Diabetes Talking

Question:

I’m looking for information on new onset diabetes arising from treatment with atypical anti-psychotic medications such as Zyprexa, Risperdal, Clozaril, Seroquel, etc.

Zeke (and all the diabetics out there), You bring up an interesting topic. I’ll post what I’ve been able to find in a quick search using Google ( www.Google.com ) in the hopes that you’ll format your results into ASCII and upload them to the diabetes groups. I also may have screwed up in my search because I’m used to AAA meaning Abdominal Aortic Aneurysm, not Atypical Antipsychotic Agents. (Can’t pass up a chance for a good joke – What’s the greatest problem facing medicine today? The finite number of 2, 3, and 4 letter acronyms. Ok, I think it’s hysterical….) Since I’m mostly writing for the folks in the diabetes forums, you’ll pardon me if I take the time to explain to them what we’re talking about. Schizophrenia and related disorders are difficult to treat. The disease itself leaves the patient with the illusion that they are very clear thinking. Even with the best drugs, the patients tend to complain that treatment leaves them feeling "thick headed." There are some other really nasty side effects, including tardive diskinesia, neuroleptic malignant syndrome, parkinson-like effects, etc. Now, you’ll understand how bad a disease schizophrenia can be when you consider that they still use these drugs! Man, if you think being a diabetic sucked…. The effects are so bad that the folks in the mental and medical health fields have a nickname for them – "shitnizines." (See, most of the drugs end in "zine".) A couple years ago, they found a drug called Clozapine (aka Clozaril). I’ll forego the laundry jokes. Schizophrenics put on this drug reported that it was if they had "woken up." The drug was a miracle cure, until someone noticed the occupance of agranulocytosis. Agranulocytosis is such bad news that patients developing it were removed from the drug, despite the lack of a clear alternative. If you’ve ever read "Flowers for Algernon," then you can imagine the hell these patients were sentenced to. Many wished to continue the drug despite the fact that it would kill them, but the medical community refused. Other Atypical Anti-psychotic Agents have been developed, but nothing with the success of Clozapine. You can see why everyone wants to find the new wonder drug. Well, it seems that there are some case reports of diabetes and diabetic ketoacidosis (DKA) popping up with the newer drugs. Is this just bad luck, or are the drugs causing the problems (or at least turning potential Type IIs into actual Type IIs)? That’s the $64 billion question – quite possibly literally. Even the ‘zines have a tendency to cause diabetes – they seem to encourage weight gain. Now, if you’ve been paying attention to my rants or just about anything on diabetes, you’ll understand the correlation. Primary Psychiatry, May 2000, Vol 7, No 5 has a review of the problem. There are several research programs that are taking AAA patients and checking insulin sensitivity. Those found to be diabetic or IGT (Impaired Glucose Tolerance) will be helped onto a different med if it is discovered during the test. Then again, if you’re one of the folks who’d rather die than go off the Clozapine, diabetes may, in fact, be an acceptable risk. This research is important. While you’d think it wouldn’t matter much to diabetics, it actually might. See, schizophrenia is thought to pretty much show up during the late teens to young adult age group. If it happens when you’re 40, they don’t call it schizophrenia any more. But it does happen, and the treatment for the adult onset is the same as for schizophrenia. Also, with Type IIs developing in 12 year olds, there may be a dramatic need to find out if these drugs will make diabetes worse. BTW: I didn’t describe schizophrenia to the diabetic folks. It’s not multiple personality disorder as it is commonly portrayed in the media and a certain Jim Carey movie. (Yes, I know, MPD is not a specific diagnosis in DSM-4. This article’s already long – you want 10 more pages?) Schizophrenics are the ones that hear voices. They rarely see things. Often they will interpret events as having personal meaning for the person- the weather man on the TV reports rain tomorrow, so that means I have to collect cans in the neighborhood.  Delusions are common, with a particular subtype including paranoid delusions. For example, some believe that the 4th Invader fleet on Mars have set up Eli Lilly and the Psychiatrists in an attempt to enslave mankind using psychoactive drugs. Again, you can see why compliance is such an issue with these patients. Most schizophrenics are non-violent, but the violent ones get the press. Often, it’s used as a defense excuse. David Berkowitz, the Son of Sam, admitted to an FBI profiler that the schtick about the dog was complete crap. Schizophrenics can become agitated. Output as well as input functions of the brain can be messed up. "Clanging speech" is characteristic. It’s a speech pattern where…heck, I can’t describe it. It’s incredibly hard to understand what they are attempting to say when they are clanging. Word sounds – onomatopoeia, alliteration, rhyme are often more important than meaning. Like I said, if you think being a diabetic sucks, this one has us beat hands down. The worst thing is, there are no great treatments. As an article in the Pittsburgh Post Gazette today points out, with the destruction of the adolescent intake units in most psych hospitals, these young patients are mostly funneled into juvenile detention facilities where they receive neither proper medical nor psychological help. I’m not sure if anyone cares or if this helps. Rob

