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Why meds that make you gain wt might put you at risk for diabetes

Posted by Sharon W on 5/03/03 at 15:33 (117756)

This link is for a Medscape article/slide show that I found quite interesting. (Unfortunately, medscape does require membership to gain access, to you may not be able to read it...)

http://www.medscape.com/viewprogram/2049

The link is very technical, but I think it shows an important link between drugs that can increase obesity, and increased insulin resistance and type 2 diabetes. Here are the parts I found most interesting:

'FFAs: A Link Between Obesity and Insulin Resistance'

'It turns out that fat is not a passive tissue. This adipose tissue is metabolically active. It is resistant to insulin and, therefore, it is undergoing accelerated lipolysis, generating free fatty acids. And those free fatty acids do exactly the opposite of what insulin would do at the tissue level.'

'So instead of muscle tissue being stimulated to take up glucose, it is inhibited. Instead of glucose production being inhibited by insulin in the liver, free fatty acids stimulate it. And what happens is that you now have this contribution to insulin resistance by this active fat tissue.'

'When we look at the metabolism of muscle in people with type 2 diabetes, what we see is that under insulin-stimulated conditions, not the basal rates, there is a significant decrease in glucose metabolism. That is where the insulin resistance manifests itself.'

'This excessive lipolysis from this rich fat store that we see under conditions of obesity certainly has a significant deleterious effect in muscle.'

'The liver isn't spared. The increased free fatty acid oxidation, the augmentation of gluconeogenesis as a result of exposure of the liver to those increased free fatty acid levels, results in hepatic glucose output being augmented, and this is precisely what drives up fasting plasma glucose levels.'

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The author goes on to describe the effects that some of the new anti-psychotic drugs being given to schitzophrenics can have on causing or increasing obesity and, consequently, increasing the risk for diabetes (and all its related problems).

He finishes with, 'In conclusion, antipsychotic treatment-induced weight gain can increase risk for hyperglycemia and type 2 diabetes, and increase risk for hypertension, dyslipidemias, and cardiovascular disease. We also know that antipsychotic treatment is associated with changes in glucose regulation, and this is potentially interacting with disease and lifestyle-related abnormalities.'

I'm thinking, what about other drugs that are sometimes taken for neuropathy, such as the antispasmotics? I've seen complaints about both Neurontin and Topamax that they seem to trigger weight gain. Wouldn't a patient taking Neurontin for nerve pain (even though it is causing her to gain weight) be running similar risks??

Sharon