Bipolar Disorder, Antipsychotic Medications, & Abnormalities in Glucose Regulation
- In patients with bipolar disorder abnormalities in glucose regulation that relate to dysregulation in various physiologic systems have been studied and reported (1)
- Treatment with atypical (second generation) antipsychotic medications has been associated with weight gain and resulting impaired glucose metabolism, exacerbation of existing type 1 and type 2 diabetes, new onset of type 2 diabetes and diabetic ketoacidosis (2)
- Case reports and controlled studies indicate that some atypical antipsychotic medications are associated with adverse effects on glucose metabolism independent of adiposity (1)
Monitoring of Glucose Regulation (3)
- Six sets of metabolic monitoring guidelines for persons taking antipsychotic medications are currently recognized (Mount Sinai; Australia; American Diabetes Association-American Psychiatric Association; Belgium; and United Kingdom)
- All monitoring guidelines recommend the Fasting Plasma Glucose as a baseline test
- Although baseline monitoring is indicated as soon as feasible, when possible, monitoring prior to antipsychotic treatment initiation is preferable as the results may influence antipsychotic choice, especially when elevated risk factors are identified
- When fasting is not feasible to obtain (patient cooperation; cost/time), alternatives considered acceptable were the HbA1c (Mount Sinai; United Kingdom) or the Random Plasma Glucose (Mount Sinai; Australia; United Kingdom); these are not diagnostic for diabetes; however, they can be used as screening tests with follow-up if elevation is found.
- Finger stick glucose testing is not recommended for screening; however, it is considered to be useful in emergency situations to rule out frank hyperglycemia / diabetic ketoacidosis.