I am 57, male. How can I treat my TD without affecting T2D?

Question

Hello doctor,

I am a 57-year-old man who developed tardive dyskinesia after long-term use of antipsychotic medications for schizophrenia.

For the past year, I have experienced involuntary lip smacking, tongue movements, and jerky hand motions, which are very embarrassing and interfere with my daily life. My AIMS (Abnormal Involuntary Movement Scale) score is 14, and my psychiatrist said this indicates moderate TD.

I have had type 2 diabetes for the past 12 years, with an HbA1c of 8.2 percent and a fasting blood sugar of 176 mg/dL, despite being on Metformin and Insulin. My blood pressure usually stays around 145/92 mmHg, and my LDL cholesterol is 148 mg/dL, suggesting a high cardiovascular risk.

Because of my involuntary movements, I often have difficulty eating and sometimes choke on food.

I recently started Valbenazine 40 mg daily, but I feel very drowsy, and my blood sugars seem harder to control. I am worried that this medication may worsen my diabetes or interact with my other medicines.

I would like to know what the safest and most effective treatment options are for tardive dyskinesia, considering my schizophrenia, diabetes, and hypertension, and whether non-drug therapies or lifestyle changes could also help reduce my symptoms.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Tardive dyskinesia (TD) can be particularly challenging to manage when coexisting with schizophrenia, diabetes, and cardiovascular risk factors, as in your case.

Your AIMS (abnormal involuntary movement scale) score of 14 indicates moderate severity, and the involuntary movements affecting eating and swallowing make treatment important.

Valbenazine is an FDA-approved (Food and Drug Administration) VMAT2 (vesicular monoamine transporter 2) inhibitor for TD and is generally considered effective, but it can cause drowsiness and, in some cases, may worsen metabolic control, especially in patients with diabetes.

Another option is Deutetrabenazine, which may have fewer sedating effects, though it also requires monitoring for depression and metabolic issues.

Adjusting your antipsychotic regimen may also help. Using lower-risk agents like Clozapine or Quetiapine, under your psychiatrist’s supervision, could reduce TD progression while still controlling schizophrenia. Since you also have uncontrolled diabetes, high blood pressure, and elevated LDL (low-density lipoprotein), optimizing these conditions with better glucose management, antihypertensives, and statin therapy is critical because VMAT2 inhibitors can sometimes complicate metabolic control.

Non-drug approaches such as physical therapy, swallowing therapy, mindfulness-based relaxation, and avoiding caffeine or stress triggers may modestly reduce symptom severity.

Importantly, coordination between your psychiatrist, neurologist, and primary physician or endocrinologist is needed to balance TD treatment with cardiovascular and diabetes management.

If drowsiness or glucose worsening continues, your doctor may consider dose adjustments, switching VMAT2 inhibitors, or supportive measures while intensifying diabetes and heart risk management.

I hope this has helped you.

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

Thank you.