Hypers and antidepressants

My T1 teenager was diagnosed with depression a year ago, and has been prescribed Zytomil (Escitalopram). The dose was increased to 20mg about 6 months ago, and since then, her glucose numbers have been so unstable. She has been running consistently high, but with terrible lows inbetween. There are very few smooth middle of the road days. We had hoped the antidepressant would flatten the curve, but it seems to have had the opposite effect. I read an article (that I now can’t find :frowning:) that linked hyperglycemia to some antidepressant medications. Does anyone have some experience of this?

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I’m not taking an antidepressant, but for me, personally, anytime I’m running high, I also see lows from trying to force it down. The two kinda always go hand in hand, for me.

Thanks for the response! Kate’s numbers can range from 3.2 to 21.4 in a single day. I guess there is over correction both ways. It just puzzles me because she had always kept her glucose in a much tighter range until a few months ago. We are seeing the endo soon, so will chat to her about all the possibilities of what is going on.

Ugh, I’ve been having those days lately as well. Is she using syringe insulin or a pump?
I’m guessing that she’s on a continuous monitor. ???

She’s probably old enough that the Doc ought to be teaching her how to set her own baseline (basal) insulin dosages. Just to cover the basics - if she doesn’t do this on her own, she needs to know how. That’s the only way she will be able to take care of this long term.

Sometimes Docs withhold this info and we produce kids who can’t survive on their own as adults. Young adults become completely dependent on the Doctor. But, the Doctors aren’t as good at setting these dosages as diabetics are. We see the data everyday. We have to know how to troubleshoot the system when it behaves badly.

If the Doc gives any trouble over this, politely remind them that she has the right to know how to take care of herself and you would like her to have some experience with this before she leaves the house to live on her own.

Its possible that antidepressants play some role in the current situation. But, the practical place to start is running some tests on her basal insulin rates.

One place to start is to note is if she goes high after eating (then, this might be bolus insulin dosages are wrong at mealtime, or she not counting carbs well, or the insulin just isn’t working fast enough). If she drifts high when she hasn’t eaten anything, then basal insulin rates are wrong. Without proper tests in the data, the Doc won’t know either. A lot of this comes down to collecting good data for the Doc and for yourself so you can see clearly where the problem is.

Feel free to ask about the details of this if you don’t already know. You can always post data here and we will look at it.

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Here’s an example of me not taking very good data for the Doc. There’s a little too much going on to see exactly where the problem is. Maybe my basals are off. I don’t remember.

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Thanks - there is a lot of useful info in your response! Kate uses a Libre CGM and injects herself. We upped her Tresiba basal when the hypers seemed consistent. She is 16, and fiercely independent. She was diagnosed when she was 11/ almost 12, so she has a few years of learning to read her body. We are also looking at how long before she eats she should inject the bolus (Apidra). At the moment she tries to inject about 15 to 20 minutes before eating. This is not always possible though (at school…) and we are still figuring out which carbs are slow release and which are faster. Do you know if there is a list of fast and slow acting carbs we can refer to?

The endo is thorough and kind and has encouraged Kate to manage her own diabetes (with our support.) I have been keeping a food/insulin/activity diary to try to figure out any patterns.

Thank you for your kind interest. It sometimes feels rather lonely being the parent of a T1.

@Wendy19 -

There’s some really handy info at the links below that will likely change your thinking on carb counting, glycemic index and glycemic load.

"It’s the glycemic response to, not the carbohydrate content of food that matters in diabetes"

http://phcuk.org/nice/

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It sounds like both you and your kiddo are on the right track. I’m sure you will work this out. Keep in contact! Its great to start at a young age with this stuff. It makes the rest of life go much smoother to learn young.

Jim posted a great starting point. You can also google “low glycemic foods” to find slower acting carbs. But, it is a little different for everyone. So, she will have to do some experimenting. Cell mag describes it like this in a short 5 minute video: https://www.eurekalert.org/pub_releases/2015-11/cp-fd111215.php

I don’t believe SSRIs like escitalopram are linked to blood sugar issues. You may be thinking of atypical antipsychotics, which can be prescribed for treatment refractory depression, which absolutely do come with significant risk of increasing insulin resistance and risk for T2 diabetes (which can also affect T1s). But seems more likely to be hormones, growth, etc, in your child’s case, and need for higher basal doses.

Thank you - this is useful info!

Very interesting - thanks for the link. And the encouragement :slight_smile:

Yes - 16 years is probably a difficult hormonal age, so we do need to take that into account too. Thanks for the feedback.

Hi Wendy,

I have been in the exact same situation; In my case, i started using Escitalopram at the same time i was diagnosed with Type 1 diabetes, and have used it for about 1 year.

I use a Medtronic sensor so i can monitor my glucose 24/7, but even with the sensor it was impossible to keep my sugar stable, especially after meals i got huge spikes. The problem was if i used extra insulin to prevent the highs, i would end up in a major hypo 1 or 2 hours later.

I wish i found out earlier that Escitalopram caused this. I stopped using Escitalopram which solved the issue…

Hope that helps.
Best regards, David.

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Hi David. Thank you - this is exactly what I am looking at. I have looked at all the numbers - and Kate’s hypos have been severe, and her hypers extreme - and the major change has been the introduction of the Escitalopram. I am most grateful to you for sharing this information. Kate’s endo knew she was taking it, but didn’t prescribe it. I am wondering if a different sort of antidepressant would interfere less with the insulin. Did you find any literature regarding the drug interaction while you were taking the Escitalopram? I am keen to learn more. Thank you so much for your help. All the best, Wendy

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Hello Wendy,

My endo also knew i was taking it but she did not warn me about it either.

However i did do some googling (i am by no means an expert…) and found this:
The results of this study strengthen the findings in individual case reports that the use of antidepressants is associated with disturbances in glucose homeostasis
in https://databankws.lareb.nl/Downloads/kwb_2009_1_ssris.pdf

Perhaps it also depends on the person, like how 1 person can react bad to eating gluten while another person has no issues at all?
I think the most important fact is that you observed the decline/unstable glucose after starting with Escitalopram, so i would definitely communicate this with your endo and the doctor who described the Escitalopram. And also emphasize the impact it had on their wellbeing.

I have no experience with/know whether other antidepressant would interfere less.

Hope that helps… best,
David.

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Thank you, David. This info is a huge help. I agree that drug reactions are different with different people. The more I dig, the more I think we need to rethink her meds. We are seeing the endocrinologist tomorrow, and will discuss it all with her. I appreciate your taking time to help me. Kind regards, Wendy

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I am a type 2 and have been on the same drug since about a year before diagnosis. For me the two conditions do not seem to be related other than the fact I have a harder time controlling my appetite when I am depressed.

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Thank you

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If you are looking for other drug options for depression, and want to avoid SSRIs like escitalopram, something like bupropion might be an option (totally different class of drugs, with different set of side effects), as long as the med is not being used for anxiety. Definitely worth asking about, and there are many other options as well. And your prescriber may be willing to cross-titrate (go down on the old med while increasing the new one) which might help reduce recurrence of mood symptoms.

Thanks - I am going to ask the doctor a lot of questions about suitability and side effects of any meds

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