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Dr. Goldberg: Hypoglycemia with Lamictal
RogueFemale2 posted:
Dear Dr. Goldberg:

I have taken Lamictal for ten years for Bipolar NOS, with no side effects of note. I am hoping that you can tell me if there is any link between Lamictal use and non-diabetic hypoglycemia, especially as a side effect that appears suddenly after many years of taking the drug.

During the past six months, I've been experiencing some rather unsettling episodes of hypoglycemia. A GTT shows that I definitely do not have diabetes, and I am of a very healthy weight, Nevertheless, instability with blood sugar seems to be worsening, decidedly. Most dramatically, I've recorded levels as low as 47 and 55 myself, using a highly-reliable home monitor. On another occasion, a blood draw at a doctor's office registered a glucose level of 52. My PCP is not concerned about this problem (and it IS becoming a sincere problem, especially in terms of driving); she has only advised that I eat more often. This answer frustrates me because I already do eat six small "meals" throughout the day, with both protein and carbs each time. When I mentioned the problem again at an appointment with her today, she said she thought the fluctuations in blood sugar was probably just due to Lamictal use.

I have to admit, I am somewhat nonplussed by her answer, given that it seems rather dismissive. But perhaps she is correct? Perhaps there IS in fact a link between anti-convulsants and non-diabetic hypoglycemia?

Hoping you can shed some light!
Joseph F Goldberg, MD responded:
Dear Roguefemale2,

There is no known effect of lamotrigine on blood sugar, nor can I think of any mechanistic rationale for a connection.

Atypical antipsychotics, by contrast, can all affect blood sugar and the action of insulin.

If your primary care doctor were concerned that you may have abnormal glucose metabolism, unrelated to lamotrigine, it would make sense to have a consultation with an endocrinologist to get a more definitive opinion on whether or not there is any issue of clinical concern.

Dr. G.
RogueFemale2 replied to Joseph F Goldberg, MD's response:
My PCP does not seem interested in the increasing number of these incidents at all, which is the source of my frustration because they have become burdensome. At least I feel justified now in my dismissal of her Lamictal idea.

Thank you. I appreciate your reply.

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Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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