After a successful Kidney Transplant, many Chronic Kidney Disease (CKD) patients who previously never had a history of blood sugar problems are at a heightened risk of developing new onset diabetes, called Post Transplant Diabetes Mellitus (PTDM). The National Kidney Foundation calls PTDM a "growing epidemic" and "a national public health problem." The figures are quite astounding, "At least 15% to 20% of transplant recipients are at risk for developing diabetes," which is associated with increased mortality (death) and morbidity (secondary disease). Specific issues include higher rates of Cardiovascular Disease and infections that may cause Kidney Transplant failure.
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The United Network for Organ Sharing lists 120,894 people waiting for an organ transplant; the large majority of whom need a KIDNEY Transplant. It is unfortunate that once they are selected for their "gift of life," as it is often called, the very immunosuppressive medications that allow the donor kidney to function also produce a toxic effect on insulin production and an increased resistance to insulin. This is the reason why approximately 15% of Kidney Transplant recipients develop diabetes within a year after transplantation. If you fall into this group, it is likely that you have a risk for developing diabetes prior to transplant. If a close relative has type II diabetes, then you are also at increased risk.
Careful selection and management of immunosuppressants is crucial to prevent diabetes. You can work closely with your Kidney Transplant team to accomplish this goal. Protocols that minimize Kidney Transplant recipients risk of contracting diabetes are more heavily being adopted, according to the National Kidney Foundation. This is good for diabetes prevention because higher doses of corticosteroid (steroid) for prolonged periods of time increases the risk of type II diabetes. Even a small reduction in a steroid like Prednisone from 10mg. to 5mg. can significantly reduce your risk for diabetes. Calcineurin inhibitors which are commonly used by Kidney Transplant recipients increase the risk of diabetes as well.
You can help to further reduce your risk of diabetes after a Kidney Transplant by:
- Balancing your weight through preventing weight gain as much as possible or losing a significant amount of weight.
- Limiting your carbohydrate intake.
- Managing your intake of unhealthy lipids (fats);
- Controlling blood pressure to preserve kidney function and reduce cardiovascular risk.
- Taking a blood glucose test at least annually, a year after receiving your transplant.
- Administering early insulin to help preserve residual islet function.
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Siraj ES, Abacan C, Chinnappa P, Wojtowicz J, Braun W. "Risk Factors and Outcomes Associated with Posttransplant Diabetes Mellitus in Kidney Transplant Recipients." Http://www.ncbi.nlm.nih.gov/. National Center for Biotechnology Information, U.S. National Library of Medicine.
"New Onset Diabetes: A Guide for Kidney Transplant Recipients." Http://www.kidney.org/. The National Kidney Foundation.