Abstract
We report a 55-year-old Japanese man who presented with symptomatic hypoglycemia attributable to atypical antipsychotic drugs (APD). He had been taking olanzapine, quetiapine, and paliperidone. One morning, his consciousness level dropped without inducement and his blood glucose was low. His symptoms improved after intravenous glucose infusion. These episodes reoccurred a few times, but ceased after APD were stopped. Physical examination did not find any organic disease that might cause hypoglycemia. Hyperglycemia, dyslipidemia, and body weight gain are well-documented side-effects of APD, but hypoglycemia is rare. There are a variety of hypotheses on how APD cause hypoglycemia: (1) Weight gain and dyslipidemia caused by APD might increase insulin resistance, meaning that excess insulin is secreted, causing hypoglycemia. (2) The quantity of basal insulin secreted by pancreatic beta cells might be enhanced by APD, which might cause hypoglycemia. (3) APD might work as an antagonist of muscarinic receptors such that insulin secretion might continue even after the glucose level has returned to normal, which might cause hypoglycemia. However, the mechanism is not fully understood and more research is needed.
References
Philip E, Lioyd A, Ashley B, et al. Evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2009;94:709–28.
Maclin P, Watkinson HM, Young AH, et al. Prevalence of obesity, glucose homeostasis disorders and metabolic syndrome in psychiatric patients taking typical or atypical antipsychotic drugs: a cross-sectional study. Diabetologia. 2005;48:215–21.
Meatherall R, Younes J. Fatality from olanzapine induced hyperglycemia. J Forensic Sci. 2002;47:893–6.
Yıldırım O, Dogan O, Semiz M, et al. Serum cortisol and dehydroepiandrosterone-sulfate levels in schizophrenic patients and their first-degree relatives. Psychiatry Clin Neurosci. 2011;65:584–91.
John W, Dan W, Robert F, et al. Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia. Arch Gen Psychiatry. 2002;59:337–45.
Melkersson Kristina. Clozapine and olanzapine, but not conventional APD, increase insulin release in vitro. Eur Neuropsychopharmacol. 2004;14:115–9.
Frank P, et al. Muscarinic mechanism of antipsychotic atyoicality. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:1125–43.
Kitahara A, Ozawa M, Nakamura H. Idiopathic reactive hypoglycemia adversely affected by unsatisfactory conjugal relationship. J Japan Diab Soc. 2004;47:825–30 (in Japanese, abstract in English).
Somnath M, Indral S, Sandal D, et al. Oral aripiprazole-induced severe hypoglycemia. Ther Drug Monit. 2012;34:245–8.
Suzuki Y, Watanabe J, Fukui N, et al. Improvement in quetiapine-induced hypoglycemia following a switch to blonanserin. Psychiatry Clin Neurosci. 2012;66:370–1.
Suzuki Y, Watanabe J, Fukui N, et al. Hypoglycemia induced by second generation antipsychotic agents in schizophrenic non-diabetic patients. BMJ. 2009;338:1387–9.
Nagamine T. Hypoglycemia associated with insulin hypersecretion following the addition of olanzapine to conventional antipsychotics. Neuropsychiatr Dis Treat. 2006;2:583–5.
Walter RB, Hoofnagle AN, Lanum SL, et al. Acute, life-threatening hypoglycemia associated with haloperidol in a hematopoietic stem cell transplant recipient. Bone Marrow Transplant. 2006;37:109–10.
Landi F, Cesari M, Zuccala G, et al. Planzapine and hypoglycemic coma in a frail elderly woman. A case report. Pharmacopsychiatry. 2003;36:165–6.
Conflict of interest
The authors state that they have no conflict of interest (COI).
Ethical standard
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ishiguro, H., Hanyu, O., Houya, S. et al. A case of hypoglycemia attributable to atypical antipsychotic drugs. Diabetol Int 6, 341–346 (2015). https://doi.org/10.1007/s13340-015-0203-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13340-015-0203-5