In order to prevent rejection during and after kidney transplantation, immunosuppressants are needed, of which immunosuppressants have a certain degree of side effects (see article: Is it better to eat more people after kidney transplantation immunosuppressant program?) Therefore, post-transplantation glucose abnormalities are likely to occur after kidney transplantation, with mild abnormalities manifested as elevated fasting glucose or elevated postprandial glucose, and in severe cases, new-onset diabetes, which is called post-transplantation diabetes mellitus (PTDM). Some patients are unaware of this and develop diabetic ketoacidosis or diabetic coma, which can cause diabetes-related complications such as coronary heart disease, fundopathy and neuropathy in the long term, greatly reducing the quality of life. Why does high blood glucose occur after kidney transplantation? There are mainly the following reasons: firstly, related to drugs: the main drugs that cause diabetes are glucocorticoids, namely methylprednisolone and prednisone, which are used in every kidney transplant patient and can cause blood glucose to rise and become steroidal diabetes, and the other drugs are tacrolimus and cyclosporine, of which tacrolimus (also known as FK506) is more obvious, and taking tacrolimus About 10% of kidney transplant patients taking tacrolimus develop new onset diabetes, while cyclosporine this side effect is relatively mild, and other immunosuppressive drugs such as sirolimus and mycophenolate do not have this side effect. Another reason is that many people will have improved appetite and weight gain after kidney transplantation, while some patients worry about transplanting a kidney and exercise less, which will also increase the chance of diabetes. There are also some people with family genetic background who do not show diabetes without immunosuppressive drugs, but develop abnormal blood sugar with some drugs that have an effect on blood sugar.
In severe cases, diabetes mellitus is manifested. Therefore, the development of diabetes after kidney transplantation is caused by multiple factors, and not entirely due to a single factor. What should I do if I have abnormal blood glucose? Glucose abnormalities after kidney transplantation are similar to those of ordinary patients, but there are also differences. The similarity is that conservative treatment, including diet control, weight loss and exercise (control your mouth and legs), can improve blood glucose, and many mild blood glucose abnormalities can be improved in this way. For some patients with high blood sugar, you can add glucose-lowering drugs, and in serious cases, you need to use insulin. The use of glucose-lowering drugs needs to be determined according to the function of the transplanted kidney, if accompanied by transplanted renal insufficiency, it is necessary to avoid the use of glucose-lowering drugs that are completely metabolized by the kidneys, which are prone to side effects such as hypoglycemia. If the transplant kidney insufficiency is more serious, you need to use insulin to control blood sugar. The difference with ordinary patients is that after kidney transplantation patients can switch their immunosuppressive regimen to achieve the effect of blood sugar adjustment. If patients taking tacrolimus have high blood sugar, they can switch to cyclosporine or sirolimus if there is no contraindication, but this switch has risks and needs to be done under the guidance of transplantation doctors, and cannot switch immunosuppressants without permission, which will bring the risk of transplantation kidney rejection, and some patients can get better results through this switch. In conclusion, abnormal blood glucose after kidney transplantation is a common complication, which requires patients to pay high attention to it. However, all these should be done under the guidance of transplant surgeon, not to blindly reduce or change the medication.