Antipsychotic Metabolic Monitoring

An antipsychotic can improve psychosis or mania while quietly changing appetite, insulin sensitivity, lipids, blood pressure, and cardiovascular risk. That risk belongs to the medication plan from the first dose, not only to people who already have diabetes. Diabetes Canada therefore recommends regular metabolic monitoring for every person treated with a second- or third-generation antipsychotic. The risk is produced by more than the drug alone. Serious mental illness, reduced activity, dietary constraints, comorbidity, and limited access to preventive care can all increase diabetes and cardiovascular risk. Screening must continue across treatment, including after a medication has been taken for months or years. The practical nursing question is not simply whether monitoring was ordered. Confirm that the measurement or laboratory result is present, record it in a way that permits trending, and escalate a meaningful change before it becomes symptomatic disease. Drug selection is part of prevention: clozapine and olanzapine have the greatest established metabolic burden, so the indication, dose, alternatives, and follow-up plan should be considered together.