I used to try to lose weight by not taking my insulin, but learned the hard way that it can cause a lot of complications including DKA.
I have two eposides of DKA in which I was place in either ICU or CCU. The first eposide, about 8 months after my diagnosis, I came down with the flu and we werent sure how to treat it. I ended up in CCU for 24 hours and basically comatose. The second time which happened this past April 2007 was because of this fad diet with not taking insulin. It doesnt work as well as some people might think it does. You might lose weight but you also lose muscle mass as well.
I'm only 23 years old and have the starting of neuropathy in my left leg. This is caused from doctor's who didnt know what they are doing. I am finally with a new doctor that understands what he is doing and is a specialist. I still have a regular doctor for everything else but he doesnt deal with my diabetes.
Cherise
Thursday, June 28, 2007
Bipolar and Diabetes
Thursday, June 28th, 2007
6:37pm
Bipolar and Diabetes
People with mental illness have a higher incidence of many medical conditions, including heart disease, asthma and other lung problems, gastrointestinal disorders, skin infections, diabetes, hypertension, migraine headaches, hypothyroidism, and cancer. Bipolar patients are also less likely to receive medical care than people without mental disorders. Substance abuse, including smoking, alcoholism, and drug abuse, also contributes to many of these problems as well as reduced access to care. Medications used for bipolar disorder can also increase the risk for medical problems.
However, people with bipolar disorder and other mental illness have a higher risk for a number of these conditions independent of these factors.
Diabetes. Diabetes is diagnosed almost three times more often in people with bipolar disorder than it is in the general population. A 2002 study reported that 58% of bipolar patients were overweight, with 26% meeting the criteria for obesity. Being overweight is a significant risk factor for diabetes and so it may be the common factor in both diseases. Drugs used to treat bipolar also pose a risk for weight gain and diabetes. Common genetic factors have also been implicated in diabetes and bipolar disorder, including those causing a rare disorder called Wolfram syndrome and those that regulate carbohydrate metabolism.
Migraine Headaches. Migraines are common in patients with a number of mental illnesses, but they are particularly common among bipolar II patients. In one study, 77% of bipolar II patients had migraines while only 14% of bipolar I patients had this headache, suggesting that different biologic factors may be involved with each bipolar form.
Hypothyroidism. Hypothyroidism (low thyroid levels) is a common side effect of lithium, standard treatment for bipolar. However, evidence also suggests that bipolar patients, particularly women, may be at higher risk for low thyroid levels regardless of which medications they use. It may in fact be a risk factor for bipolar disorder in some patients.
6:37pm
Bipolar and Diabetes
People with mental illness have a higher incidence of many medical conditions, including heart disease, asthma and other lung problems, gastrointestinal disorders, skin infections, diabetes, hypertension, migraine headaches, hypothyroidism, and cancer. Bipolar patients are also less likely to receive medical care than people without mental disorders. Substance abuse, including smoking, alcoholism, and drug abuse, also contributes to many of these problems as well as reduced access to care. Medications used for bipolar disorder can also increase the risk for medical problems.
However, people with bipolar disorder and other mental illness have a higher risk for a number of these conditions independent of these factors.
Diabetes. Diabetes is diagnosed almost three times more often in people with bipolar disorder than it is in the general population. A 2002 study reported that 58% of bipolar patients were overweight, with 26% meeting the criteria for obesity. Being overweight is a significant risk factor for diabetes and so it may be the common factor in both diseases. Drugs used to treat bipolar also pose a risk for weight gain and diabetes. Common genetic factors have also been implicated in diabetes and bipolar disorder, including those causing a rare disorder called Wolfram syndrome and those that regulate carbohydrate metabolism.
Migraine Headaches. Migraines are common in patients with a number of mental illnesses, but they are particularly common among bipolar II patients. In one study, 77% of bipolar II patients had migraines while only 14% of bipolar I patients had this headache, suggesting that different biologic factors may be involved with each bipolar form.
Hypothyroidism. Hypothyroidism (low thyroid levels) is a common side effect of lithium, standard treatment for bipolar. However, evidence also suggests that bipolar patients, particularly women, may be at higher risk for low thyroid levels regardless of which medications they use. It may in fact be a risk factor for bipolar disorder in some patients.
