Ethnicity has also been associated with certain behavioural risk factors for type 2 diabetes. The tricyclic antidepressants are established treatments for peripheral diabetic neuropathy. The selective serotonin reuptake inhibitors present important benefits and risks in the treatment of comorbid depression and diabetes. With regard to body weight, a meta-analysis shows fluoxetine can achieve moderate but statistically significant weight loss in adults with type 2 DM (Norris et al., 2004).
The serotonin-norepinephrine reuptake inhibitors (SNRIs) venlafaxine (Effexor) and duloxetine (Cymbalta) present potential advantages in the treatment of comorbid diabetes and depression.
To our knowledge, there are no studies of mirtazapine (Remeron) for depression with comorbid diabetes or for diabetic neuropathy. There are also no studies of bupropion (Wellbutrin) specifically for the treatment of depression comorbid with diabetes. Estimates show that about 30% of diabetes cases in the United States are undiagnosed (CDC, 2003). Reports link MAOIs with sudden hypoglycemia requiring emergency intervention (Goodnick, 1997).
Tricyclic antidepressants increase weight, although specific agents differ substantially in amount of weight gain (Zimmermann et al., 2003). Neither drug has been specifically studied for treatment of depression and comorbid diabetes. A placebo-controlled trial of bupropion in men with diabetes and erectile dysfunction who weren't depressed showed no worsening of sexual function and no change in measures of diabetic control during treatment (Rowland et al., 1997).
Given that psychiatrists are often the main physician contact for patients with severe mental illness, they play a vital role in recognizing the signs and symptoms of new-onset diabetes as well as the potentially life-threatening symptoms of hyper- and hypoglycemia (Table 1). This effect could be particularly troubling with concomitant use of diabetes medications such as insulin and the sulfonylureas that can cause hypoglycemia. They may indirectly improve diabetes by improving depression but also have a direct hyperglycemic effect. A randomized, placebo-controlled study demonstrated fluoxetine effectively reduced depressive symptoms in an eight-week trial, with a trend toward improved glycemic control in patients with diabetes (both types 1 and 2) and MDD (Lustman et al., 2000b). Despite evidence for improved depression, improved glycemic control and weight loss with SSRIs, one area in which they lack effectiveness is neuropathy.
A single case report described new-onset type 2 DM in conjunction with mirtazapine-induced weight gain (Fisfalen and Hsiung, 2003).
Bupropion appears to be at least weight-neutral, if not weight-decreasing (Appolinario et al., 2004). Further evidence for potential benefits in glycemic control came from a study by Ghaeli et al. Although extensively studied, SSRIs are not appropriate monotherapy for diabetic neuropathy (Duby et al., 2004). Happens because the amount of insulin produced is not sufficient for the body or because body cells do not respond to insulin properly (insulin resistance).Diabetes type 2 more common in adult life, as it often called adult-onset diabetes.
In terms of weight, phenelzine (Nardil) appears to induce weight gain, although reports on other MAOIs are mixed (Zimmermann et al., 2003). This disease used to be called non-insulin dependent of diabetes mellitus (NIDDM) because it does not depend on the hormone insulin.
The same study found significantly increased fasting blood glucose in patients without diabetes treated with the TCA imipramine (Tofranil). This is important, given the association of these medications with the new onset of type 2 DM.
However, path analysis showed the direct effect of nortriptyline was to worsen glycemic control (independent of weight gain), whereas depression improvement had an independent beneficial effect on glycosylated hemoglobin. Prudent patient care may dictate extending this surveillance to patients treated for depression.
An open-label, 52-week trial of duloxetine for MDD showed a mean weight gain of approximately 5 lb (Raskin et al., 2003). Inhibiting the 2C9 isoenzyme will increase sulfonylurea levels, potentially leading to dangerous hypoglycemia (Cozza et al., 2003). Diabetes type 2 can also be caused by the amount of insulin produced is not sufficient for the body’s pancreas.
It is the two most important elements that must be maintained properly by people with diabetes. Regular exercise will increase your metabolism, able to maintain glucose levels remain normal and increase the sensitivity of cells to insulin.People with diabetes, either type 1 or type 2, should be examined in blood glucose levels regularly. Always consult your doctor to plan a lifestyle appropriates to their respective conditions. Many people with diabetes can still live a normal life and the length by adopting a healthy lifestyle. Share on: Twitter Facebook Google +Posts Related to Type 2 Diabetes Causes Symptoms Treatment4 Differences Between Diabetes Type 1 and Type 2Most people do not understand what the difference between diabetes type 1 and type 2.
Most people think that diabetes is just one disease that occurs due to high sugar levels in the blood. This condition (prediabetes) almost always comes before a person has type 2 diabetes that more severe.
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