Q:  Zyprexa & Pre-existing Diabetes

I read about the concerns with Zyprexa and developing diabetes - but, what if you are already a type 1 diabetic.  Are there any concerns with Zyprexa that need to be monitored then?
 

Dear Alison
I've not seen a study on this yet, but I can tell you that several of my patients' glucose control seemed to have worsened when they were on, improved when they were off, and worsened again when they went off again. But that's only about 3 patients to go by. Digging around a bit via Google I found a Canadian report from 2001, when the problem was first being recognized. It noted that "Of the 35 reports in which disorders of hyperglycemia were denoted, there were 4 cases of pre-existing diabetes". In other words, these 4 people apparently had enough worsening of their diabetes to get reported to Health Canada. "Exacerbation of pre-existing diabetes" is also reported in a summary from 2003.  

On the basis of this very brief search and my experience, I'd say the answer to your question is yes, monitoring for worsening glucose control is warranted when an atypical anipsychotic such as Zyprexa is started (and probably when it is stopped, watching for hypoglycemia so that the medication approach can be adjusted accordingly). Patients will need to be watchful for this interaction as busy psychiatrists may overlook it. 

Dr. Phelps

Published March, 2006