Zyprexa & Diabetes
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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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