How to manage schizophrenia, TD and T2D at 41?

Hello,

Welcome to icliniq.com.

I understand your concern.

Managing schizophrenia alongside type 2 diabetes and now tardive dyskinesia (TD) can be very challenging, especially when symptoms and medications seem to interact.

Firstly, it is quite possible that your elevated blood sugars are contributing to the worsening of TD symptoms. While high glucose does not directly cause TD, fluctuations in blood sugar can affect how your nervous system and medications interact. They can also influence fatigue, concentration, and even the metabolism of medications.

Your current use of Risperidone, an antipsychotic known to potentially cause or worsen TD with long-term use, could also be a contributing factor.

While Valbenazine is appropriate and commonly used for TD, its dose should only be adjusted after evaluating its effects over time and ideally under the guidance of a neurologist or psychiatrist experienced in movement disorders.

Fatigue and difficulty concentrating may stem from multiple sources, such as elevated blood sugar, medication side effects, or even poorly managed sleep or mental health symptoms.

Skipping doses, whether of antidiabetic or psychiatric medications can worsen both glucose control and psychiatric stability, so it is essential to find a way to minimize side effects without compromising your treatment.

Regarding switching antipsychotics, yes, it may be a reasonable consideration, especially for one with a lower risk of TD, such as Clozapine or newer atypical antipsychotics, but this must be done cautiously and in close consultation with your psychiatrist, as maintaining stability in schizophrenia is the top priority.

Investigations to be done:

• Repeat fasting and postprandial blood glucose to monitor and stabilize levels.

• Recheck HbA1c (glycated hemoglobin) in three months.

• Serum B12, folate, and TSH (thyroid stimulating hormone) levels to rule out metabolic contributors to fatigue and neurological symptoms

• Review current medications for potential interactions and issues with dose timing

• Conduct a neurological examination and assess TD severity (using the AIMS scale, if available)

Treatment plan:

• Optimize diabetic control: Consider switching Glipizide to a DPP-4 (dipeptidyl peptidase-4) inhibitor (example: Sitagliptin) or a GLP-1 (glucagon-like peptide-1) analog if weight is also a concern, under the guidance of a diabetologist.

• Do not stop or adjust the dose of valbenazine without input from your neurologist.

• A psychiatrist review is advised to explore safer antipsychotic alternatives with a lower risk of TD.

• Consultation with a movement disorder specialist may be beneficial, especially if TD symptoms are significantly affecting quality of life or not responding to current treatment.

• Address fatigue through improved glucose control, B12 screening, and adjustments to medication timing.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.