A case of a female presenting with recurrent episodes of diabetic ketoacidosis, denovo post kidney transplant

New onset diabetes after transplant (NODAT) occurs in a quarter of patients following renal transplants. NODAT is known to shorten the graft and patient survival. It is under diagnosed as a result of using fasting blood sugar or HbA1c as the investigation of choice as hyperglycemia tends to occur mainly post prandially.

 

Immunosuppressants are thought to play a major role in the causation of NODAT. Among those calcineurin inhibitors are thought to cause pancreatic beta cell exhaustion and corticosteroids to induce peripheral insulin resistance. By the time impaired glucose tolerance manifests, nearly 50% of pancreatic beta cells have become dysfunctional. Therefore if we chose to treat NODAT the traditional way using lifestyle modifications, oral hypoglycemics and then insulin, we may lose the opportunity to reverse the damage to pancreatic beta cells. Beta cell sparing using intensive Insulin therapy is the recommended treatment coupled with metformin in the prevention and treatment of NODAT.