Hyperglycemia and diabetes

A small minority of candidates for liver transplantation have specifically diagnosed diabetes mellitus prior to liver transplantation. However, many are hyperglycemic prior to transplantation due to sepsis or liver disease. Liver disease appears to change the patient's insulin to glucagon ratio in favor of increased blood glucoses.

Although the liver failure has been cured, in the late postoperative period several factors continue to predispose these patients to hyperglycemia. Prednisone is know to increase blood glucoses. Furthermore, cyclosporine causes mild to moderate peripheral, tissue insulin receptor resistance that also may cause hyperglycemia. Therefore, approximately 10 percent of our patients require subcutaneous insulin administration following transplantation. These recipients are easily controlled with insulin without problems of constant variation in dosage regimes. These patients have rarely developed diabetic ketoacidosis, hyperosmolar coma, or other complications (i.e., peripheral vascular, retinal or renal dysfunction).

The treatment plan for hyperglycemia usually includes dividing the prednisone dose in a B.I.D dosing schedule (i.e., 20 mg q day to 10 mg B.I.D.). Subcutaneous regular and NPH insulin is administered as needed based on blood glucose readings by glucometer. These particular patients should receive ADA diet teaching, and should record blood glucoses B.I.D. as needed to assure adequate and consistent control.