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Table 6 Guidelines for treatment of post-transplant diabetes

From: Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation

Oral antidiabetic agents have not been studied in terms of efficacy and safety in transplant recipients, pediatric recipients in particular. Insulin therapy is preferred in all unstable situations because of its anabolic effect. The objective is to tailor the insulin therapy to food habits, in order to limit weight loss
Most antidiabetic agents contraindicated in cases of kidney failure and cholestasis. In contrast, acarbose despite digestive side effects and glinides can be useful. - slow-acting insulin (often an insulin analogue like detemir (12 hours) or glargine (24 hours))
- Metformin: risk of lactic acidosis. Repaglinide (0.5 mg to 4 mg before each snack) can be used instead of injections of ultra-rapid insulin (particularly in patients on low doses of steroid). - rapid-acting insulin (lispro, aspart or glulisine) (2 hours) or regular insulin (4 hours) administered at meal times.
- Sulphamides with a long half-life (such as gliclazide) increase the risk of hypoglycemia.   - NB: ultra-rapid insulin (lispro, aspart or glulisine) can be administered immediately after the end of the meal, when the food intake is somewhat unpredictable
NB
- Gliptins sometimes lead to pancreatitis - Change regularly insulin injection site, to avoid lipodystrophy.
- GLP-1 agonists promote nausea and weight loss. - Adapt length of the needle: 4-5 mm if body weight <40 kg, 6 in a lean, 8 in a normal-weight and 12 mm in an obese person.
- The patient must learn to recognize and treat symptoms of hypoglycemia: