metabolic effects diabetes rachel shynn clinical nurse educator community mental health
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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 approachDiabetes, 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