What to do about 'high blood sugar' after liver transplant surgery when you're malnourished?

After liver transplant surgery, high blood sugar and muscle loss are common enough to be called “post-transplant diabetes.” This is primarily due to the medications required after transplantation.

“Immunosuppressants and steroids are vital medications after transplantation, but they can have some side effects,” said Kim Yeon-kyung, a clinical nutritionist at Asan Medical Center, on the hospital's official YouTube channel.

Kim noted that problems may occur, such as elevated blood sugar, muscle loss, and hyperlipidemia, emphasizing the need for a dietary approach to prevent and treat them.

Most patients who have undergone liver transplant surgery due to cirrhosis or liver cancer are often in poor nutritional condition. After transplantation, blood sugar is also prone to rise due to medications used to suppress the immune rejection of the transplanted organ. So, what dietary guidelines should liver transplant patients follow?

“High blood sugar can be a side effect of immunosuppressant medications, and if you're eating too much bread or other snacks (in addition to regular meals) to recover too quickly, you may need to cut back a bit,” Kim said.

What should patients do if they can't eat well but their medication is causing their blood sugar to rise?

“Patients who struggle to eat should not further reduce their food intake, even if blood sugar levels increase. It's good to change sugary drinks, but we don't have any special restrictions on meals,” Kim said, stressing that the most important thing is to “eat regularly (even if blood sugar rises).”

In addition, the energy metabolism is very high right after the liver transplant, so it's important to provide nutrition actively during this period.

“After this time, you're gaining weight, and your nutrient absorption is much better, so you're in a very good nutritional state,” Kim said. “Still, you should ensure you're eating the right amount of food for your needs because you can have side effects if you overeat it. It takes about three months for energy metabolism to stabilize.”

After liver transplantation, a high-protein diet is also necessary, as immunosuppressants and steroid medications can cause muscle loss.

“Immediately after transplantation, muscle loss can occur quickly because there are restrictions on activities,” Kim said. “So, consuming enough protein, the material that builds muscle, is important.”

So, should liver transplant patients continue to eat complementary foods, including beef soup, to supplement their nutrition? The answer is “no.”

“It can be necessary and helpful to have a complementary food sometimes while eating well daily,” Kim said. “However, when we do a nutrient analysis of beef soup, the broth doesn't have much of the protein or calcium you'd expect.”

“If you put steamed rice in beef soup and eat it with kimchi, you're not getting a lot of nutrients, and its nutritional composition is a little poor, which can have unintended consequences,” Kim said. “It's important not to rely too heavily on complementary foods and not to overdo it but to eat them once or twice as a treat while maintaining your regular diet.”