likelihood of developing high blood sugar levels and diabetes. Doctors will usually try to put you on the smallest e Continue reading >>

Assessment And Management Of Atypical Antipsychotic-induced Metabolic Abnormalities

Assessment And Management Of Atypical Antipsychotic-induced Metabolic Abnormalities

Assessment and Management of Atypical Antipsychotic-Induced Metabolic Abnormalities Northeastern Ohio Universities College of Pharmacy Northeastern Ohio Universities College of Pharmacy Northeastern Ohio Universities College of Pharmacy Atypical or second-generation antipsychotics (SGAs) have become the mainstay of therapy for treating schizophrenia since their emergence in the 1990s. These medications have largely replaced the use of typical or first-generation antipsychotics (FGAs), as they have demonstrated similar efficacy with minimal to no extrapyramidal symptoms (EPS) at therapeutic doses. However, SGAs have gained much notoriety for causing metabolic derangements including weight gain, dyslipidemia, and hyperglycemia including new-onset type 2 diabetes mellitus (T2DM). These adverse effects are all risk factors for cardiovascular disease, and along with lifestyle and genetic components, contribute to the decreased lifespan of patients with schizophrenia.1 Therefore, it is important to fully assess, and inform patients of, the risks versus the therapeutic benefit of these agents. Clozapine (Clozaril), the first atypical antipsychotic, was approved for use by the FDA in 1989. Currently, there are eight other SGAs indicated for the treatment of schizophrenia: aripiprazole (Abilify), asenapine (Saphris), iloperidone (Fanapt), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon). Although widely used in schizophrenia, SGAs are also used for other psychiatric disorders including bipolar disorder, major depressive disorder, and autism.2 SGAs demonstrate their efficacy by antagonizing the D2 receptors in the mesolimbic and mesocortical dopamine tracts in the brain. It is thought that dopaminergic dysfunct Continue reading >>

Zyprexa Toxicology Litigation Support Consultox

Zyprexa Toxicology Litigation Support Consultox

Anti-psychotics including Clozapine, olanzapine, Quetiapine, and risperidone have been reported to increase the risks of elevated blood sugar and diabetes. There is a very significant literature database that suggests that olanzapine (Zyprexa) seriously increases the risk of hyperglycemia, diabetic ketoacidosis, and death. While the induction of Type 2 diabetes may be reversible after discontinuing the drug, untreated diabetic ketoacidosis is fatal. On March 1, 2004, Eli Lilly, the manufacturer of Zyprexa, proclaimed a safety alert and indicated a label change for the drug warning against possible increased risk of hyperglycemia and diabetes in patients taking this medication. Possible mechanisms for this adverse reaction include excessive weight gain associated with insulin resistance, inhibition of glucose transport, alpha-2-adrenergic inhibition of insulin release, and blockade of pancreatic beta-cell 5HT[1A] receptors. Dr. Parent has consulted on a Zyprexa death case and has opined that there is a causal relationship between Zyprexa and diabetic ketoacidosis with subsequent death. Dr. Parent believes that there is sufficient support in the published literature for the construction of a causation report that will survive a Daubert challenge. Selected references on this subject are provided below. Ai, D., Roper, T. A. and Riley, J. A., Diabetic ketoacidosis and clozapine. Postgraduate Medical Journal, 74(874), 493-494 (1998). Ananth, J., Parameswaran, S. and Gunatilake, S., Side effects of atypical antipsychotic drugs. Current Pharmaceutical Design, 10(18), 2219-2229 (2004). Avella, J., Wetli, C. V., Wilson, J. C., Katz, M. and Hahn, T., Fatal olanzapine-induced hyperglycemic ketoacidosis. American Journal of Forensic Medicine and Pathology, 25(2), 172-175 (2004). Be Continue reading >>

