Hyperglycemia and Diabetes in Adult Kidney Transplant

If you are considering a kidney transplant, or have already received one, there are some things you need to know. This blog post focuses on hyperglycemia and diabetes related to kidney transplant.

Nutrition care for kidney transplant patients is a complex process. A transplant recipient’s nutritional status is impacted by many different things – appetite, weight, digestive issues, altered electrolytes, the use of steroids and immunosuppressant drugs, and medical conditions that existed prior to, or continue to exist after transplant surgery. Continual follow up visits with a doctor and dietitian are needed to reassess nutrition goals, monitor the effectiveness of therapy, and address complications that may arise post-transplant. An individualized diet for kidney transplant will be provided by the transplant team dietitian.

Transplant Medications

After a kidney transplant, drugs are prescribed to stop the body from rejecting the new kidney. Corticosteroids such as prednisone and calcineurin inhibitors such as Cyclosporine A and tacrolimus are two of the medications commonly used to suppress the immune system. While this helps keep the body from rejecting the new kidney, there are possible side effects. Hyperglycemia, also called high blood sugar, is a side effect of these medications. It is a common occurrence in many transplant patients. Why does this happen? First of all, prednisone causes insulin resistance, a condition in which the body does not use insulin properly. Secondly, calcineurin inhibitors impair insulin secretion. Both of these conditions can result in high amounts of sugar being left in the blood. In addition, personal or family history of diabetes, age, ethnicity and obesity can all increase the risk of hyperglycemia.

Is Hyperglycemia Serious?

Hyperglycemia should be taken very seriously, as it can increase the chances of infection and loss of the transplanted kidney. High blood sugar can decrease the chances of survival after transplant. So, how can you help prevent or manage hyperglycemia after a transplant?

• Monitor your glucose levels closely per your transplant team’s instructions.
• Ask your dietitian for diet and physical activity recommendations. Once cleared by your doctor, exercise as recommended to help control glucose levels.
• Ask your doctor if you will need medications to help manage your glucose.
• Consider a referral to an endocrinologist (diabetes-specialist) if your diet, exercise and medications are not controlling your glucose levels.

Weight Gain and Transplant

Weight gain of 20 to 40 pounds is fairly common after transplant surgery. What causes it? Reduced calorie needs after stopping dialysis, the elimination of previous diet restrictions, the increased appetite from steroid use, and being of the female gender are all linked to weight gain after transplant surgery. In addition, rapid weight gain can also increase the risk of hyperglycemia.  Follow these tips to help manage your weight and glucose levels:

• Reduce portion sizes of sugary or high-carbohydrate foods while still eating adequate amounts of calories and protein each day.
• Keep a food diary to show to your dietitian at your follow up visits.
• Set realistic goals in your weight journey.
• If you find yourself using food as a “comfort” or “reward,” talk with your dietitian about different behavior modification techniques to help you have a healthy relationship with food.

For many transplant recipients, as steroid doses decrease, glucose levels return to normal. However, anywhere from 12% to 46% of patients will develop diabetes for the long-term after transplant. Therefore, it is very important that you follow the recommendations from your dietitian and doctor to help you stay healthy after transplant.

For more information go to “Understanding Kidney Transplant.”

Reference

A Clinical Guide to Nutrition Care in Kidney Disease, second edition, by Laura Byham-Gray, Jean Stover, and Karen Wiesen. Page 94. Chapter: Nutrition Management of the Adult Renal Transplant Patient

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.