Endocrine Abstracts

A 73-year-old lady with a history of type two diabetes since 1993, mastectomy for carcinoma left breast in 2000, primary hypothyroidism, and hypertension was referred to the local hospital in view of poor glycaemic control in July 2001. Her medications included Thyroxine, Atenolol, and Tamoxifen, Frusemide, Gliclazide 160 mg BD and Pioglitazone 30 mg. At the time of referral her weight was 68.5 kg, (BMI 23.7), HbA1c 10.2%. She was started on Humalog mix 25 BD. In 2003 her weight went up to 83.3 kg with HbA1c of 7.8%. In 2004 she was started a basal bolus regime with Humalog TDS and Glargine. In 2010 her weight increased to 93.9 kg (BMI 32.5) with HbA1c of 8.5%. She became depressed with 25 kg weight gain over a period of 9 years and therefore started on an antidepressant in September 2011. When reviewed in January 2012 her weight was down to 89 kg with a better HbA1c of 7.0% without changes in her diet, physical activities and renal function. She was having hypoglycaemias. She sensibly cut down the insulin doses. Now she is only on Glargine 40 units at night. The cause of hypoglycaemia was investigated including the short synacthen test which was normal. Apparently she was commenced on Citalopram by the GP for 12 months.

Conclusion: Patients with type two diabetes are at a higher risk for depression. Selective serotonin reuptake inhibitors (SSRIs) are effective anti-depressant. Hypoglycaemia in insulin treated diabetic patient is common. Taking a thorough drug history is essential especially Citalopram when presented with hypoglycaemia with no apparent reason. About 1% of people taking Citalopram developed hypoglycaemia. SSRIs do not seem to influence plasma insulin levels or augment hypoglycaemic action of injected insulin.