To explore the effect of lithium carbonate combined with olanzapine on glucose and lipid metabolism, as well as gender differences in treating bipolar disorder (BD). 110 BD patients admitted to the Fifth People's Hospital of Luoyang from February 2022 to January 2024 were retrospectively included in the study. Patients were categorized into two groups based on treatment: The single group (lithium carbonate, n = 50) and the coalition group (lithium carbonate + olanzapine, n=60). Post-treatment, the coalition group's YMRS score was 4.67±1.34 points and BRMS score was 24.93±2.30 points, both lower than the single group's YMRS score of 7.64±1.51 points and BRMS score of 34.38±2.30 points (P<0.05). The coalition group's effective rate was 96.67%, significantly higher than the single group's 82.00% (P<0.05). Post-treatment, the coalition group had lower levels of FBG, TC, TG and LDL-C than the single group, while HDL-C was higher (P<0.05). Additionally, glycolipids levels in both male and female subgroups increased post-treatment compared to pre-treatment. The efficacy of lithium carbonate sustained-release tablets combined with olanzapine in the treatment of bipolar disorder (BD) is well-established. This combination therapy can effectively alleviate manic and psychiatric symptoms, enhance patients' social functioning and improve their quality of life. Furthermore, it has a minimal impact on glucose and lipid metabolism, with no observed gender differences.