(pdf) Hyperglycemia - Induced By Olanzapine

(pdf) Hyperglycemia - Induced By Olanzapine

including liver, thyroid and kidney function tests discontinued and he was kept on Fluvoxamine 100 mg tab. The elevated blood glucose showed resistance to insulin sliding scale and remained high for a few days. Oral hypoglycemic agent, Gliclazide 80 mg tab/bid was added to insulin coverage. Three days later, his blood glucose was still not controlled (19 mmol/L) and the Gliclazide dosage was increased to 100 mg tab/bid. Four days later Metformin 500 mg tab/bid was added to insulin sliding scale and Gliclazide tab. The fasting blood sugar level was decreased to 8 mmol/L within 3 discontinued and Olanzapine was replaced by Risperidone 4 mg/day. After one month of follow- up, fasting and random blood sugar were still within normal range, Gliclazide and Metformin tab were stopped. Three months later diabetic diet was replaced with normal diet. Regular follow-up continued; first weekly, then bimonthly to monitor fasting and random blood sugar. The patient body weight was 100 kg at the start of Olanzapine drug therapy and increased to 102 kg when severe hyperglycemia developed. The last evaluation of the patient was carried out in August 2004. The patient onset. So close monitoring of blood glucose is necessary after initiation of Olanzapine to detect hyperglycemia. One of the major limitations in this report, the concomitant drug effect of Olanzapine and Fluvoxamine contributed to the hyperglycemia, In conclusion, Olanzapine can possibly increase the risk of acquiring type II diabetes, which is not dose dependent and is reversible. A family history of diabetes mellitus is considered as a risk factor. Florid hyperglycemia could not be explained in this case by the postulated weight gain as a risk factor. Routine monitoring of blood glucose level is necessary in patients rece Continue reading >>

Olanzapine-induced Severe Hyperglycemia Was Completely Reversed By The Restoration Of Insulin Secretion After Switching To Aripiprazole And Initiating Insulin Therapy

Olanzapine-induced Severe Hyperglycemia Was Completely Reversed By The Restoration Of Insulin Secretion After Switching To Aripiprazole And Initiating Insulin Therapy

Corresponding Author: Dr. Masaru Nakamura, M.D., Ph.D., 10-1, Kusatsu-Umegadai, Nishi Ward, Hiroshima City, Japan, Tel: 082-277-1001, Fax: 082-277-1008 E-mail: [email protected] Olanzapine-induced severe hyperglycemia was completely reversed by the restoration of insulin secretion after switching to aripiprazole and initiating insulin therapy Masaru Nakamura, M.D., Ph.D.,1 Yukari Masaoka, M.D.,2 1: Department of Psychiatric Internal Medicine, Kosekai-Kusatsu Hospital, Hiroshima, Japan 2: Department of Psychiatry, Kosekai-Kusatsu Hospital, Hiroshima, Japan 3: Department of Psychiatric Internal Medicine, Shinseikai-Ishii Memorial Hospital, Iwakuni, Japan A 54-year-old Japanese man who had received a diagnosis of schizophrenia and been treated with olanzapine for nearly 16 months consulted our department because of severe hyperglycemia (535 mg/dL). The use of antipsychotics, switching the patient from olanzapine to aripiprazole, and 7 weeks of insulin therapy resulted in a decrease in the patients postprandial blood glucose levels and an increase in his postprandial C-peptide levels (442 mg/dL to 106 mg/dL and 1.72 ng/mL to 4.94 ng/mL, respectively) as well as an improvement in his pre-prandial levels (250 mg/dL to 85 mg/dL and 1.00 ng/mL to 1.69 ng/mL, respectively) with almost no change in the 24- hour urinary excretion of C-peptide. These results suggested that an insufficiency of insulin secretion, not insulin resistance, was associated with the patients severe hyperglycemia, and that olanzapine-induced pancreatic -cell impairment might be reversible if the hyperglycemia is diagnosed and treated sufficiently early. When prescribing second-generation antipsychotics such as olanzapine, clinicians should take the level of insulin into account in addition to mon Continue reading >>

Can Olanzapine Make You Diabetic?

Can Olanzapine Make You Diabetic?

Olanzapine is an atypical antipsychotic that has been widely used because of its better clinical efficacy, superior activity against negative symptoms, lesser extra-pyramidal symptoms, and better tolerability profile compared to typical antipsychotics. Recently, a flurry of reports have stated that olanzapine is associated with high blood sugar levels in new onset or pre-existing diabetes mellitus and ketoacidosis, which may be reversible after discontinuation of olanzapine. The exact cause of glucose dysregulation by olanzapine is not clear. It has been hypothesized that 5-HT1 antagonism may decrease the responsiveness of the pancreatic beta cells, thus reducing the secretion of insulin and causing hyperglycemia. In vivo studies suggest that olanzapine impairs glycogen synthesis via inhibition of the classical insulin signaling cascade and this inhibitory effect may lead to the induction of insulin resistance in olanzapine-treated patients. Since olanzapine is becoming more and more popular as a first line agent in the treatment of psychosis as well as in mood disorders, proper guidelines have to be established for monitoring blood glucose levels and determination of risk factors for diabetes mellitus. Hence, it is very important for clinicians that all patients started on olanzapine require regular monitoring of their blood sugar levels. Clinicians should take at most precaution in pre-existing diabetic patients before starting olanzapine. If olanzapine is suspected to being a causal factor for hyperglycemia, we can reduce that risk by withdrawal of olanzapine or switching over to some other medicines without worsening the psychiatric condition of patient. India being a diabetes rich country; the author strongly suggests at least a baseline survey should be undertaken Continue reading >>