Response:

snip I’m not sure if anyone cares or if this helps. Rob

Rob, Thank you very much. This was just the right amount of information for me and a suggestion for where to go for more when I have the time. Thank you very much. It is helpful and much appreciated! — Theresa low-carbing at last! dx ‘98 t2 insulin, diet & exercise 6.1% Being happy doesn’t mean everything’s perfect, it just means you’ve decided to see beyond the imperfections.

Response:

I’d like to know what you find out…I had someone on Risperdal who had same concerns. Aimee

– Hide quoted text — Show quoted text – I’m looking for information on new onset diabetes arising from treatment with atypical anti-psychotic medications such as Zyprexa, Risperdal, Clozaril, Seroquel, etc. This is for a pharmacy college project. Any information, contacts, or links would be greatly appreciated! Thank you, Thomas E. Tamayo

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I’m looking for information on new onset diabetes arising from treatment with atypical anti-psychotic medications such as Zyprexa, Risperdal, Clozaril, Seroquel, etc. This is for a pharmacy college project. Any information, contacts, or links would be greatly appreciated! Thank you, Thomas E. Tamayo

I’d like to find out this info as well. Where can we obtain your reports or reports such as these? Theresa

Response:

I hope this student finds something — students are supposed to be doing their own research! and if he can’t find anything, either it’s not there to be found or he needs to improved his research methods. There are people at colleges who can help with this part of his education — they’re called research librarians (or similar). "tlfrost" wrote … "Zeke"  wrote … I’m looking for information on new onset diabetes arising from

treatment with atypical anti-psychotic medications such as Zyprexa, Risperdal, Clozaril, Seroquel, etc. This is for a pharmacy college project. Any information, contacts,

or links would be greatly appreciated! I’d like to find out this info as well. Where can we obtain your

reports or reports such as these? – Hide quoted text — Show quoted text –

Response:

I would add that you need to be very careful in looking at the sponsors of any studies you are researching for this project. The risk of diabetes associated with atypicals is turning into a huge marketing issue; much of what you’re likely to read in the professional literature, especially in review articles and journal "supplements," is produced by pharmaceutical marketers to support the sales of their medications. Not to say that all the information is biased or incorrect; just something to keep in mind when reading the studies or reviews. – Hide quoted text — Show quoted text – Please tell me you are looking elsewhere first, and this is a "survey question".  Are you asking people to state if they, or someone they know  has diabetes as a result of using an atypical anti-psychotic? This is a great place to get info from people who deal with diabetes. People will help you if they can. However, being in pharmacy college, you should be looking to primary information.  You may get some response…but I seriously hope you have adverse drug reaction sources and are searching primary literature databases, including looking for individual case reports. Are you contacting the companies that manufacture these meds? Dave I’m looking for information on new onset diabetes arising from treatment with atypical anti-psychotic medications such as Zyprexa, Risperdal, Clozaril, Seroquel, etc. This is for a pharmacy college project. Any information, contacts, or links would be greatly appreciated! Thank you, Thomas E. Tamayo

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I’m looking for information on new onset diabetes arising from treatment with atypical anti-psychotic medications such as Zyprexa, Risperdal, Clozaril, Seroquel, etc. This is for a pharmacy college project. Any information, contacts, or links would be greatly appreciated! Thank you, Thomas E. Tamayo

Response:

Please tell me you are looking elsewhere first, and this is a "survey question".  Are you asking people to state if they, or someone they know  has diabetes as a result of using an atypical anti-psychotic? This is a great place to get info from people who deal with diabetes. People will help you if they can. However, being in pharmacy college, you should be looking to primary information.  You may get some response…but I seriously hope you have adverse drug reaction sources and are searching primary literature databases, including looking for individual case reports. Are you contacting the companies that manufacture these meds? Dave – Hide quoted text — Show quoted text – I’m looking for information on new onset diabetes arising from treatment with atypical anti-psychotic medications such as Zyprexa, Risperdal, Clozaril, Seroquel, etc. This is for a pharmacy college project. Any information, contacts, or links would be greatly appreciated! Thank you, Thomas E. Tamayo

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