Lithium diabetes mellitus

It has been reported that diabetes mellitus is three times more common in bipolar patients than in the general population (680). However, lithium does not appear to increase the risk of diabetes mellitus, and its use in patients with pre-existing diabetes is generally safe, assuming that the diabetes is well controlled. 

When lithium toxicity has been reported in patients with diabetes mellitus, it has been attributed to impaired glucose intolerance (681). 

Two patients with diabetes mellitus developed lithium toxicity (serum concentrations 3.3 and 3.0 mmol/1) in association with impaired consciousness, and hyperglycemia that resolved after intravenous insulin and fluids (683). 

When a 45-year-old man with severe lithium-induced diabetes insipidus developed hyperosmolar, nonketotic hyperglycemia, it was suggested that poorly controlled diabetes mellitus may have contributed to the polyuria (684). Prior contact with a female patient who had developed hyperosmolar coma secondary to lithium-induced diabetes insipidus (685) allowed physicians 4 years later to treat her safely after a drug overdose and a surgical procedure, by avoiding intravenous replacement fluids with a high dextrose content (despite stopping lithium several years earlier, the patient continued to put out 10 liters of urine daily) (686). 

Difficulty in attaining a therapeutic serum concentration of lithium despite increased doses was attributed to increased renal clearance due to the osmotic effect of glycosuria in a 44-year-old man with poorly controlled diabetes mellitus (682). 

Uzu T, Ichida K, Ko M, Tsukurimichi S, Yamato M, Takahara K, Ohashi M, Yamauchi A, Nomura M. [Two cases of lithium intoxication complicated by type 2 diabetes mellitus.]J Jpn Diabetes Soc 2001 44 767-70. 

An isolated report describes a diabetic patient receiving insulin who developed hypeiglycaemia when his serum-lithium levels were high, but not when the lithium dose was reduced. Lithium can raise blood glucose levels and in some instances this has been associated with the development of diabetes mellitus, but the association is unclear and there is little or no evidence that its use normally causes significant changes in diabetic controL... 

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Jones GR, Lazarus JH, Davies CJ, Greenwood RH. The effect of short term lithium carbonate in type n diabetes mellitus. HormMetabRes( 9S3>) 15, 422-4. 

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