Reversibility Of Antipsychotic Treatmentrelated Diabetes In Patients With Schizophrenia

Reversibility Of Antipsychotic Treatmentrelated Diabetes In Patients With Schizophrenia

Reversibility of Antipsychotic TreatmentRelated Diabetes in Patients With Schizophrenia A case series of switching to aripiprazole 1University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium 2Department of Epidemiology and Public Health, University of Liege, Liege, Belgium 3Division of Diabetes, Nutrition and Metabolic Disorders, Faculty of Medicine, University Liege, Liege, Belgium Address correspondence to Marc De Hert, Leuvense Steenweg 517, 3070 Kortenberg, Belgium. E-mail: marc.de.hert{at}uc-kortenberg.be Diabetes Care 2006 Oct; 29(10): 2329-2330. A case series of switching to aripiprazole At present, antipsychotic drugs are not specifically referred to in the list of substances that can induce diabetes in the most recent American Diabetes Association guidelines ( 1 ), but there is a growing body of evidence that antipsychotic drugs might have diabetogenic properties ( 2 , 3 ). At present, there are no clear guidelines on what the best therapeutic strategies are when diabetes is detected during treatment with antipsychotics. Data from pharmacovigilance studies suggest that a significant proportion of recent-onset cases of diabetes can be reversed. Recent Belgian guidelines for screening and monitoring patients treated with antipsychotics propose a switch to an antipsychotic with a safer metabolic profile, but this strategy has not been evaluated systematically ( 3 ). We have recently reported on five patients with treatment-emergent diabetes who were successfully switched to a more suitable antipsychotic, which resulted in the reversal of diabetes (to risperidone in one patient [ 4 ] and amisulpride in four patients [5]). Since aripiprazole, a second-generation antipsychotic agent described as having a good metabolic profile ( 6 8 ), became Continue reading >>

Sound Mind, But Sweet Blood: Olanzapine Induced Hyperglycaemia

Sound Mind, But Sweet Blood: Olanzapine Induced Hyperglycaemia

Sound mind, but sweet blood: olanzapine induced hyperglycaemia Gideon Mlawa, Rakhi Seth, Sandeep Deshmukh & Patrick Sharp Southampton General Hospital, Southampton, UK. Background: Atypical antipsychotic agents are useful in treating patients with schizophrenia and other psychoses, but may cause hyperglycaemia. Hyperglycaemia is not dose dependent and is reversible on stopping the treatment. Occurrence of diabetes after atypical antipsychotic drug administration is of major concern as patients may not recognise their symptoms, and health workers may fail to reach an early diagnosis, with major implications for morbidity and mortality. The effect and ability of various atypical antipsychotic drugs to cause diabetes is debatable. The current available evidence seems to indicate that olanzapine and clonazapine have the highest propensity to induce diabetes compared to other atypical antipsychotics. We present a case of a 37-year-old lady with advanced Huntingtons chorea who was admitted after general deterioration at home over 3 days, with loss of appetite, high temperature, worsening of chorei form movements, urinary frequency and reduced level of consciousness. On admission she was found to be in significant metabolic acidosis (pH 7.22), hyperglycaemic (glucose 73.3 mmol/l), renal failure and hypernatraemic (Na+170). Inflammatory markers were raised (WCC 23.6, CRP 42) and her urine dipstick was positive for blood, protein, glucose, and ketones. She was treated for urinary sepsis with IV antibiotics, IV fluids and insulin sliding scale. There was no family history of diabetes. She was on olanzapine 20 mg once/day started 2 years prior to admission as well as sulpiride 200 mg mornings, and 600 mg evenings. She was discharged home on insulin (Mixtard 30) 34 units morning, Continue reading >>

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