What is the relationship between hypoglycemia and the use of Risperidone (risperidone) in a patient with Type 1 Diabetes Mellitus (T1DM)?

From the Guidelines

Risperidone can potentially worsen hypoglycemia in patients with type 1 diabetes, and therefore, it is crucial to closely monitor blood glucose levels and adjust treatment regimens as needed to prevent hypoglycemia and its associated risks, such as cognitive decline and increased risk of dementia, as suggested by studies 1. When managing hypoglycemia in patients with type 1 diabetes on risperidone, consider the following key points:

• Individuals at risk for hypoglycemia should be asked about symptomatic and asymptomatic hypoglycemia at each encounter, as recommended by the Diabetes Care study 1.
• Glucose (15–20 g) is the preferred treatment for the conscious individual with hypoglycemia, although any form of carbohydrate that contains glucose may be used, and glucagon should be prescribed for all individuals at an increased risk of severe hypoglycemia, as stated in the Diabetes Care study 1.
• If a patient with type 1 diabetes on risperidone is experiencing hypoglycemic episodes, consider reducing the risperidone dose or switching to an alternative antipsychotic with less metabolic impact, such as aripiprazole or ziprasidone, and adjust insulin dosing as needed, potentially reducing basal insulin by 10-20% if hypoglycemia persists.
• Ensure the patient carries fast-acting glucose (glucose tablets, juice) and glucagon emergency kit for severe episodes, and provide patient education about recognizing hypoglycemia symptoms and proper management, as emphasized in the Annals of Internal Medicine study 1.
• A multidisciplinary approach involving both psychiatry and endocrinology is ideal to balance mental health needs with diabetes management, and ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if low cognition and/or declining cognition is found, as recommended by the Diabetes Care study 1.

From the Research

Hypoglycemia in Type 1 Diabetic Patients on Risperidone

• Hypoglycemia is a significant concern for individuals with type 1 diabetes, and certain medications like risperidone may impact glucose regulation 2, 3.
• Risperidone has been associated with the development of transient type 1 diabetes mellitus and diabetic ketoacidosis in some cases 2.
• The risk of hypoglycemia in type 1 diabetic patients can be managed with strategies such as continuous glucose monitoring, optimizing insulin doses, and carbohydrate intake 4, 5.
• Therapeutic options for hypoglycemia in type 1 diabetes include intranasal glucagon, which has been shown to be effective in treating insulin-induced hypoglycemia 6.

Risperidone-Associated Hyperglycemia and Hypoglycemia

• Risperidone has been linked to hyperglycemia, with reports of new-onset diabetes, exacerbated preexisting diabetes, and diabetic ketoacidosis 3.
• The mechanisms underlying risperidone-associated hyperglycemia are not fully understood but may involve changes in insulin sensitivity and glucose metabolism.
• Hypoglycemia-associated autonomic failure is a significant concern in type 1 diabetes, and strategies to avoid hypoglycemia, such as continuous glucose monitoring, may help reduce the risk of severe hypoglycemic events 4.

Management of Hypoglycemia in Type 1 Diabetes

• The American Diabetes Association recommends a management protocol for hypoglycemia, including a clear prevention and treatment plan 5.
• A tailored approach to glycaemic goals and therapy selection can help individualize care and reduce the risk of hypoglycemic events.
• Continuous glucose monitoring and real-time glucose monitoring can be effective tools in managing hypoglycemia risk, particularly in individuals with impaired hypoglycemia awareness or a history of severe hypoglycemic events 4, 5.