Brief Answer:
frequent blood investigations; lifestyle modifications.

Detailed Answer:
Hello
Welcome to HealthcareMagic.
I can understand your concerns for your brother.

You brother is taking clozapine and risperidone forte for schizophrenia and has been prescribed glycomet GP1 for diabetes.

The anti-diabetic medication Glycomet GP1 and its dose is very much ok.
This drug can be safely given with antipsychotic medicines.

I would suggest you to go for fasting blood sugar testing every three months. for first year.

At this point, I would like to tell you some more facts and give you some advices:

1. Clozapine and risperidone are known to cause diabetes or precipitate diabetes.
Since treatment of schizophrenia is extremely essential, There are some antipsychotics like aripiprazole and amisulpride, which are considered relatively safe in schizophrenia patients who are diabetic.
As your brother is taking clozapine, It suggests that he is having resistant schizophrenia. If giving clozapine is essential, I would suggest a replacement of risperidone by aripiprazole (under his doctor's supervision).

2. With clozapine, some investigationa are important:
Complete blood count, lipid profile, liver function tests, renal function tests, fasting blood sugar levels and ECG (atleast every three months). These are also needed as your brother also has diabetes.

3. Anti-diabetic medications are to be taken half hour before meals. Take night dose of glycomet GP half hour before dinner and antipsychotics after meals at bedtime.
Take morning dose of glycomet GP empty stomach.

4. Since there can be some bloating and flatulence with these medications, an antacid like omeprazole is also advised empty stomach.

5. Anitdiabetic drugs donot cause hypoglycemia. Do not worry about this.

Apart from drug treatment, lifestyle modifications are extremely important.
I will give you a diet chart which your brother can follow for better management of diabetes:

At 6.00 am- 1 cup tea (without sugar) and 2 XXXXXXX gold biscuits.
At 9.00 am- half glass double toned milk (without sugar), 1 chapati with 1 small bowel of vegetables.
At 11.00 am- 1 fruit (apple)
At 1.00 pm- 1 chapati, 1 small bowl vegetables/boiled pulses, 1 plate salad, 1 small bowl curd.
At 3.00 pm- 1 bowl soup.
At 5.00 pm- 1 small bowl sprouts.
At 8.00 pm- repeat diet taken at 1 pm.
At 10.00 pm- 1 glass of milk (without sugar).

Avoid sugar, fatty foods.

I know this is a strict diet plan and may be difficult to follow.But he should try to follow this as far as possible.

Along with this, brisk morning walk for 30 minutes is to be done.

Kindly discuss these issues with your doctor.

Hope this helps.

Feel free to discuss further.

I wish good health for your brother.

Thanks.
Dr. Shubham Mehta, MD.

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Brief Answer:
glimepiride 2mg can taken in morning.

Detailed Answer:
Hello again.
Thanks for the follow-up response.

He can take Glimepiride 2mg once in morning and metformin 500 mg twice a day. There is no problem in this.
Also, the chances of anti-diabetic drugs causing hypoglycemia is extremely low. These drugs bring back sugar levels to normal and not cause hypoglycemia.

In my opinion, aripiprazle should be started at dose of 5mg to be given for one week and risperidone should be stopped after one week. Then the dose of aripiprazole can be increased as needed (under doctor's guidance).

(Here, I am assuming that your brother has resistant schizophrenia as he is being treated with clozapine. Clozapine is THE DRUG OF CHOICE for resistant schizophrenia).

I am available at Navjeevan Multispeciality Hospital, XXXXXXX (Haryana) for personal consultations.

For more details, you can visit my profile for the details using the following link:
http://doctor.healthcaremagic.com/doctors/dr-shubham-mehta/68996

You can also discuss any health related issues directly with me at your convenience.

Take care.
Thanks.

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