■1型糖尿病的特征是绝对胰岛素缺乏,需要终生强化胰岛素治疗,并伴有每日自我监测,自我管理,持续教育,和复杂的糖尿病护理。定期的患者-临床医生根据年龄共享治疗决策,性别,合并症,药物,膳食的预测影响,身体活动,压力,荷尔蒙的变化,胰岛素治疗,血糖变化模式是实现血糖目标的关键.双相情感障碍的各个阶段及其治疗对连续葡萄糖水平的影响仍未被探索,需要进一步评估。
本病例报道了一名41岁的白种人女性,确诊为双相II型障碍和1型糖尿病,她停止了长期稳定情绪的喹硫平药物治疗。在喹硫平停药前和停药后6个月进行的实时连续血糖监测显示药物与未药物双相情感障碍隐藏的血糖模式。尽管已知喹硫平的不良代谢作用,与未用药的双相情感障碍阶段相比,在抗精神病药物治疗期间,连续血糖监测获得了更稳定和接近正常的连续血糖值,且血糖值和血糖变异性显著较高.
病例报告强调了正在进行的双相情感障碍精神药物治疗在1型糖尿病合并症中的重要性,以降低情绪诱发的反应性,情感上的紧迫感,和可能导致血糖异常的非情绪冲动。如果没有得到有效治疗,“双相型糖尿病”可能发展为多种精神和躯体并发症。双相情感障碍各阶段和相应的连续葡萄糖模式之间的双向联系可以帮助推进临床决策和产生创新研究,可以转化为有效的临床实践。
Type 1 diabetes mellitus is characterized by an absolute insulin deficiency requiring the lifetime intensive insulin therapy accompanied by daily self-monitoring, self-management, ongoing education, and complex diabetes care. Regular patient-clinician shared therapeutic decisions based on age, sex, comorbidities, medications, predicted impact of meals, physical activity, stress, hormonal changes, insulin therapy, and patterns of glycemic changes are key for achieving glycemic targets. The impact of various phases of bipolar disorder and their treatment on continuous glucose levels remains unexplored and calls for future assessments.
The present
case reports a 41-year-old Caucasian female with an established diagnosis of bipolar II disorder and type 1 diabetes mellitus who discontinued long-term mood-stabilizing pharmacotherapy with quetiapine. Real-time continuous glucose monitoring performed before and 6-months following the discontinuation of quetiapine revealed hidden glucose patterns in medicated versus unmedicated bipolar disorder. Despite the known adverse metabolic effects of quetiapine, the continuous glucose monitoring captured more stable and near-normal continuous glucose values during the antipsychotic treatment compared to unmedicated stages of bipolar disorder with considerably higher glucose values and glucose variability.
The
case report highlights the importance of the ongoing psychopharmacotherapy of bipolar disorder in comorbid type 1 diabetes mellitus to reduce mood-induced reactivity, emotional urgency, and non-emotional impulsivity that may contribute to dysglycemia. If not effectively treated, the \"bipolar diabetes\" is likely to progress to multiple psychiatric and somatic complications. The bidirectional links between the phases of bipolar disorder and the corresponding continuous glucose patterns can help advance clinical decision-making and yield innovative1 research that can translate into efficacious clinical practice.