pre diabetes following transplant

[Taconeo]

my transplant was very successful 2 years ago due to polycystic kidneys but I have been diagnosed with pre diabetes just recently, my diet is really good mostly because of my preference which is for fresh home cooked meals , salads , protein & I walk every day but my consultant says prednisone & tacrolimus is to blame as well as weight gain , I wondered if any readers here has had any success reversing pre diabetes following transplant & what worked for you , I understand 5% loss of body weight is key but i would love to hear anyones direct experience 😊

[blackkat2]

I've done pretty well. Firstly, I got off the prednisone as soon as possible. Low carb diet, regular (virtually daily) exercise (HIIT and resistance training). My old endocrinologist had me on glimeperide because nothing else was studied in transplant recipients, tried to get me on insulin. I said no, not till I tried all possible lifestyle adjustments. New endo, in consult with transplant nephro, has me on low dose Jardiance. Lost the weight gained from the glimeperide and blood sugar controlled without insulin. Requires vigilance, like everything else.

[Palmtreeguy]

i, also, have had this issue. It is quite common. A noted side effect of Tacro. I stopped the prednisone, and did finger sticks for several months. I was on insulin, but just for a week. I stick to my "prison diet" - no concentrated sugar, low carb, low calorie. Blood sugar is now pretty much where it should be. Have kept the weight off. I found out that stress can spike blood sugar. I also take Metformin.

[pepeagamez in reply to Palmtreeguy]

i am in the same boat. My after transplant nephrologist told me to consult my family doctor and ask him to refer me to a dieticien. No help from them so far. I just have to follow what I feel is best for me. Eat well, exercise.

[Palmtreeguy in reply to pepeagamez]

I have a dietician as part of my Transplant Team. She is very good about what to eat and what not. For example, when I had constipation, I thought I was doing well by eating prunes. She said take the pills instead - ALL dried fruit is bad for me because they concentrate sugar. Who knew?

[pepeagamez in reply to Palmtreeguy]

when I was doing dialysis I had a dieticien as a part of the team too. Now is not the case... I do not feel good about it....

[Darlenia]

Hi. My hubby is a T2D. He has been a diabetic most of his life, but managed to get off all diabetic meds while on dialysis. Immediately after his transplant last year, it roared back into his life. He follows a strict low sugar and low carb diet and his weight is at an optimum place. The immunosuppressants are definitely the driver behind the resurgence. There isn't much more he can do other than take his insulin. His transplant wasn't a perfect match, it fell into the average range and also had a few issues. So his team believes the type and dosages of his immunosuppressants are appropriate and necessary. He has made peace with his situation.

[PostivelyJo]

I have PKD . Luckily I came off prednisolone and lost lots of weight . Coukd you push for that ?

[Taconeo in reply to PostivelyJo]

do you have transplant?

[MToQ in reply to PostivelyJo]

May I ask what dose of prednisone?

[PostivelyJo in reply to MToQ]

I was on a maintenance dose of 5mg which I reduced slowly by 1 mg over 4/5 months

[PostivelyJo]

yes. Sept 2019

[redpanda67]

I will say, this is one of my biggest pet peeves in transplant right now. I am a research scientist and have spent the last 15 years studying metabolism, diabetes, and transplantation. A very large portion of transplant patients will develop T2D, or at least prediabetes. More importantly one of the bigger problems is not the A1C or fasting glucose levels, but the elevated post-meal glucose levels later in the day. It may not be uncommon for a patient to have normal fasting glucose levels and even fall within normal range with their A1C, but give them a glucose challenge, especially later in the day after fasting for 8 hours, with 100grams of sugar and their blood glucose levels will skyrocket into 200-300s and take more than 4-5 hours to return to below 140, a normal healthy person will rise into the 200s and quickly drop after 2 hours. This is an early sign of insulin resistance, almost pre - prediabetes.

Because blood glucose levels are so important to kidneys, I strongly believe that ALL transplant patients should be given a glucose monitor before leaving the hospital after their transplant and should be encouraged to use it at least a few times a week during different times of the day. Better yet are the continuous glucose monitors. I have been using these for several years. They are expensive and not covered by insurance most of the time, so I use one about every 1-2 months. I started using them because I wanted to see what food was impacting my glucose levels the most. Some people are more sensitive to certain carbs than others. I, for example, can never eat another potato in my life because it increases my glucose into the high 200s, whereas the same amount of carbs from plain white rice only increases my glucose into the lower 200s. It also helped me understand when I can eat certain foods. I am much better off eating high-carb meals in the morning when my body seems to have a better insulin response and eating low-carb meals in the evening when my insulin response is not as good. I had to completely flip my eating habits. Heavy breakfasts and light salads for dinner.

Transplant patients are not like most other people, T2D and insulin resistance are directly related to the drugs we take. Prednisone is the big culprit, but so is tacrolimus, sirolimus, and even to some extent cyclosporin. These all-cause significant disruptions to normal metabolism and the effect is most noticeable in insulin/glucose regulation. The second effect is mostly noticed in weight gain. Because of this problem, my attitude is most transplant patients should be put on glucose-lowering drugs proactively as soon as their post-meal glucose levels begin to spike too high. But, in order for doctors to know about this trend it requires more intervention in the form of simple glucose monitors or continuous glucose systems. I have been extremely lucky because I have a great endocrinologist who has no issues writing me a prescription for continuous glucose monitors, even though I have to pay out of pocket. She also has a lot of background working with transplant patients and understands the significant differences between a "normal" person with insulin resistance vs a transplant patient. A normal person can quickly reverse the effects of insulin resistance with weight loss and diet management, and while both are important for transplant patients, the unfortunate truth is that those interventions still will not reverse the effects of using immunosuppressants on our metabolism.

Even within the medical community, there is still a lot of misinformation regarding diet and metabolism. It is extremely frustrating as someone who works in this field and even more so as a patient when you begin to look at a very small group of people who have a completely different metabolism compared to the normal population. Both my transplant docs and PCP had no interest in prescribing meds for high glucose and kept telling me to exercise and eat right. It is not entirely their fault because they are providing the best care based on their experience and recommendations from the larger medical community. Even my endocrinologist gets pushback from her community that "lifestyle intervention" is the first and most effective method for weight loss and treatment of insulin resistance, when in fact you can do both at the same time. Why not prevent the damage from elevated glucose levels using a medication, while at the same time working to improve eating and exercise habits?

Sorry for the rant, I've been in long discussions with people regarding this issue recently.

[Taconeo in reply to redpanda67]

Thank you , this is so informative & such useful information , I was wanting to ask about a glucose monitor next routine appointment , I am trying hard with a low carb diet & to reverse the pre diabetes , hope I can get there