Metabolic effectsDiabetes

Rachel Shynn

Clinical Nurse Educator

Community Mental Health

Diabetes• Diabetes is a chronic disease with serious

complications, currently affecting an estimated 1.5 million Australians. About 275 adults develop diabetes every day.

• Research shows that most Australians think diabetes is not a serious illness, and believe they have a lower risk of developing it than they actually do .

Diabetes Australia

Diabetes• Type 2: lifestyle and other factors

- Diet controlled

- Diet and Medication controlled

- Insulin required.

• Type 1: autoimmune condition

• Gestational Diabetes

Diabetes Risk Factors

• Family History• Birth weight• Ethnicity• Age• Obesity• Physical inactivity• Diet

Other Risk Factors• Increase risk with mental illness and

schizophrenia• schizophrenic patients have an increased

prevalence of diabetes(15-18%).• 2-4 times the normal population• High prevalence of undiagnosed diseases

including diabetes

Diabetes, severe Mental illness and Antipsychotic Drugs: The Myths

Unravelled: Dr Richard Holt.

Why increase Risk factors with schizophrenia

• Genetics• low birth rate• Lifestyle• Illness timeline• Drugs (illicit, alcohol, prescribed)

• High BMI = increase risk (prior to diagnosis and starting antipsychotics)

Medications• Oral Hypoglycaemics

– insulin secretogogues. Stimulate pancreatic insulin secretion, eg Diamicron

– insulin sensitisers. Reduce insulin resistance. Eg Metformin

– Acarbose. Inhibits enzymes that break down complex carbohydrates(CHO) in gut wall, delays CHO digestion and glucose absorption, eg Glocobay.

(Lyn Billington LRH pharmacist)

Clinical implications

• Need to screen all patients for diabetes

• Need to implement lifestyle modifications

• Need to manage diabetes

Treatment Recommendations• Baseline measure of plasma glucose level (fasting

plasma preferred).collected prior to antispychotics

• Pts who have risk factors for Diabetes should have fasting plasma levels monitored 4 months after starting medication then yearly.

• Staff should be aware of the symptoms of new onset diabetes.-educate patients as well.

• Staff should ensure that Pts are followed up by a health care professional knowledgeable about Diabetes. Http://ajp.psychiatryonline.org, pg1338

Summary• Schizophrenia is associated with DM

• Complex disease to manage

• Patients with schizophrenia requiring screening for diabetes.

• Patients with Diabetes starting on antipsychotics may notice an altered glucose control.

• Importance of treating mental state.

• It is a multi-discipline approachDiabetes, severe Mental illness and Antipsychotic Drugs: The Myths

Unravelled: Dr Richard Holt.

Diabetes

“Diabetes is a disease which often shows in families which insanity prevails”

Henry Maudsley

1879

Diabetes