Post transplant diabetes patient education class


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Diabetes issues in post-organ transplant recipients. Presented by Methodist Hospital, Houston, TX

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Post transplant diabetes patient education class

  1. 1. Post Transplant Diabetes What Every Patient Should Know
  2. 2. Reasons a patient should be concerned about diabetes:• Diabetes is a serious disease that is associated with many health problems and complications.• Diabetes is an even greater risk for persons who have undergone organ transplantation. 2
  3. 3. The type of diabetes that may occur after organ transplantation is called “new onset diabetes” or“post-transplant diabetes mellitus” (PTDM). 3
  4. 4. Those transplantrecipients that experience new onset diabetes (PTDM) may have features of either Type I or Type II diabetes. 4
  5. 5. RISK FACTORS ASSOCIATED WITH DIABETES MELLITUS:• Family history – Some people have inherited a tendency to develop the disease, particularly if this tendency is in both parents or a sibling.• Obesity – This is a strong risk factor for Type II diabetes, particularly for those who have been obese many years. 5
  6. 6. • Ethnic background – African-American/black, Native Americans, Native Alaskans, Hispanics, Pacific Islanders and Asian Americans are at highest risk. – Persons in some ethnic groups have two to three times the risk of developing diabetes compared with all people. – Type I diabetes, inherited from both parents, is more common in Caucasians. 6
  7. 7. • Inactive life style• Abnormal blood fats (cholesterol/triglycerides)• Anti-rejection medications – Some of the medications (immunosuppressive medications) that a patient takes to prevent his or her body from rejecting a transplanted organ may increase the risk for developing diabetes. – As a result, the body will respond differently to the foods eaten, leading to post-transplant diabetes mellitus (PTDM). – Most anti-rejection medications may increase the risk of diabetes. However, some of these medications are linked with a higher risk. 7
  8. 8. Can a patient lower the risk for developing diabetes? Some risk factors cannot be changed. Examples are age and ethnic background. 8
  9. 9. However, there are several risk factors that can be influenced bychanges in a person’s lifestyle. 9
  10. 10. Those changes include:• Improving overall health through diet and exercise• If overweight, weight reduction is very important to reduce the risk for diabetes.• Nutrition can be improved with a balanced diet. The transplant dietician, nurse coordinator or physician can provide the best diet for each individual patient. 10
  11. 11. In attempting to reducestress, a patient may feel comfortable discussingincreased post-transplantstress with the transplant social worker, nursecoordinator or physician. 11
  12. 12. These professionals can also refer thepatient to additionalcounseling services for advice. 12
  13. 13. Transplant patients are faced with many responsibilities to assure continued good health.One of those responsibilities is to proactively monitor themselves for symptoms of diabetes. 13
  14. 14. Early detection andtreatment of diabetes may reduce one’schance of developing complications. 14
  15. 15. Signs and Symptoms of Post-Transplant Diabetes Mellitus 15
  16. 16. Though it is possible to develop diabeteswithout noticing any changes, it is common to have some of the following symptoms: Frequent urination Excessive thirst Extreme hunger Tiredness Tingling or numbness in the hands or feet Sudden vision changes Irritability Unexpected weight loss Slow healing cuts or infections Constant itching 16
  18. 18. Diabetes is diagnosed by determininglevels of glucose in the blood through use of several types of tests.• A fasting glucose test involves analyzing a small sample of blood after a patient has fasted for several hours.• A glucose tolerance test, which requires several blood samples over several hours, may also be performed. 18
  19. 19. The trend of blood glucose levels in persons who have diabetes will rise. This occurs when there is aninadequate amount of insulin or when the insulin is being prevented from properly entering the cells. 19
  20. 20. Some patients find that simple changes in anti-rejection medications help control diabetes.With others, changing eating habits and losing excess weight is effective.Adding exercise to one’s daily routine helps control this disease. 20
  21. 21. Diabetes may require daily insulin injections or medications that can be taken by mouth.In Type II diabetics, the supply of insulin is inadequate. Oralmedications stimulate the pancreas to produce the insulin. 21
  22. 22. It is essential for patients diagnosed with post- transplant diabetes mellitus to monitor glucose levels regularly throughout each day. 22
  23. 23. Monitoring is usually performedwith a hand-held glucometer every morning and prior to meals. The nurse coordinator and physicianwill instruct the patient to record daily blood glucose readings.This information should accompany the patient to each transplant clinic appointment. 23
  24. 24. Routine care and inspection of the following is imperative: feet skin eyes teeth gums 24
  25. 25. LONG-TERM COMPLICATIONS OF DIABETES• If left untreated or uncontrolled, diabetes can result in serious problems involving the: – Heart – Eyes – Kidneys – Nerve endings – Blood vessels• It is important to remain aware of symptoms and watch for their occurrence so that early treatment may be initiated. 25
  26. 26. Symptoms of heart problems: Pounding headaches Blurred vision Dizziness Numbness and tingling Irregular heartbeat Shortness of breath 26
  27. 27. Symptoms of diabetic neuropathy (caused by damage to nerve endings) Tingling Decreased sensation Pain in arms or legs 27
  28. 28. Vision changes– Long-term, uncontrolled diabetes results in a thickening of the blood vessels in the eye (diabetic retinopathy).– If left undetected, it can cause blindness.– As patients often do not experience symptoms, routine eye exams are necessary. 28
  29. 29. High blood pressure (hypertension) – High blood pressure is often an indication that the kidneys are not working well. – Diabetics have a 50% greater risk for developing kidney disease than non- diabetics. – High blood pressure that is not treated is a major contributor to kidney disease. 29
  30. 30. It is important thatthe blood pressure of a transplant patient be monitored frequently. 30
  31. 31. Each patient will receive a bloodpressure cuff after transplantation. The nurse coordinator will teach thepatient the correct way to take a bloodpressure reading and how to record the numbers. Normal blood pressure ranges will also be discussed. 31
  32. 32. If the patient is diagnosed with hypertension, anti- hypertensive medicationswill be prescribed in orderto reduce the development of kidney disease. 32
  33. 33. Swelling (edema) in the lower legs,numbness and cold feet, poor or slowwound healing may occur.– Poor blood flow in the extremities, due to a thickening of the blood vessels (arteriosclerosis), may increase the risk for infections.– This may be severe enough to eventually require amputation of toes, feet or part of the leg.– Additionally, arteriosclerosis is a risk factor for heart disease. 33
  34. 34. LIVING WITH DIABETES Although there is no curefor diabetes, this disease is treatable. 34
  35. 35. If you are diagnosed with post-transplant diabetes, you should begin to:– Start by learning as much as you can about the disease– Talk to your physician, your diabetes educator and your transplant coordinator about your immunosuppressive therapy and routine care.– Record your blood glucose levels and learn about the methods to help you maintain your insulin levels.– Make healthy lifestyle choices through diet, exercise and stress reduction to maintain a healthy weight.– Request support from your family, friends and other diabetics, as well as your transplant team. 35
  37. 37. Questions orComments? 37