Insulin Therapy for Post-transplant Glucocorticoid Induced Hyperglycemia
Insulin Therapy for Post-transplant Glucocorticoid Induced Hyperglycemia
No consensus guidelines exist for management of post-transplant glucocorticoid induced
 hyperglycemia, but most published reviews recommend insulin as first line therapy. A variety
 of insulin regimens have been proposed, including mealtime short-acting regular or analog
 insulin, once daily neutral protamine hagedorn (NPH) insulin, pre-mixed insulin, or basal
 insulin alone such as glargine or detemir. However, no randomized trial has ever examined
 different insulin regimens to determine which most effectively controls post-transplant
 steroid-induced hyperglycemia. Consequently, the proposed study intends to examine three
 commonly used insulin regimens used for managing post-transplant once-daily
 glucocorticoid-induced hyperglycemia to determine which is most effective:

 -  Group 1: Intermediate-acting (NPH) insulin at breakfast

 -  Group 2: Short-acting insulin (regular or aspart) before meals

 -  Group 3: Insulin glargine at breakfast

 Question/Hypothesis:

 Among three commonly used insulin regimens, which is most effective for managing
 post-transplant once-daily glucocorticoid-induced hyperglycemia?
Inclusion Criteria:

 1. Have undergone bone marrow, liver, lung, or renal transplant.

 2. Be using once daily oral glucocorticoid therapy (total daily dose of Prednisone ≥10
 mg, Hydrocortisone ≥40 mg, Dexamethasone ≥1.5 mg) administered in the morning and
 expected to continue for at least 2 weeks.

 3. Have pre-existing or newly diagnosed diabetes mellitus established by any of the
 criteria listed below:

 1. Fasting plasma glucose ≥7.0 mmol/L (repeated x 1)

 2. Any plasma glucose ≥11.0 mmol/L

 4. Have at least three pre-meal inpatient capillary blood glucose (CBG) readings ≥ 7.8
 mmol/L

 5. Be eating meals by mouth

 Exclusion Criteria:

 1. Heart, Pancreas, Islet cell transplant recipients

 2. Previous use of Basal-Bolus or Pre-Mixed Insulin regimen

 3. Diabetes mellitus type I

 4. NPO (not eating meals by mouth)

 5. Receiving enteral (tube feeds) or parenteral (TPN) nutrition