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Organ Donation and Transplantation - Diabetes after a kidney transplant

 

Key Points

  • Diabetes is also called ‘sugar diabetes’ or ‘diabetes mellitus’
  • Diabetes is common after transplantation (15 to 20 out of 100 receiving a transplant)
  • If not properly treated, diabetes can cause complications
  • Treatment of diabetes is with diet and drugs (tablets or insulin infections)

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What is diabetes?

In diabetes the level of sugar in the blood does not stay level. Sugar is needed for energy by all parts of the body, and sugar is dissolved in the blood so that it can be carried around. The level of sugar in the blood usually stays the same, throughout the day. That means that if you eat a lot of sugar, for example a chocolate bar, although the sugar passes into your body very quickly, it is put into store and the level of sugar in the blood does not go up. If you do not eat all day, sugar is released from storage, so that level of sugar in the blood does not fall.

In diabetes, if you eat a lot of sugar, the level of sugar in the blood goes too high. If you do not eat for a long time, the level of sugar in the blood may fall too low.

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Why is diabetes a problem after kidney transplantation?

There are several reasons why diabetes can be a problem after a transplant.

  1. If someone has diabetes before a transplant, when they are on dialysis, it’s very unusual for the diabetes to go away. Indeed, it often gets harder to control.
  2. Some of the drugs given to keep the transplant working – the anti-rejection drugs – can cause diabetes as a side effect. Prednisolone (a steroid), cyclosporin and tacrolimus can all cause diabetes. These drugs are important in transplantation and research has not yet found better ones. Therefore, even if one of these drugs causes diabetes, it is not usually possible to come off them completely.
  3. Diabetes is very common in the general population. As many as 30% (one in three) of people who are elderly and overweight have diabetes, even though this is often mild. Therefore someone could develop diabetes, even though it is not caused by their transplant.
  4. People may also be at extra risk of developing diabetes after a kidney transplant if they are of black or south Asian ethnic origin, or have several family members with diabetes.

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How is diabetes diagnosed?

Most transplant teams include measurement of the sugar level in the routine blood tests performed before and after a transplant. Usually changes in the blood results will be detected before any symptoms are experienced, especially as diabetes most commonly develops in the first 3 months after a transplant, when blood tests are very frequent. Diabetes can cause thirst, passing urine frequently, and infections such as thrush (an infection causing a sore throat or itching in the genital area). If someone has any of these symptoms after a transplant, they should ask the transplant team to check for diabetes.

Once diagnoses is confirmed the treatment is a multi-strategy approach and includes optimising your anti rejection drugs, commencing tablets or insulin. This is done in close liaison with a diabetic specialist nurse and a specialist diabetic doctor.

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NKF Controlled Document No. 269: Diabetes after a kidney transplant written: 17/09/2004 last reviewed: 23/09/2016