Clinical use of the euglycemic hyperinsulinemic clamp for diagnosis of tacrolimus-induced insulin resistance after combined pancreas-kidney transplantation

INSULIN resistance and hyperinsulinism after pancreas transplantation are well known consequences due to immunosuppressive therapy and systemic insulin delivery. Impaired glycemic control may develop. The differentiation from pancreas rejection may be difficult; pancreas biopsy is still a diagnostic tool not widely used. Glucose tolerance tests provide information on the secretory function of the b cell. Fasting insulin levels are often variable and interpretation can be difficult. To assess insulin resistance in recipients of a pancreas–kidney transplant we employ the euglycemic hyperinsulinemic clamp (EHC) as developed by De Fronzo in 1979. The following case report illustrates the use of EHC to investigate the impact of immunosuppressant drugs in a patient with progressively deteriorating glycemic control within the first 6 months after transplantation.