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Q: Zyprexa & Diabetes
After reading and hearing about Zyprexa and diabetes I am concerned
because diabetes runs in my family. I have been on Zyprexa for 3 years at
varying doses. Prior to Zyprexa I was underweight, which was a big problem for
me. When I started the Zyprexa my weight increased 15 lbs over 3 years. In
addition I quit smoking which I attribute some added weight. I do have fat that
is increasing in my abdomen area (i am male if that matters)... How does one
know if diabetes is a threat? Zyprexa works so well for me I am afraid to come
off of it. Im not sure what to do.....
Dear Dan --
Understandable question. With the help of some lawyers, from Texas I believe it
is, advertising in a very scary way on TV, there's been a tremendous increase in
anxiety about the long-term effects of Zyprexa in particular, and some of its
cousins as well. Not that such worry isn't justified, but the level of it may
have gotten a bit out of proportion. But your situation is a good example of
"now what do we do?"
So, as your doctor may well have done already, the
current approach is to measure a couple of standard indicators of glucose
management: your "fasting blood sugar", a simple chemistry test (measure in the
morning, with nothing by mouth except water from 9 pm the previous evening); and
your "hemoglobin A1c. The latter is a test of how much glucose is stuck on your
red blood cells, roughly speaking (here's more detail on exactly
what is HgbA1c),
which serves as an indicator of how much glucose has been around for the last
6-8 weeks in your blood. Where the fasting glucose shows what's going on today,
the HgbA1c shows what's been going on in the last month. Between the two of
them, that's a pretty good indication of whether there's any drift in the
direction of "glucose-out-of-control", which can become diabetes in the longer
term.
The other aspect of metabolic changes with Zyprexa is
what happens to your cholesterol levels. So, those have to be checked too (same
fasting blood test). But huge numbers of Americans have cholesterol levels that
are "risk factors" for heart disease and other vessel-disease related
conditions, so unless you have a "baseline" before Zyprexa to compare to, then
seeing elevated cholesterol now does not necessarily mean that "Zyprexa did
it". Pretty obvious; but unless you have that baseline value, it won't be
completely clear what to do if your cholesterol is now too high
(cholesterol used there in the generic sense; more precisely, your total
cholesterol, your LDL cholesterol, and your triglycerides -- technically lumped
as "your lipids"). Should you then switch from Zyprexa? And even if you have a
baseline test to compare to, and now your lipids are too high, what to do?
Should you switch to a medication which will not be known in advance to work as
well?
This is a tricky question to work out with your
doctor. Even if all you had was steady increase in abdominal fat, that alone
(without any blood test abnormalities) might be reason enough to wonder about
trying to switch medications -- particularly if you were exercising regularly
and eating a reasonable diet, and that was still happening. You are doing those
things, aren't you. Of course you are.
Fortunately there are some candidate medication
alternatives. I feel like half my time is spent trying to get the results from
other medications that I could almost certainly get with Zyprexa. It's
incredibly effective. It's just also incredibly metabolically deranging, in
many people (I'm trying to be careful not to sound like those lawyers!) Zyprexa
is good short term medication, really good. And there are some people who can
get away with taking it long-term too. The rest of my patients have to work
with me while we try all the other mood stabilizers, trying to hit all the
targets, sometimes with multiple medications, that we can usually get quickly
and simply with Zyprexa. Good luck to you and your doc' as you try to carefully
plan your next move. (PS: way to go, quitting those cigarettes! they probably
carried at least as much risk as your metabolic story to date. Now let's just
make sure you don't get diabetes to substitute into that risk picture. Have a
nice walk today!)
Dr. Phelps
Published January, 2005
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