Metabolic effects Diabetes

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Metabolic effectsDiabetes

• Rachel Shynn
• Clinical Nurse Educator
• Community Mental Health

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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

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Diabetes

• Type 2 lifestyle and other factors
• - Diet controlled
• - Diet and Medication controlled
• - Insulin required.
• Type 1 autoimmune condition
• Gestational Diabetes

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Diabetes Risk Factors

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

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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.

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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)

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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)

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Clinical implications

• Need to screen all patients for diabetes
• Need to implement lifestyle modifications
• Need to manage diabetes

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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

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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 approach
• Diabetes, severe Mental illness and Antipsychotic
  Drugs The Myths Unravelled Dr Richard Holt.

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Diabetes

• Diabetes is a disease which often shows in
  families which insanity prevails
• Henry Maudsley
• 1879

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Diabetes