We report the case of a euglycaemic woman whose glucose controlrapidly decompensated following olanzapine initiation leading todiabetic coma. Hyperglycaemia has been associated with chronicpsychotic disorders and antipsychotics for many years. However, it is unusual to see such rapid and life-threatening changes associated with treatment. The case highlights that changes in antipsychotic treatment may be associated with large changes in glucose tolerance, and that it is possible to continue antipsychotic treatment with appropriate diabetic care.
Davis J M , Chen N , Glick I D (2003) A meta-analysis of the efficacy ofsecond-generation antipsychotics . Arch Gen Psychiatry60: 553–564
5.
Harris M I (1993) Undiagnosed NIDDM: clinical and public health issues . Diabetes Care16: 642–652
6.
Haupt D W , Newcomer J W (2001) Hyperglycemia and antipsychotic medications . J Clin Psychiatry62 (Suppl 27): 15–26
7.
Johnson R P , Al Taher M T , Madlock L E , Guo M , Nasdahl C S (2002) Increasing insulin dose for olanzapine-related diabetes . Am J Psychiatry159: 150–151
8.
Koro C E , Fedder D O , L’Italien G J , Weiss S S , Magder L S , Kreyenbuhl J , Revicki D A , Buchanan R W (3-8-2002) Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study . BMJ325: 243–243
9.
Maule S , Giannella R , Lanzio M , Villari V (1999) Diabetic ketoacidosis with clozapine treatment . Diabetes Nutr Metab12: 187–188
10.
Mir S , Taylor D (2001) Atypical antipsychotics and hyperglycaemia . Int Clin Psychopharmacol16: 63–73
11.
Muench J , Carey M (2001) Diabetes mellitus associated with atypical antipsychotic medications: new case report and review of the literature . J Am Board Fam Pract14: 278–282
12.
Mukkerjee S , Decina P , Bocola V (1996) Diabetes mellitus in schizophrenic patients . Comp Psychiatry37: 68–73
13.
Newcomer J W , Haupt D W , Fucetola R , Melson A K , Schweiger J A , Cooper B P , Selke G (2002) Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia . Arch Gen Psychiatry59: 337–345
14.
Nicolai J , Smith S J , Keunen R W (2001) Simultaneous side effects of both clozapine and valproate . Intens Care Med27: 943–943
15.
Ragucci K R , Wells B J (2001) Olanzapine-induced diabetic ketoacidosis . Ann Pharmacother35: 1556–1558
16.
Ryan M C , Collins P , Thakore J H (2003) Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia . Am J Psychiatry160: 284–289
17.
Saydah S H , Loria C M , Eberhardt M S , Brancati F L (2001) Subclinical states of glucose intolerance and risk of death in the US . Diabetes Care24: 447–453
18.
Selva K A , Scott S M (2001) Diabetic ketoacidosis associated with olanza-pine in an adolescent patient . J Pediatr138: 936–938
19.
Straker D , Mendelowitz A , Karlin L (2002) Near fatal ketoacidosis with olanzapine treatment . Psychosomatics43: 339–340
20.
Turnbull D M , Bone A J , Tames F J , Wilson L , Baird J D , Sherratt H S (1985) The effect of valproate on blood metabolite concentrations in spontaneously diabetic, ketoacidotic, BB/E Wistar rats . Diabetes Res2: 45–48
21.
Wilson D R , D’Souza L , Sarkar N , Newton M , Hammond C (2003) New-onset diabetes and ketoacidosis with atypical antipsychotics . Schizophr Res59: 1–6
