Diabetes issues in post-organ transplant recipients. Presented by Methodist Hospital, Houston, TX

1. Post Transplant Diabetes
What Every Patient Should
Know

2. Reasons a patient should be
concerned about diabetes:
• Diabetes is a serious disease that is
associated with many health problems
and complications.
• Diabetes is an even greater risk for
persons who have undergone organ
transplantation.
2

3. The type of diabetes that
may occur after organ
transplantation is called
“new onset diabetes” or
“post-transplant diabetes
mellitus” (PTDM).
3

4. Those transplant
recipients that experience
new onset diabetes
(PTDM) may have
features of either Type I
or Type II diabetes.
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5. RISK FACTORS ASSOCIATED
WITH DIABETES MELLITUS:
• Family history
– Some people have inherited a tendency to
develop the disease, particularly if this
tendency is in both parents or a sibling.
• Obesity
– This is a strong risk factor for Type II
diabetes, particularly for those who have
been obese many years. 5

6. • Ethnic background
– African-American/black, Native Americans,
Native Alaskans, Hispanics, Pacific Islanders
and Asian Americans are at highest risk.
– Persons in some ethnic groups have two to
three times the risk of developing diabetes
compared with all people.
– Type I diabetes, inherited from both parents,
is more common in Caucasians.
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7. • Inactive life style
• Abnormal blood fats (cholesterol/triglycerides)
• Anti-rejection medications
– Some of the medications (immunosuppressive
medications) that a patient takes to prevent his or her
body from rejecting a transplanted organ may
increase the risk for developing diabetes.
– As a result, the body will respond differently to the
foods eaten, leading to post-transplant diabetes
mellitus (PTDM).
– Most anti-rejection medications may increase the risk
of diabetes. However, some of these medications are
linked with a higher risk.
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8. Can a patient lower the risk
for developing diabetes?
Some risk factors cannot be
changed.
Examples are age and ethnic
background.
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9. However, there are
several risk factors
that can be
influenced by
changes in a person’s
lifestyle. 9

10. Those changes include:
• Improving overall health through diet and exercise
• If overweight, weight reduction is very important
to reduce the risk for diabetes.
• Nutrition can be improved with a balanced diet.
The transplant dietician, nurse coordinator or
physician can provide the best diet for each
individual patient.
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11. In attempting to reduce
stress, a patient may feel
comfortable discussing
increased post-transplant
stress with the transplant
social worker, nurse
coordinator or physician.
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12. These professionals
can also refer the
patient to additional
counseling services
for advice.
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13. Transplant patients are faced
with many responsibilities
to assure continued good
health.
One of those responsibilities is to
proactively monitor themselves
for symptoms of diabetes.
13

14. Early detection and
treatment of diabetes
may reduce one’s
chance of developing
complications.
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15. Signs and Symptoms
of Post-Transplant
Diabetes Mellitus
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16. Though it is possible to develop diabetes
without noticing any changes, it is common to
have some of the following symptoms:
Frequent urination
Excessive thirst
Extreme hunger
Tiredness
Tingling or numbness in the hands or feet
Sudden vision changes
Irritability
Unexpected weight loss
Slow healing cuts or infections
Constant itching 16

17. DIAGNOSIS AND
TREATMENT
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18. Diabetes is diagnosed by determining
levels of glucose in the blood through
use of several types of tests.
• A fasting glucose test involves analyzing
a small sample of blood after a patient
has fasted for several hours.
• A glucose tolerance test, which requires
several blood samples over several hours,
may also be performed. 18

19. The trend of blood glucose
levels in persons who have
diabetes will rise.
This occurs when there is an
inadequate amount of insulin
or when the insulin is being
prevented from properly
entering the cells. 19

20. Some patients find that simple changes
in anti-rejection medications help
control diabetes.
With others, changing eating habits and
losing excess weight is effective.
Adding exercise to one’s daily routine
helps control this disease.
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21. Diabetes may require daily
insulin injections or
medications that can be taken
by mouth.
In Type II diabetics, the supply of
insulin is inadequate. Oral
medications stimulate the pancreas
to produce the insulin.
21

22. It is essential for patients
diagnosed with post-
transplant diabetes
mellitus to monitor
glucose levels regularly
throughout each day.
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23. Monitoring is usually performed
with a hand-held glucometer every
morning and prior to meals.
The nurse coordinator and physician
will instruct the patient to record daily
blood glucose readings.
This information should accompany the
patient to each transplant clinic
appointment. 23

24. Routine care and inspection of
the following is imperative:
feet
skin
eyes
teeth
gums 24

25. LONG-TERM COMPLICATIONS OF
DIABETES
• If left untreated or uncontrolled, diabetes can result in
serious problems involving the:
– Heart
– Eyes
– Kidneys
– Nerve endings
– Blood vessels
• It is important to remain aware of symptoms
and watch for their occurrence so that early treatment
may be initiated.
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26. Symptoms of heart problems:
Pounding headaches
Blurred vision
Dizziness
Numbness and tingling
Irregular heartbeat
Shortness of breath
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27. Symptoms of diabetic neuropathy
(caused by damage to nerve endings)
Tingling
Decreased sensation
Pain in arms or legs
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28. Vision changes
– Long-term, uncontrolled diabetes results
in a thickening of the blood vessels in the
eye (diabetic retinopathy).
– If left undetected, it can cause blindness.
– As patients often do not experience
symptoms, routine eye exams are
necessary.
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29. High blood pressure (hypertension)
– High blood pressure is often an
indication that the kidneys are not
working well.
– Diabetics have a 50% greater risk for
developing kidney disease than non-
diabetics.
– High blood pressure that is not treated is
a major contributor to kidney disease.
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30. It is important that
the blood pressure of
a transplant patient
be monitored
frequently.
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31. Each patient will receive a blood
pressure cuff after transplantation.
The nurse coordinator will teach the
patient the correct way to take a blood
pressure reading and how to record the
numbers. Normal blood pressure
ranges will also be discussed.
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32. If the patient is diagnosed
with hypertension, anti-
hypertensive medications
will be prescribed in order
to reduce the development
of kidney disease.
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33. Swelling (edema) in the lower legs,
numbness and cold feet, poor or slow
wound healing may occur.
– Poor blood flow in the extremities, due to a
thickening of the blood vessels
(arteriosclerosis), may increase the risk for
infections.
– This may be severe enough to eventually
require amputation of toes, feet or part of the
leg.
– Additionally, arteriosclerosis is a risk factor for
heart disease. 33

34. LIVING WITH
DIABETES
Although there is no cure
for diabetes, this disease is
treatable.
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35. If you are diagnosed with post-
transplant diabetes, you should begin to:
– Start by learning as much as you can about the disease
– Talk to your physician, your diabetes educator and your
transplant coordinator about your immunosuppressive
therapy and routine care.
– Record your blood glucose levels and learn about the
methods to help you maintain your insulin levels.
– Make healthy lifestyle choices through diet, exercise and
stress reduction to maintain a healthy weight.
– Request support from your family, friends and other
diabetics, as well as your transplant team.
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36. REMEMBER…
THE MORE YOU LEARN,
THE MORE YOU CAN
DO TO HELP KEEP
DIABETES UNDER
CONTROL.
Compliancy is very
important.

37. Questions or
Comments?
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