Transient Diabetes Associated With Withdrawal of Lithium Therapy
BY: Onyebuchi E. Okosieme, MRCP, Andrew Campbell, MBBCH, Katie Patton, MBBCH and Marc L. Evans, MD, MRCP
From the Centre for Endocrine and Diabetes Science, School of Medicine, Cardiff University, Cardiff, U.K
Address correspondence to Dr. Onyebuchi E. Okosieme, Centre for Endocrine and Diabetes Science, School of Medicine, Cardiff University, Cardiff, U.K. E-mail: okosiemeoe@cf.ac.uk
We describe a patient with bipolar disease who developed diabetic ketoacidosis following discontinuation of long-term lithium treatment. Diabetes resolved completely after 7 months of insulin therapy. Transient diabetes in this patient could have been precipitated by withdrawal of lithium therapy.
A 26-year-old white male was admitted to our hospital with vomiting and abdominal pain. He suffered from bipolar disorder and had been on lithium treatment for 3 years. Six weeks before presentation, he had discontinued lithium due to persistent tremors and 2 weeks afterward developed excessive thirst and polyuria. He had no personal or family history of diabetes and was not receiving any other medications. On arrival, his BMI was 24 kg/m2 and he was dehydrated and acidotic (pH 7.11), with ketonuria and hyperglycemia (blood glucose 33 mmol/l). We diagnosed diabetic ketoacidosis and treated him accordingly with intravenous fluids and soluble insulin. He rapidly improved and was discharged on twice-daily biphasic insulin. HbA1c (A1C) was 7.2% 1 month later. Subsequently, he experienced repeated hypoglycemic spells, which led to cessation of insulin after 7 months. At this stage, A1C was 5.4% and oral glucose tolerance test was normal, with adequate insulin and C-peptide responses to a glucose load. GAD and islet cell antibodies were negative. After 3 years off treatment, his A1C has remained <5.5%.
We considered several explanations for the unusual profile of diabetes in this patient. The initial presentation was suggestive of type 1 diabetes, but the remitting course makes this diagnosis unlikely. Although prolonged remission may occur in early type 1 diabetes, this honeymoon period is unlikely to last 3 years. Atypical type 2 diabetes, characterized by ketosis at onset and subsequent remission, has been described in African patients but not in whites (1). Nonetheless, the negative antibodies and subsequent insulin independence in this case favor type 2 diabetes as the more likely diagnosis. The onset of diabetes followed discontinuation of lithium, thus suggesting that lithium withdrawal precipitated diabetes. The effects of lithium on carbohydrate metabolism are complex, and improvement and worsening of glucose tolerance have both been observed in patients receiving lithium (2, 3). Studies in rats show that lithium exerts antidiabetic effects by increasing glycogenesis, either through an insulin-sensitizing action or through direct activation of enzymes involved in hepatic glycogenesis (3). An intriguing possibility in this case, therefore, is that diabetes was masked by lithium treatment and precipitated by its withdrawal. To the best of our knowledge, this is the first report of diabetes occurring in association with lithium withdrawal. Clinicians should be vigilant to similar cases that may provide insights into atypical presentations of diabetes.
From the Centre for Endocrine and Diabetes Science, School of Medicine, Cardiff University, Cardiff, U.K
Address correspondence to Dr. Onyebuchi E. Okosieme, Centre for Endocrine and Diabetes Science, School of Medicine, Cardiff University, Cardiff, U.K. E-mail: okosiemeoe@cf.ac.uk
We describe a patient with bipolar disease who developed diabetic ketoacidosis following discontinuation of long-term lithium treatment. Diabetes resolved completely after 7 months of insulin therapy. Transient diabetes in this patient could have been precipitated by withdrawal of lithium therapy.
A 26-year-old white male was admitted to our hospital with vomiting and abdominal pain. He suffered from bipolar disorder and had been on lithium treatment for 3 years. Six weeks before presentation, he had discontinued lithium due to persistent tremors and 2 weeks afterward developed excessive thirst and polyuria. He had no personal or family history of diabetes and was not receiving any other medications. On arrival, his BMI was 24 kg/m2 and he was dehydrated and acidotic (pH 7.11), with ketonuria and hyperglycemia (blood glucose 33 mmol/l). We diagnosed diabetic ketoacidosis and treated him accordingly with intravenous fluids and soluble insulin. He rapidly improved and was discharged on twice-daily biphasic insulin. HbA1c (A1C) was 7.2% 1 month later. Subsequently, he experienced repeated hypoglycemic spells, which led to cessation of insulin after 7 months. At this stage, A1C was 5.4% and oral glucose tolerance test was normal, with adequate insulin and C-peptide responses to a glucose load. GAD and islet cell antibodies were negative. After 3 years off treatment, his A1C has remained <5.5%.
