Schizophrenia Makes Diabetes Management Challenging

Proper management of schizophrenia and diabetes is imperative for physical and mental health. Both illnesses require structured treatment plans and continuous monitoring and attention. Without sufficient care and management, quality of life, physical health, and mental health plummet. Worse, the risk of death increases. Someone living with schizophrenia faces a shorter lifespan than those without it; tragically, schizophrenia shortens lives by up to 30 years. Having diabetes further increases the risk of early death. Treatment and management are essential but quite difficult. Multiple obstacles interfere with diabetes and schizophrenia management ("The Strong Link Between Schizophrenia and Diabetes").

The Difficulties of Schizophrenia and Diabetes Management

Treating these two illnesses can feel like an insurmountable challenge. Treating just one can be hard. When someone is dealing with both schizophrenia and diabetes, they face numerous obstacles.

One treatment problem involves medication that must be taken in order to treat schizophrenia’s hallucinations and delusions. In many cases, antipsychotic medication needs to be strong in order to reduce symptoms. As effective as antipsychotics are in reducing the symptoms of schizophrenia, they make diabetes worse.

Antipsychotics come with side-effects. Among the many unwanted effects of antipsychotic medication are significant weight gain, high cholesterol, and increased triglycerides (fats in the bloodstream). These can cause type 2 diabetes to develop quickly (see "Do Antipsychotic Medications Cause Diabetes?"). If diabetes is already present when antipsychotic treatment begins, diabetes complications worsen. Blood sugar becomes more difficult to control, and complications of hypo- and hyperglycemia become dangerous. Poorly managed diabetes leads to a host of health problems.

Sometimes, switching to a different antipsychotic medication or lowering the dose can help reduce the negative impact on diabetes ("Are There Any Safe Antipsychotics in Diabetes Treatment?"). That’s not always an option, though, because by changing or adjusting antipsychotics, there’s a risk of making the psychotic symptoms of schizophrenia worse. Treating schizophrenia with antipsychotics can worsen diabetes, but helping diabetes by reducing medication can intensify schizophrenia. Finding the right medication and dosage is a delicate balancing act.

Beyond medication, the nature of schizophrenia makes diabetes management tough. Schizophrenia is associated with unhealthy lifestyle factors, all of which contribute to or exacerbate diabetes. Some factors include:

• Sedentary lifestyle
• Lack of proper nutrition
• Cigarette smoking
• Obesity
• Non-adherence to treatment
• Impaired insight
• Poor insight/understanding of the impact of these illnesses
• Limited access to medical care

Schizophrenia even interferes in self-care. Diabetes requires self-care, but schizophrenia makes that hard. Schizophrenia can cause problems in executive functioning, working memory, and motivation. When hallucinations and delusions are part of the picture, the ability to monitor and treat blood sugar levels is drastically reduced. Blood sugar goes uncontrolled, and complications arise.

Facing these treatment obstacles can be disheartening. As each condition worsens, both become even more difficult to keep under control. There are some solutions that can make schizophrenia and diabetes management a bit better.

Solutions to Schizophrenia and Diabetes Management

As with many things in life, early detection can improve outcomes. Because diabetes is so common in schizophrenia, it’s important that people be screened immediately upon receiving a diagnosis of schizophrenia.

Doctors may take baseline readings of height, weight, body mass index (BMI), blood pressure, fasting plasma glucose, and lipid levels. Then, these should be remeasured and compared to initial readings at every medical visit. This allows doctors to catch things like increases in weight and blood sugar levels early and treat them before they spiral out of control.

Consistent, thorough care is important for people with schizophrenia and diabetes. In addition to frequent medical visits, other steps must be taken for proper care. Among the management solutions:

• Lifestyle management to watch weight, exercise, and diet
• Quitting smoking
• Increasing nutritious eating and decreasing processed foods, soda, etc.
• Psychoeducation to increase understanding and motivation to follow through with treatment
• Self-care

Living with and treating both diabetes and schizophrenia is overwhelming. People living with these conditions need a support system. Getting to regular doctor visits, complying with medication, monitoring blood sugar, and engaging in other management plans can be nearly impossible without support. With help, someone’s chances of treatment compliance and success increase.  

One more key point to remember for improved treatment is that these two different conditions are so interconnected that the best thing to do is often treating them as one. A holistic treatment approach that attends to physical and mental health is perhaps the best road to the management of diabetes and schizophrenia.

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