A renal transplant recipient presents to the outpatient transplant clinic with blood glucose values for the past 3 days exceeding 250 mg/dL. The patient takes prednisone 5 mg daily and tacrolimus (Prograf) 2 mg twice daily
Hemoglobin A1C level drawn the day of the clinic appointment was 8.5%. What is the best interpretation of this finding by the nurse? a. The patient is at increased risk for infection.
b. The patient has developed posttransplant diabetes.
c. Temporary elevations in blood sugars are normal.
d. Discontinuation of steroids will normalize values.
B
A patient taking steroids and calcineurin inhibitors is at risk for the development of posttransplant diabetes as a complication of long-term medication therapy. Although the lab values in isolation do not indicate infection, blood sugars must be normalized to promote healing. Hemoglobin A1C levels indicate the level of blood sugar control over the past 2 to 3 months. Findings should not be considered temporary. Although steroids can elevate blood sugar values, discontinuation of steroid therapy may not be feasible in all transplant recipients.
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