BY FRANCISCO FERNANDEZ AND DIANA F. RAMIREZ
The Rio Grande Valley Diabetes Association and The Monitor unite to provide education to the public about the prevention and control of diabetes through monthly articles. This month’s topic is about the connection between diabetes and psychosis.
Last year, we reviewed the connection of depression to diabetes and its management. Today, we will explore another connection: the increased morbidity and mortality in patients with severe mental illness and psychotic disorders like schizophrenia.
Individuals with schizophrenia have a 20-year shorter lifespan than peers without schizophrenia. While in some patients premature death is due to smoking, hypertension, inactivity, poor diet, obesity and increased blood cholesterol and lipids, in many it is due to diabetes. Why is this? Some individuals experience a metabolic disturbance associated with their treatment for schizophrenia. These include the second generation antipsychotic agents like clozapine, olanzapine, risperidone, quetiapine and others. Unfortunately, these medications add insult to injury by way of increased weight gain, impaired glucose tolerance and new onset diabetes. While lifestyle risks are involved, direct and indirect effects of the medications used in their treatment are a significant factor.
Schizophrenia is one of the most demanding of the severe mental illnesses because it requires strict management on a daily basis. On the medical side, the same is true for diabetes. Both combined can result in one of the worst clinical outcomes due to interference with self-care management and treatment compliance. Schizophrenia is associated with poor diabetes self-care (including oral medication taking, dietary modifications, exercising and monitoring of blood glucose) making the care of schizophrenia critically important in the treatment of diabetes. It can become a vicious cycle of poor control of the schizophrenia with poor control of the diabetes. This often results in the development of depression and possibly suicide. Fortunately, in this case, the same strategy outlined last year with slight modifications works just as well.
Simply put, it is “control all controllables.”
Step 1: Consider the overall risks for any individual with schizophrenia who is going to initiate or change treatment; be sure to have a baseline fasting plasma glucose and HgA1c test; and monitor these during psychiatric treatment every four to six months. If all values are normal in the first year of treatment, then repeat annually.
Step 2: If your screening values are abnormal indicating possible diabetes, have your provider refer you to a primary care physician or subspecialist for follow-up. Be sure that your “team” is communicating. Coordination of care among all treatment team members is critical to prevent complications or recurrent and relapsing psychiatric disease, and the medical condition.
Step 3: On an ongoing basis, individuals with schizophrenia may have their capacity for self-management assessed as well as exploring feelings of “loss of control” over self-management leading to suboptimal disease management and outcomes. Assistance prioritizing the order of importance of specific tasks is critical.
The Rio Grande Valley Diabetes Association is a local non-profit organization whose mission is dedicated to the prevention of diabetes and its complications through educational services, early detection and awareness. The RGVDA’s focus is to bring attention on a growing health epidemic that affects one out of every four people in Hidalgo Country, making it one of the worst afflicted areas in the country. Type 2 diabetes is preventable and also manageable through a healthy regimen of exercise and dieting, the RGVDA offers free monthly cooking classes on the second Tuesday of the month in Edinburg. For more information call your RGVDA office at (956) 782-1900.
Sugar-Free Sugar Cookies
3/4 cup unsalted butter
1/4 cup light butter
1 cup Splenda No Calorie Sweetener, Granulated
1 tablespoon vanilla
1/4 cup egg substitute
1/4 cup water
3/4 teaspoon vinegar (white or cider)
1-1/2 cups all-purpose flour
1-1/2 cups cake flour
1/4 teaspoon salt
1 teaspoon baking powder
1. Preheat oven to 350 degrees F. Lightly oil a cookie sheet and set aside.
2. Blend together butters, Splenda Granulated Sweetener and vanilla in a medium mixing bowl with an electric mixer. Blend butter till softened. Add egg substitute, water and vinegar. Mix briefly. Add flours, salt and baking powder. Mix on low speed, until dough is formed. Do not over mix.
3. Remove dough from bowl and place on a floured work surface. Divide dough in half. Pat each half into a circle and cover with plastic wrap. Refrigerate approx. 1 hour, allowing dough to chill.
4. Remove dough from refrigerator and roll out on a floured work surface to desired thickness, approx. 1/4 inch. Cut with cookie cutters. Place cookies on prepared sheet.
5. Bake in a preheated 350 degrees F oven 10-12 minutes or until lightly browned on the back. Cool on a wire rack.
Nutritional information (per serving)
Calories from Fat: 30
Sodium: 30 mg
Cholesterol: 10 mg
Saturated Fat: 2g
Dietary Fiber: 0g
2 Cups Splenda powdered sugar
1/2 Teaspoon flavor extract
1-2 Tablespoons water or milk
Put the Splenda powdered sugar into a medium-sized bowl. Add in the extract and slowly stir in the liquid. Mix until the consistency is smooth.
In necessary, continue adding small amounts of liquid into the glaze until you have the consistency you desire.
Make this glaze chocolate by adding 1-2 tablespoons of Cocoa powder into the powdered sugar before adding in the liquid.
Francisco Fernandez, M.D., is a professor in the Department of Psychiatry, Neurology, and Neurosciences for the University of Texas Rio Grande Valley School of Medicine. Diana F. Ramirez is the executive director for the Rio Grande Valley Diabetes Association.