Caution Urged For Diabetics Using Selective Serotonin Reuptake Inhibitor

[Guest guest]

Caution Urged For Diabetics Using

Selective Serotonin Reuptake Inhibitor

JoAnn Guest

Mar 22, 2005 13:24 PST

==========================================================

Cameron Johnston / DG News 9jul01

http://www.mindfully.org/Health/Diabetics-SSRI-Caution.htm

 

MONTREAL, QC -- Diabetics patients with depression who are bei

ng treated with selective serotonin reuptake inhibitor agents need more

rigorous blood glucose monitoring, May Clinic researchers recommend.

 

Patients with diabetes who are being treated with selective serotonin

reuptake inhibitors (SSRIs) should make sure their primary care doctor

as well as their specialists know what drugs they are using to treat

their depression.

 

According to a small case study from the Mayo Clinic in Rochester,

Minnesota, United States, SSRIs might have an impact on diabetics that

leaves these patients susceptible to hypoglycemic reactions with

devastating results.

 

In a presentation at the 6th joint meeting of the Lawson Wilkins

Pediatric Endocrine Society and the European Society for Paediatric

Endocrinology (ESPE) in collaboration with the Australasian Paediatric

Endocrine Group, the Japanese Society for Pediatric Endocrinology, and

the Latin American Society for Paediatric Endocrinology, Mayo

investigators discussed the case of two diabetics who were being treated

with SSRIs while they were taking insulin. While the two drugs did not

have an adverse interaction in these patients, they did result in a loss

of awareness of hypoglycemic response.

 

In both cases, the patients, aged 17 and 21 years, had been managing

their diabetes adequately, with few, if any, episodes of hypoglycemia

requiring outside intervention. After taking the normal manufacturer's

recommended doses of sertraline and paroxetine, they both experienced

more episodes of hypoglycemia. In one case, the hypoglycemic reactions

were serious enough to warrant emergency treatment five times.

 

The patients also experienced significantly more incidents of

hypoglycemia not requiring outside help.

 

Glucose from the periphery fuels the central nervous system, explained

lead investigator Dr. Ana Sawka, of the department of endocrinology and

metabolism at the Mayo. Classic warning symptoms of hypoglycemia,

including palpitations, hunger, anxiety and diaphoresis occur when blood

glucose falls below 3.3 mmol/L. Neuropenic symptoms including confusion,

dizziness, blurred vision and cognitive dysfunction occur when blood

glucose falls below 2.8 mmol/L.

 

Dr. Sawka speculated that since SSRIs are often used to control appetite

in obese patients, they could also suppress the appetite in these

patients so the reduced caloric intake resulting in significantly lower

blood sugars.

 

Also, since SSRIs cause some sedation, it might be that the patient was

unaware of the impending hypoglycemic attack.

 

She added that the SSRI fluoxetine has been shown to decrease relative

cerebral glucose metabolism in the amygdaloid complex, which could

happen, although it is a remote possibility.

 

Dr. Sawka said, however, that SSRIs specifically do not influence plasma

insulin levels, nor do they augment the hypoglycemic action of injected

insulin.

 

In this case, it appears simply that the patients experienced gradually

lower blood sugar and either because of the drowsiness or for other

reasons, were not aware of the condition until they started to show

physical and neurological symptoms.

 

It is important to point out that the patient's hypoglycemia awareness

returned once they had discontinued using the SSRIs, Dr. Sawka said,

although they did not return to normal immediately upon cessation of

antidepressant therapy.

 

She said that the condition might occur only in a small number of

diabetic patients -- although depression and the use of antidepressants

is not uncommon in this population.

 

Nonetheless, all diabetic should be aware that this reaction can happen

and physicians should be aware that of what drugs the patient is using

and that the risk for this kind of interaction can occur.

_________________

 

JoAnn Guest

mrsjo-

DietaryTi-

www.geocities.com/mrsjoguest/Genes

 

 

 

 

AIM Barleygreen

" Wisdom of the Past, Food of the Future "

 

http://www.geocities.com/mrsjoguest/Diets.html

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Make your home page