November is National Diabetes Awareness month, and if you or someone you know is taking a medication for schizophrenia or bipolar disorder, this information may be useful. Second generation (atypical) antipsychotic medications such as Abilify Maintena, Aristada, Invega Sustenna, Invega Trinza, and Risperdal Consta can be used for these conditions. However, as a side effect, these medications may increase your blood sugar. Here is what you should know:

What do the guidelines say?

According to the American Psychiatric Association (APA) guideline on the treatment of patients with schizophrenia, screening for diabetes and high cholesterol should be done 4 months after they start a second generation (atypical) antipsychotic, and then at least every year afterwards.

To screen for diabetes, blood work is needed. Once your primary care provider gets the results, they will check your fasting blood sugars and your hemoglobin A1C to see if you have or are at risk of having diabetes. You need to fast before your blood test, which means no caloric intake for at least 8 hours. This is why it is done in morning after you sleep for 8 hours. You can drink water before your blood test.

Can these medications cause diabetes?

According to the APA guidelines, side effects of these medications include weight gain, high cholesterol, high blood sugar, and it may contribute to the development of diabetes. Because of the rare occurrences of extremely high blood sugar, diabetic coma, or death, the FDA has requested that all manufacturers of second generation antipsychotics to include a warning in their product labeling regarding the side effects of high blood sugar and diabetes. According to the package insert of these medications, patients who have risk factors for diabetes such as obesity or a family history of diabetes should get screening done at the beginning of treatment. This is done so that the best medication can be recommended.

According to the package inserts of these medications, if you or someone you know is taking one of these medications and experiencing side effects such as constant hunger, thirst, or need to urinate, it is recommended to undergo screening for diabetes. If you have diabetes and your blood sugar is not controlled, then an adjustment to your diabetes therapy will be required.

What can be done to prevent or further control diabetes?

According to the American Diabetes Association guidelines, losing weight and moderate physical activity such as brisk walking for at least 150 minutes a week can be helpful in preventing diabetes. One study known as the DPP trial demonstrated that this can reduce the incidence of type 2 diabetes by 58% over 3 years. Also, low calorie and low fat diet is recommended. If you have diabetes, make sure you take all of your medications and check up with your primary care provider to make sure that your blood sugar and A1C is at goal.

Written by:
Baasit Talebi
PharmD Candidate 2021
Temple University School of Pharmacy