Anti-psychotics least likely to cause type 2 diabetes

[paranoid android]

Okay so i have recently found out that there is a history of diabetes in my family. Right now i take between 300-400mg's of quetiapine a day for bipolar disorder and my doctor is already wary of prescribing anti-psychotics so i imagine if i tell him about my family history that will be the end of the quetiapine. Unfortunately the only other atypical my insurance covers is risperidone which also causes type 2 diabetes along with making me feel like a zombie. So this pretty much leaves the typicals of which i have taken chlorpromazine, methotrimeprazine aka Levomepromazine and prochlorperazine. I have only taken the Thorazine/largactil and Compazine for nausea and vomiting and i have taken the methotrimeprazine for both sleep and nausea. I didn't find the Thorazine to be as bad in terms of side effects as some of the atypical anti-psychotics even in the 100mg range so i would be willing to try that as a add on to the lamotrigine i take as my mood stabilizer.

Are the typicals as bad for causing diabetes as the atypicals? I couldn't find alot of info on that so any advice would be appreciated

 

[sekio]

unfortunately the tricyclics are not really any better, they can cause diabetes as well.

i think the prodiabetic effects of antipsychotics are related to their activity as dopamine antagonists disrupting horomones in the body (i.e. insulin, prolactin), that is, all the "classical" antipsychotics that work by blockading dopamine receptors will to some extent induce diabetes. you may just want to be proactive with staying healthy & keep going to your dr for physicals, & stay on the quetiapine if it's working well for you.

refs
http://www.ncbi.nlm.nih.gov/pubmed/17192159
http://www.ncbi.nlm.nih.gov/pubmed/5717295
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.1964.tb04953.x/abstract
http://bjp.rcpsych.org/content/184/47/s64.full (interesting review)

 

[paranoid android]

Ah fuck that sucks . It does make sense though because the typicals also fuck with your hormones. What i don't get though is why quetiapine get's a worse rap for causing type 2 diabetes compared to risperidone which is a much stronger dopamine antagonist and fucks with your prolactin levels far worse. Olanzapine works far better for me then quetiapine does and with olanzapine (especially the orally disintegrating wafers) i can take it just for emergencies. With quetiapine it takes a good week for it to fully kick in for me. Sadly my insurance does not cover olanzapine and i can't afford the outrageous price of about $8 per 10mg tablet.

I have been trying to eat healthier lately but unfortunately between the psych meds, opiates and cannabis i crave sweets and fatty foods like a motherfucker. I can't do much exercising at the moment because i completely fucked up a muscle in my shoulder and chest so bad that i can barely lift my left arm over my head without taking 600mg's of ibuprofen. Thankfully i have a pretty fast metabolism and at 5'9 and about 170lbs i'm not overweight.

I don't know if my doc will keep me on the quetiapine as he seems to really not like anti-psychotics and he always gives me a physical whenever i have to see him. He almost took me off the quetiapine a few months ago when i found out i had first degree heart block. Other then that i am healthy. I would give adding lithium to the lamotrigine a try but it's a hours drive to the nearest hospital from where i live and when you first start lithium you need alot of blood tests which would be a major pain in the arse. But i may have to look into that option.

 

[chaos_destroy]

You should have a look into the atkins diet. It is all about getting your body to use fat instead of glucose as its energy source (ketosis). Which is to some extent what anti-psychotics do. I suspect this is in part why anti-psychotics cause such uncontrollable weight gain. Because most the carbs you eat would get stored not used. Anyway atkins diet will prevent you from getting diabetes. If fact if you had diabetes atkins diet would mean you probably wouldn't need medication.

Ketosis has been shown to improve bipolar symptoms as much as medication also.

 

[Gaius]

Ketosis has been shown to improve bipolar symptoms as much as medication also.

That's pretty cool. What is the mechanism?

 

[paranoid android]

You should have a look into the atkins diet. It is all about getting your body to use fat instead of glucose as its energy source (ketosis). Which is to some extent what anti-psychotics do. I suspect this is in part why anti-psychotics cause such uncontrollable weight gain. Because most the carbs you eat would get stored not used. Anyway atkins diet will prevent you from getting diabetes. If fact if you had diabetes atkins diet would mean you probably wouldn't need medication.

Ketosis has been shown to improve bipolar symptoms as much as medication also.

I have actually been trying a version of the atkins diet lately to see if it improves my stomach. I have had alot of stomach problems lately and my gastroentologist thinks it's probably a combination of IBS and a food allergy. I am sensitive to wheat so i have mostly cut that out and most other foods that are loaded with carbs. I don't know it's been affecting my mood much but it's helping my stomach alot and that alone makes me happy. Having to eat buscopan like candy so i don't feel like i am dying from the pain is not fun at all.

Unfortunately it's hard to eat healthy when your on a very limited budget like i am. Good meats like steak, pork and all that are expensive as fuck and so is fresh fruits and veggies. I could live quite happily off bacon and eggs every morning for breakfast and steak with broccoli every evening for dinner . I still like my sweets though and the goddamn meds certainly don't make it easy to avoid them. Opiates and quetiapine make me crave sugar like a motherfucker. The other day i ate half a rhubarb and strawberry pie to myself when i got the munchies real bad ffs

 

[chaos_destroy]

That's pretty cool. What is the mechanism?

Not exactly sure on the mechanism but I know anti-psychotics increase your metabolism of fats and reduce glucose metabolism which ultimately results in chronic increased levels of glucose and hence insulin which can lead to diabetes. Ketogenic diets like atkins cause your body to use fats instead of glucose also by removing the glucose from the system. When in ketosis, whether from a diet or medication most carbs consumed will get stored as fat as the body is not longer using them as fuel. In atkins this is fine as you aren't consuming many anyway but from medication if your still eating normally this will result in fat gain even if calorie deficient. There are some reports of treating type II with a ketogenic diet. Apparently ketogenic diets also help control, sodium concentrations in the brain which is a common issue in bipolar and something most meds treat too.

Albaugh, V. L., et al. (2012). "Atypical Antipsychotics Rapidly and Inappropriately Switch Peripheral Fuel Utilization to Lipids, Impairing Metabolic Flexibility in Rodents." Schizophrenia Bulletin 38(1): 153-166.


El-Mallakh, R. S. and M. E. Paskitti (2001). "The ketogenic diet may have mood-stabilizing properties." Med Hypotheses 57(6): 724-726.


Phelps, J. R., et al. (2012). "The ketogenic diet for type II bipolar disorder." Neurocase.