Glucose control before, during, and after orthotropic heart transplantation presents unique challenges. The presence of advanced heart failure contradicts the use of oral metformin and thiozolidinediones (TZDs). The benefit of insulin has been questioned, and recent investigations question the degree of glycemic control in the ICU.¹ Scant published data report on the efficacy of oral hypoglycemics on graft function and survival. The purpose of this summary is to present our approach to patients either listed for or undergoing heart transplantation at The Methodist Hospital.