Endocrine Abstracts (2005) 10 P20

New onset diabetes associated with the atypical antipsychotic olanzapine

SR Mehta1, A Hameed1, D Patel1, A Christen1, H Mather2 & J Valabhji1

1Department of Metabolic Medicine, St Mary’s Hospital, London, United Kingdom , 2Department of Diabetes and Endocrinology, Ealing Hospital, London, United Kingdom.

Schizophrenia is associated with higher risk of Type 2 diabetes. There are several reports of Type 2 diabetes presenting as diabetic ketoacidosis, particularly in young obese African-Caribbean subjects. We report 3 cases of new onset diabetes presenting with diabetic ketoacidosis (see Table 1) in African-Caribbean males treated with olanzapine for chronic schizophrenia.

Table 1 Metabolic parameters on admission

Glucose (mmol/l)66.833.435.8
HCO3- (mmol/l)
Urine ketones++++++++++

Case 1 is a 23 year old gentleman who presented in 2001 with anorexia, polydipsia, polyuria and vomiting four months after starting olanzapine. As an in-patient his olanzapine was switched to risperidone. He was discharged on human mixtard, but stopped taking this as an out-patient. When reviewed in diabetic clinic 8 weeks after discharge his blood sugars had normalised off all treatment, and remained normal six months later.

Case 2 is a 38 year old obese gentleman who has gained weight since starting olanzapine in 2002. He was admitted to hospital in July 2005 with a history of polydipsia, polyuria and vomiting. He was discharged on Novomix which he continues to take.

Case 3 is a 46 year old gentleman who was started on olanzapine in 1992 and was diagnosed with diabetes in January 2005, presenting with diabetic ketoacidosis. He was discharged on Novomix. Since discharge he has had 2 further episodes of ketoacidosis following inadvertent discontinuation of insulin.

These cases highlight the heterogeneity of diabetes associated with schizophrenia and its treatment.

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