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Acta Diabetologica

, Volume 51, Issue 1, pp 141–145 | Cite as

Deterioration of glycemic control after corticosteroid administration in islet autotransplant recipients: a cautionary tale

  • Anh Ngo
  • David E. R. Sutherland
  • Gregory J. Beilman
  • Melena D. Bellin
Case Report

Abstract

Islet autotransplantation (IAT) is performed at the time of total pancreatectomy (TP) to prevent or minimize post-surgical diabetes. Corticosteroids induce insulin resistance and present a risk to islet autografts, through glucotoxicity and increased metabolic demand on a marginal islet mass. We present four IAT recipients treated with oral or injected corticosteroids after transplant for medical conditions unrelated to chronic pancreatitis or TPIAT. Hyperglycemia or insulin resistance was evident in all four patients, including reversion to long-term insulin therapy in two patients. One patient receiving corticosteroid injections had a transient increase in hemoglobin A1c (+0.6% above baseline), and one patient given a one time dose of oral dexamethasone exhibited hyperglycemia despite high insulin (>200 mU/L) and C-peptide (15.3 ng/mL) production on an oral glucose tolerance test. IAT recipients have insufficient islet mass to compensate for the insulin resistance induced by corticosteroids. Caution should be given to using these agents in IAT recipients. When corticosteroids are medically necessary, insulin therapy should be administered temporarily to compensate for the increased metabolic demand and minimize long-term risks on the islet graft.

Keywords

Beta Cell Chronic Pancreatitis Sitagliptin Total Pancreatectomy Continuous Subcutaneous Insulin Infusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

Dr. Melena Bellin is supported by a K23 career development award from the NIDDK (1K23DK084315-01A1).

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Anh Ngo
    • 1
  • David E. R. Sutherland
    • 2
    • 3
  • Gregory J. Beilman
    • 2
  • Melena D. Bellin
    • 2
    • 3
    • 4
  1. 1.Des Moines University, College of Osteopathic MedicineDes MoinesUSA
  2. 2.Department of SurgeryUniversity of MinnesotaMinneapolisUSA
  3. 3.Schulze Diabetes Institute, University of MinnesotaMinneapolisUSA
  4. 4.Department of PediatricsUniversity of Minnesota Amplatz Children’s HospitalMinneapolisUSA

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