Prograf vs Fruit

I'm taking Prograf (FK506 Tacrolimus) for post liver transplant survival - almost 4 yrs. Prograf made me hyperglycemic which created a lifestyle change of no sugars, <2g carb sugar, and no fruit. My fasting glucose is always below 125 and my HgbA1c always 6%. I take 250 mg of Metformin once a day.

Several weeks back I consumed < ¼th tsp of mango as a test. Within two hours my glucose level went to 161. I have tried to eat fruits over the years but each time I'm jacked. What can I do to be able to eat fruits w/o raising my level? I dislike needles so injecting insulin is not the answer nor do I wish to raise the Metformin intake. Can this be had?

[Anita Ramsetty, MD]

Hi,
First, you are to be commended on being able to change your diet and stay with it for so many years. That is quite an accomplishment. Several of the post-transplant medications do cause elevated blood sugars. I am afraid that your fruit "test " has shown you cannot handle much of a sugar load without going high. You are on a minimal dose of metformin(I have never even seen that dose used, usually the smallest dose is 500mg). I understand your desire not to add more medication, but if you want to add fruits back to your diet(which does have added benefits), you will likely need to increase the metformin or change to another medication. There is a good chance you will not need insulin at this time--it will depend on how you respond to the oral medications.
Good luck and take care.

[WaveRider]

Thank you for responding. I sent my PCP an email asking about a Metformin increase, and, yes, I'm at half a pill - 250mg. Prograf has me teeter tottering between normal and diabetes.

"...change to another medication" What other medications are safe with Prograf?

[Anita Ramsetty, MD]

Hi,
Since you have already tried the metformin, I would suggest simply increasing it (as you have discussed with your doctor) slightly to 500mg and see what happens. You may not need to switch to another medication at all.
My drug database is unfortunately down at this moment so I cannot tell you for certain which drugs do not interact with prograf. The best option is to speak with the pharmacist who will be able to run simultaneous drug profiles to look for any problems with interactions.
best of luck to you.