Post Transplant Diabetes

1. Post Transplant Diabetes Lung Transplant Education Series Valerie Durney, NP, CCTC

2. OVERVIEW • What is diabetes • Why do I have elevated blood sugars post transplant if I didn’t before? • Why good glucose control is important • What factors effect my blood sugar Post Transplant Diabetes

3. Insulin is a hormone produced by the pancreas to control blood sugar • Diabetes is a condition when the pancreas is unable to produce enough insulin or your body becomes resistant to it Post Transplant Diabetes

4. To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested: • A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body. • An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel. Post Transplant Diabetes

5. People with diabetes have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy. • Prograf & prednisone can cause elevation in blood sugars resulting in diabetes • If you have diabetes before transplant there is a high likelihood you will need insulin after transplant • Anyone can develop an insulin requirement post transplant Post Transplant Diabetes

6. NOW WHAT DO I DO ABOUT IT? • Dietary modifications • Exercise • Monitor blood sugars • Administer insulin Post Transplant Diabetes

7. Monitoring blood sugars • Glucometer obtained prior to discharge from hospital with lancets/test strips • Typically monitor blood sugars 4x/day Post Transplant Diabetes

8. Insulin Sliding scale vs. standing dose Always administer before eating Considerations before procedures Storage Post Transplant Diabetes

9. WHAT YOU NEED TO KNOW ABOUT HIGH BLOOD SUGARS • High blood glucose means you don't have enough insulin in your body, also called hyperglycemia • This can happen if you miss taking your diabetes medicines, eat too much, or don't get enough exercise Post Transplant Diabetes

10. Having an infection, being sick, or being under stress can also make your blood glucose too high • High blood sugar can make you feel: 4 Thirsty 4 Tired 4 Blurry vision 4 Excessive urination 4 GI upset Post Transplant Diabetes

11. WHAT YOU NEED TO KNOW ABOUT LOW BLOOD SUGARS • Low blood glucose, also called hypoglycemia, happens if your blood glucose drops too low • Low blood glucose can be caused by taking too much diabetes medicine, missing a meal, delaying a meal, exercising more than usual, or drinking alcoholic beverages Post Transplant Diabetes

12. HOW LOW BLOOD GLUCOSE CAN MAKE YOU FEEL • Weak • Confused • Irritable • Hungry • Tired • Sweaty • Headache • Shaky • If your blood glucose drops lower, you could pass out or have a seizure If you have any of these symptoms, check your blood glucose! Post Transplant Diabetes

13. IF THE LEVEL IS BELOW 70… Have one of the following right away: • 3 or 4 glucose tablets • 1 serving of glucose gel-the amount equal to 15 grams of carbohydrate • 1/2 cup, or 4 ounces, of any fruit juice • 1/2 cup, or 4 ounces, of a regular—not diet—soft drink • 1 cup, or 8 ounces, of milk • 5 or 6 pieces of hard candy • 1 tablespoon of sugar or honey Post Transplant Diabetes

14. Diabetes medicines can cause low blood glucose • Always carry food or glucose tablests for emergencies • You should also wear a medical alert bracelet or necklace at all times Post Transplant Diabetes

15. Make healthy food choices Pay attention to portion sizes & always combine foods (ie: carb + pro) Eat foods that have less fat and salt Eat foods with more fiber MANAGING YOUR DIABETES Post Transplant Diabetes

16. Get 30 to 60 minutes of physical activity on most days of the week Stay at a healthy weight Learn to cope with stress Take medicines even when you feel good MANAGING YOUR DIABETES Post Transplant Diabetes

17. Post Transplant Diabetes Always contact your transplant coordinator for with any questions or concerns! Linda: 617-732-7299(last names starting with A-K) Betsy: 617-732-5971(last names starting with L-Z) or via Patient Gateway

18. REFERENCES • American Diabetes Association. Standards of Medical Care in Diabetes – 2012. Diabetes Care. 2012; 35 Suppl 1:S11-S63 • American Diabetes Association website • www.ncbi.nlm.nih.gov • www.transplantliving.org