Table 6 Guidelines for treatment of post-transplant diabetes
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. | Â | - 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: | ||