We considered several explanations for the unusual profile of diabetes in this patient. The initial presentation was suggestive of type 1 diabetes, but the remitting course makes this diagnosis unlikely. Although prolonged remission may occur in early type 1 diabetes, this honeymoon period is unlikely to last 3 years. Atypical type 2 diabetes, characterized by ketosis at onset and subsequent remission, has been described in African patients but not in whites (1). Nonetheless, the negative antibodies and subsequent insulin independence in this case favor type 2 diabetes as the more likely diagnosis. The onset of diabetes followed discontinuation of lithium, thus suggesting that lithium withdrawal precipitated diabetes. The effects of lithium on carbohydrate metabolism are complex, and improvement and worsening of glucose tolerance have both been observed in patients receiving lithium (2, 3). Studies in rats show that lithium exerts antidiabetic effects by increasing glycogenesis, either through an insulin-sensitizing action or through direct activation of enzymes involved in hepatic glycogenesis (3). An intriguing possibility in this case, therefore, is that diabetes was masked by lithium treatment and precipitated by its withdrawal. To the best of our knowledge, this is the first report of diabetes occurring in association with lithium withdrawal. Clinicians should be vigilant to similar cases that may provide insights into atypical presentations of diabetes.
Atypical Antipsychotics and Diabetes
The FDA and the Eli Lilly and Company have notified healthcare professionals1 of a revision to the WARNINGS section of the labeling for Zyprexa (olanzapine), describing the increased risk of hyperglycemia and diabetes in patients taking Zyprexa. FDA has asked all manufacturers of atypical antipsychotic medications, including Lilly, to add this Warning statement to their labeling.
AAPs, also called "novel" antipsychotics, include Clozaril® (clozapine, Novartis), Risperdal® (risperidone, Janssen), Seroquel® (quetiapine, AstraZeneca), Geodon® (ziprasidone, Pfizer), and Abilify® (aripiprazole, Bristol Myers Squibb and Otsuka American Pharmaceutical). These prescription medications are used in the treatment of schizophrenia.
Lilly's statement (March 1, 2004) includes the following:
Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics including Zyprexa. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Given these confounders, the relationship between atypical antipsychotic use and hyperglycemia-related adverse events is not completely understood. However, epidemiological studies suggest an increased risk of treatment-emergent hyperglycemia-related adverse events in patients treated with the atypical antipsychotics. Precise risk estimates for hyperglycemia related adverse events in patients treated with atypical antipsychotics are not available.
Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.
The mechanism involved in the development of hyperglycemia in patients with schizophrenia are unclear. Studies indicate that the hyperglycemia is not dose dependent, is frequently reversible on cessation of treatment with AAPs, and reappears on reintroduction of these therapies.
Two reports have been published summarizing data about AAPs and hyperglycemia, using data collected in the FDA's MedWatch program. In the first report 2, 384 cases of clozapine-associated diabetes were identified. Of these, new-onset diabetes was diagnosed definitively in 242 patients, and 54 patients had exacerbation of preexisting disease. There were 80 cases of metabolic acidosis or ketosis. Twenty-five patients died during hyperglycemic episodes. Forty-six patients had improved glycemic control after discontinuation or dose reduction of the drug. The authors state that a causal relationship between clozapine and diabetes was suggested by the number of reports, the temporal relation to clozapine initiation, the relatively young age of the affected patients, and the prompt reversibility on withdrawal of the drug in some patients. The severity of reported cases ranged from mild glucose intolerance to diabetic ketoacidosis or hyperosmolar coma. In the second report 3, 289 cases of olanzapine-associated diabetes were identified. Of these, new-onset diabetes was diagnosed definitively in 225 patients, and 57 patients had exacerbation of preexisting disease. A causal relationship between olanzapine and diabetes was suggested.
AAPs, also called "novel" antipsychotics, include Clozaril® (clozapine, Novartis), Risperdal® (risperidone, Janssen), Seroquel® (quetiapine, AstraZeneca), Geodon® (ziprasidone, Pfizer), and Abilify® (aripiprazole, Bristol Myers Squibb and Otsuka American Pharmaceutical). These prescription medications are used in the treatment of schizophrenia.
Lilly's statement (March 1, 2004) includes the following:
Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics including Zyprexa. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Given these confounders, the relationship between atypical antipsychotic use and hyperglycemia-related adverse events is not completely understood. However, epidemiological studies suggest an increased risk of treatment-emergent hyperglycemia-related adverse events in patients treated with the atypical antipsychotics. Precise risk estimates for hyperglycemia related adverse events in patients treated with atypical antipsychotics are not available.
Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.
The mechanism involved in the development of hyperglycemia in patients with schizophrenia are unclear. Studies indicate that the hyperglycemia is not dose dependent, is frequently reversible on cessation of treatment with AAPs, and reappears on reintroduction of these therapies.
Two reports have been published summarizing data about AAPs and hyperglycemia, using data collected in the FDA's MedWatch program. In the first report 2, 384 cases of clozapine-associated diabetes were identified. Of these, new-onset diabetes was diagnosed definitively in 242 patients, and 54 patients had exacerbation of preexisting disease. There were 80 cases of metabolic acidosis or ketosis. Twenty-five patients died during hyperglycemic episodes. Forty-six patients had improved glycemic control after discontinuation or dose reduction of the drug. The authors state that a causal relationship between clozapine and diabetes was suggested by the number of reports, the temporal relation to clozapine initiation, the relatively young age of the affected patients, and the prompt reversibility on withdrawal of the drug in some patients. The severity of reported cases ranged from mild glucose intolerance to diabetic ketoacidosis or hyperosmolar coma. In the second report 3, 289 cases of olanzapine-associated diabetes were identified. Of these, new-onset diabetes was diagnosed definitively in 225 patients, and 57 patients had exacerbation of preexisting disease. A causal relationship between olanzapine and diabetes was suggested.
Introduction Post
Thursday, June 28th, 2007
5:30pm
What's going on: Day 4 of A+ Certification Training
Where I am at: Teleperformance USA, Salt Lake City, UT
Ok I know I probably should have started this on Day 1 of Training at Teleperformance but it is not really going to have anything to do with a lot of what I am doing. I doing this blog more medically than any thing else and how my diabetes and bipolar mix with my chaotic abilities. Though the first day was quite interesting. A lot of things were happening to our trainer that shouldnt have be happening. Oh well. I cant always control my abilities.
One thing important that is happening is my fiancee's sentencing on his first DUI charge. I'm trying to cope the best that I am able to. I'm also trying to help him as much as possible though I think that I am not doing enough because he is still worried about it. Tomorrow I am going to do all that I have to to help him. I know that I can do it especially after how much energy I used at his Arraignment hearing for the second DUI charge. My Chaos Star was really hot by the time everything was said and done.
I have articles that I will posting deal with medications for bipolar that affect diabetes. Diabetes posts, Bipolar treatments and natural treatments, and other things. The Chaos part is more of a personal experiences than anything else.
Enjoy reading.
Blessed be.
Cherise
5:30pm
What's going on: Day 4 of A+ Certification Training
Where I am at: Teleperformance USA, Salt Lake City, UT
Ok I know I probably should have started this on Day 1 of Training at Teleperformance but it is not really going to have anything to do with a lot of what I am doing. I doing this blog more medically than any thing else and how my diabetes and bipolar mix with my chaotic abilities. Though the first day was quite interesting. A lot of things were happening to our trainer that shouldnt have be happening. Oh well. I cant always control my abilities.
One thing important that is happening is my fiancee's sentencing on his first DUI charge. I'm trying to cope the best that I am able to. I'm also trying to help him as much as possible though I think that I am not doing enough because he is still worried about it. Tomorrow I am going to do all that I have to to help him. I know that I can do it especially after how much energy I used at his Arraignment hearing for the second DUI charge. My Chaos Star was really hot by the time everything was said and done.
I have articles that I will posting deal with medications for bipolar that affect diabetes. Diabetes posts, Bipolar treatments and natural treatments, and other things. The Chaos part is more of a personal experiences than anything else.
Enjoy reading.
Blessed be.
Cherise
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