Diabetes After a Transplant

Even if you did not have diabetes before, you may develop diabetes after an organ transplant. This type of diabetes is called "new-onset diabetes" after transplant. It is also called "NODAT" for short. New-onset diabetes can occur as a side effect of the medications that you need to prevent rejection of your new organ.

One reason is medication. After a transplant, you must continue to take anti-rejection medicines (called "immunosupressants") to prevent your body from rejecting the transplanted organ. Normally, your body fights off anything that isn't part of itself, like germs or viruses. That system of protection is called your immune system. Anti-rejection medicine keeps your immune system less active. Without it, your immune system would see your new organ as a "foreign invader" and try to destroy it. Unfortunately, these medications can also increase your risk for diabetes – or make it worse.

Many things can put you at risk for diabetes. Some factors are things you cannot change, like your age or ethnic background. But others are things you can change, like being overweight or not getting enough exercise. Some common factors that are associated with diabetes are:

• Being overweight
• Lack of exercise
• Unhealthy eating
• Being African-American/Black, American Indian, Alaskan Native, Hispanic, Pacific Islander or Asian
• Being age 45 or older
• Having a family history of diabetes
• Having had diabetes during pregnancy
• Having high blood pressure or abnormal blood fats (cholesterol or triglycerides)
• Having had an hepatitis C virus infection

Having a high blood sugar level due to diabetes can cause serious damage to your heart, blood vessels, eyes, feet, and nerves.

You may experience some warning signs, or you may not. Not everyone has warning signs. The best way to find diabetes is to be tested for it regularly. Diabetes is called a "silent disease" because many people do not have symptoms. Some of the warning signs are:

• Being very thirsty
• Urinating often (especially at night)
• Feeling very hungry or tired
• Losing weight without trying
• Having sores that heal slowly
• Having dry, itchy skin
• Losing the feeling in your feet or having tingling in your feet
• Having blurry eyesight

You should get tested for it. A simple blood test to check your blood sugar levels is the best way to find diabetes or pre-diabetes. Pre-diabetes is a condition where blood sugar levels are higher than normal, but not high enough for a diagnosis of diabetes. Finding and controlling diabetes (and pre-diabetes) early is important. Talk to your healthcare provider about getting tested for diabetes.

• Be physically active on a regular basis
• Eat healthy meals
• Lose weight if you need to
• Maintain a healthy lifestyle and keep your blood sugar, blood pressure, and blood fats under control
• Be tested regularly for diabetes

Blood sugar levels will be closely watched while you are in the hospital after the transplant and in the outpatient clinic. If needed, your doctors will help you develop a plan to keep your blood sugar under control. If you are on corticosteroid medication (such as prednisone), your blood sugar levels will improve as the dose of this medication is decreased in the first two months after transplant.

If you have diabetes, it's important to keep your blood sugar under control. It will help you keep your heart, blood vessels, eyes, feet, and nerves healthy. Your transplant team will help you manage your blood sugar. High blood sugar is usually managed with:

• A carbohydrate-controlled diet
• Exercise, as allowed by your doctor
• Diabetes medications

© 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.