Diabetes associated with atypical antipsychotic treatment may be severe but reversible: case report.

OBJECTIVE: To draw attention to severe presentations of atypical neuroleptic related diabetes and to document that a marked degree of remission can take place after drug withdrawal. METHOD: We describe two patients who presented with diabetic ketoacidosis after treatment with quetiapine and risperidone, respectively. RESULTS: Both patients were negative for islet cell antibodies. They both required treatment with insulin, one in very high dosage, but their insulin requirements fell progressively after the atypical antipsychotic was withdrawn. After several months, neither patient required antidiabetic treatment. CONCLUSIONS: Atypical antipsychotic-induced diabetes does not always take a "type 2" presentation in which weight gain and insulin resistance are implicated. Sometimes the presentation is with diabetic ketoacidosis, requiring insulin treatment, which can nevertheless be reversible.