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January 23, 2006

Hyperglycemia and DKA, Other

Question from Cincinnati, Ohio, USA

In October 2005, my 65 year old father had a lung transplant. You can imagine all the medicine he is on now! Due to the steroids he takes, his blood sugar is always elevated. His postprandial levels are usually 200 to 350 mg/dl [11.1 to 19.4 mmol/L]. His fasting levels are 100 to 180 [5.6 to 10.0]. Whenever he is in the hospital, they have him on insulin shots. But, when he gets out of the hospital, they say to treat him with diet. He is not very cooperative with his diet and he does not exercise. The lung transplant team does not seem to be worried about his diabetes going untreated. As mentioned, they do treat it inpatient, but never when he is released. How dangerous is it for him to continue to go with high blood sugar that is untreated?

ANSWER:

It appears that his post-meal blood sugars are high. His fasting values are also high, but I am not clear what the usual values usually run. Being in the hospital usually means there is some underlying problem, such as an infection, episode of rejection, or problems breathing. These can raise his blood sugars in the short-term. There is evidence in the kidney transplant literature that diabetes after kidney transplant is associated with increased cardiovascular risk. It would be unusual if this weren't true in the lung transplant population, as well. In addition, poorly controlled blood sugars are associated with an increased risk of infection. My view is that elevated blood sugars need to be treated. There may be some other overriding issues. First, do the doctors have evidence to suggest the blood sugars are not usually elevated? For instance, they may have a hemoglobin A1c value that suggests the sugars are usually good. Second, the doctors may feel that the elevated blood sugars are just a small thing in the larger picture. Third, they may not have the resources or expertise to deal with the elevated blood sugars. This gives you some questions you can share with the medical team and allow you to sort out what is best for your father. JTL