From the Research
Lithium can potentially cause hypoglycemia in patients with bipolar disorder, and its interaction with hypoglycemia is complex, involving alterations in insulin sensitivity and glucose metabolism. The relationship between lithium and hypoglycemia is multifaceted, with evidence suggesting that lithium may impair glucose metabolism, leading to a worse clinical presentation of psychiatric illness and a poor response to mood stabilizers 1. Patients taking lithium should be aware of the symptoms of low blood sugar, such as shakiness, confusion, irritability, dizziness, and sweating, and monitor their blood glucose levels regularly, especially when starting treatment or adjusting dosages.
Some studies have investigated the effects of lithium on glucose metabolism, with one study finding that lithium treatment was associated with symptomatic and biochemical hypoglycemia during a glucose tolerance test 2. Another study suggested that lithium could improve glucose metabolism in patients with diabetes, particularly when used in combination with other therapies 3. More recent research has proposed that lithium's therapeutic effect in bipolar disorder may be mediated by its action on insulin signaling pathways, including the phosphatidylinositol 3-kinase/Protein Kinase B (PI3K/Akt) pathway 4.
In terms of management, patients experiencing hypoglycemic symptoms while on lithium should check their blood glucose levels if possible, consume 15-20 grams of fast-acting carbohydrates, and contact their healthcare provider. Regular meals, avoiding alcohol on an empty stomach, and routine blood work to monitor both lithium levels and metabolic parameters are important preventive measures. Healthcare providers may need to adjust lithium dosing or consider alternative mood stabilizers if hypoglycemia becomes problematic. The most recent study suggests that lithium can ameliorate insulin-deficient hyperglycemia by attenuating pancreatic α-cell mass and hepatic gluconeogenesis, independently of exercise-induced metabolic changes in the muscle 5.
Key considerations for patients with bipolar disorder taking lithium include:
- Monitoring blood glucose levels regularly
- Being aware of the symptoms of low blood sugar
- Consuming regular meals and avoiding alcohol on an empty stomach
- Informing their psychiatrist about any history of hypoglycemia or diabetes
- Considering alternative mood stabilizers if hypoglycemia becomes problematic.