Post-Transplant Diabetes

By Jeanette F. Lorang, RN

You have traveled a tough road to get through a successful transplant. Then, you are diagnosed with having Post Transplant Diabetes Mellitus (PTDM)!! What is that about? No one in your family has diabetes. You don't even know anyone who does! How can this be? What is going on? You are barely keeping up with dose changes of your medications let alone being able to pronounce their names or even to spell them!

Well, you may have had some feelings like that if you have been diagnosed with Diabetes Mellitus. Where does this all come from? A few different reasons are involved. First, your body is under a lot of stress, this raises your blood sugar levels. When your body is not able to successfully bring those levels down, you have hyperglycemia (high blood sugar).

Your anti-rejection medications can lead to diabetes. These drugs have become much better in suppressing the immune system; therefore transplants have been more successful. The negative is that they decrease your body's ability to make insulin, increase insulin resistance and are harmful to the cells that make the insulin.

Steroids are a common medication in the transplant world. They can trigger your body to respond differently to foods called carbohydrates. Carbohydrates (CHO) are in certain food groups such as grains/starches, fruits, & milk. Your body turns carbohydrates into sugar. You need CHO for your body to heal, repair itself and have energy. When you eat CHO's, your blood sugar naturally rises. Your body, in turn, will increase the insulin it makes to bring the blood sugar level down. For some, CHO's cause the blood sugar to rise higher than normal. For you, your blood sugar rose so high while taking steroids that you need insulin injections to bring the blood sugar level down. This is not unusual, especially right after a transplant. Your Health Care Team or dietician will direct you on what foods you should be aware of to help minimize the spikes in your blood sugars. The need for insulin is very different for everyone. It depends upon the type of transplant you have, the amount of steroids you are taking, how sick you are as well as other factors that are not as obvious. You may need insulin for a very short time, or for a few months. There are multiple factors that are contributing to this. Your Health Care Providers will look at weaning you from your insulin as soon as safely possible.

What else could have put you at risk? These factors for diabetes are put into two different categories: changeable and not changeable. The non-changeable risks would be age, family history and ethnic background. So, those who have family members with diabetes as well as those of particular ethnic groups (such as African-American/black, American Indian, Alaskan Native, Hispanic, Pacific Islander or Asian) are at a higher risk than those without this history. Another non-changeable, is if you are over 45 years of age. Risk factors that are somewhat changeable are, and that puts you at a higher risk of diabetes according to the American Diabetes Association are 1) a diet that is not "healthy", 2) inactive life style, 3) overweight, 4) low HDL cholesterol or high triglycerides, and 5) high blood pressure.

Is it normal to be diagnosed with Diabetes after a transplant? One study suggests that one out of ten people who have transplants will develop diabetes. How are you diagnosed with Diabetes? The diagnosis comes after having 2 fasting blood sugar readings that are greater than 126mg/dl. Then what? The next step is that you would learn to test your own blood sugars at home. It is typical to test before meals and sometimes before bedtime. This is often something decided by your Health Care Provider or Endocrinologist (Dr who specializes in the Endocrine system -which includes the pancreas where your body makes insulin). Transplants Centers will differ in when to be testing the blood sugar. It is common to monitor when fasting. In the morning, before breakfast (after not eating all night), before other meals throughout the day (allowing 4 hours of not eating anything prior to testing before the next meal and bedtime) Insulin is prescribed to control the blood sugars when they are elevated. Sometimes pills can be prescribed if the blood sugar level is elevated only a little bit. Even a combination of medications can be used to control the blood sugars; it depends on what your Doctor prescribes for you to keep the blood sugars controlled. What is a normal blood sugar reading? The blood sugars typically run 70 - 100 mg/dl when there is no diabetes. When a person has diabetes, the ideal blood sugar goal is 80 - 130 mg/dl. A blood sugar goal is set by your Doctor and is dependent upon multiple circumstances that he is overseeing. The biggest goal is to work at attaining blood sugars that are consistent throughout the day. Such as, the blood sugar readings before meals are all are running greater than 200, versus bouncing from 70's to 250's to 90 to 300's. Having consistent medications, food and activity can help with this.

After having been diagnosed with PTDM, you may feel that it is overwhelming. The good news is that it is possible for your blood sugars to be controlled. It may take a bit of time and effort at first to get the hang of testing your blood sugar and injecting insulin. But, over time, this will become more "natural". Please remember that diabetes is a serious disease. Diabetes has great risks to people who have had a transplant. It raises the danger of organ rejection, serious infections and even death. If your anti-rejection medications and steroid doses decrease, your insulin needs will decrease. Also, if you are careful with decreasing your food portions and increase your activity your insulin needs will need to decrease even more. It is even possible, to transition to pills after being on insulin or even controlling your diabetes with diet and exercise. A healthy diet and staying active helps your body to be strong. With a strong healthy body, you are able to celebrate life!