Journal of the Japan Diabetes Society

To determine whether diet is associated with obesity-independent insulin resistance, we studied how dietary content and caloric intake relate to insulin resistance in 85 women college students aged 18-22 years. Subjects were weighed daily during the seven-consecutive-day dietary assessment. Insulin resistance was measured using homeostasis model assessment (HOMA-IR) and body composition was determined by dualenergy X-ray absorptiometry (DXA). Twelve (14%) of the 85 had HOMA-IR of ≤2.5 and consumed more energy, carbohydrates, protein, and fat-specifically, saturated fat-than did those with HOMA-IR of <1.6. In stepwise multiple regression analysis including all nutrients as independent variables, body fat mass, saturated fat, and beta carotene potency (inverse) were significant determinants of HOMA-IR independent of leptin, adiponectin, and plasminogen activator inhibitor-1. Dairy products and vegetables (inverse) were significant independent predictors of HOMA-IR in multiple regression analysis including all foods as independent variables. Our results suggest that vegetable intake should be increased and saturated fat (dairy product) intake decreased to lower insulin resistance in young women.

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A 44-year-old woman seen in an emergency for convulsions one month after 3 mg/day of risperidone was added to her treatment in 2007 was found to have a blood glucose level of 2,089 mg/dl. She was diagnosed with hyperosmolar nonketotic diabetic coma and given insulin, and risperidone was discontinued. After discharge, her diabetes was controlled by diet alone.
Four months after discharge, her delusions relapsed and perospirone hydrochloride was started. Six mg/day of aripiprazole was added 5 months after perospirone hydrochloride was started. She redeveloped severe diabetes mellitus within a month of aripiprazole initiation, although she maintained HbA₁c of 5% when treated with perospirone hydrochloride alone. On admission in 2008, she required treatment with insulin (30 units/day), but her insulin requirements fell shortly after aripiprazole was stopped. She did not require insulin therapy on discharge.
Aripiprazole, a relatively new antipsychotic drug approved for treating schizophrenia, is considered to have the fewest side effects of all atypical antipsychotics, but our case suggests the importantance of carefully monitoring blood glucose when prescribing atypical antipsychotics such as aripiprazole.

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