Metabolic effects Diabetes 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 approach Diabetes, 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