Clozapine-induced Insulin-resistant Hyperglycemia in a Diabetic Patient

Abstract

Clozapine is superior to all other antipsychotics in treatment-resistant schizophrenia. However, metabolic side effects are common while treating patients with clozapine. Administering clozapine in a patient who already is diabetic involves careful weighing of risks and benefits. Here, we report our experience of starting clozapine in a known diabetic patient. Clozapine was started in a patient with treatment-resistant psychosis in view of suicidal risk. Her diabetes mellitus was under good control with oral medications. After initiation of clozapine, blood sugars increased several fold within few days. Blood glucose continued to increase even with high doses of insulin and insulin infusion. Finally, blood sugars came under control only after discontinuation of clozapine. Precautionary measures while initiating clozapine in a diabetic patient are suggested – close monitoring of blood sugar during the initial few days and intensive intervention if blood sugar levels increase. Discontinuation of clozapine should also be kept in mind as a last resort.

Development and validation of a risk prediction nomogram for disposition of acute clozapine intoxicated patients to intensive care unit

“…70 Clozapineassociated distortion of regulatory molecules, such as glucagon, is another assumption. 71 Chang et al attributed clozapine-associated hyperglycemia to oxidative stress, which reduces glucose transporters' expression. 70 In agreement with the current study, a previous study recommended using the blood glucose level on admission as an outcome predictor of acute drug poisoning.…”

“…70 Clozapine-associated distortion of regulatory molecules, such as glucagon, is another assumption. 71 Chang et al attributed clozapine-associated hyperglycemia to oxidative stress, which reduces glucose transporters’ expression. 70…”

Risk Factors for the Need of Intensive Care Unit Admission Among Acute Clozapine Poisoned Patients: A Retrospective Cohort Study

“…For abnormally distributed data, the variables were summarized as the median and interquartile range (IQR, expressed as 25 th -75 th percentiles), and comparison between two groups was carried out using the Mann-Whitney test. Multivariate backward, stepwise logistic regression was conducted to assess the contribution of relevant variables to the need for ICU admission, which had a p-value less than 0.2 on univariate analysis (Bursac et al, 2008), with odds ratio (OR) and 95% confidence interval for OR (95% CI) calculated for each variable. Analysis of the receiver operating characteristic (ROC) curve was done to assess the relation between true-positive results and falsepositive results for each measurement (DeLong et al, 1988).…”

Antipsychotics inhibit the mitochondrial bioenergetics of pancreatic beta cells isolated from CD1 mice

“…APs are classified as either old typical (conventional) or newer atypical APs with different common side effects, including extrapyramidal manifestations, 4 atropine‐like action 5 and metabolic disorders 6 . Since the mid‐1960s, AP treatment was associated with the aggravation of already existing DM or the development of new‐onset type II DM with reported higher risk of hyperglycaemic emergencies 7‐12 …”