Steroid induced hyperglycaemia is common after kidney transplantation. Divided twice daily (BD) prednisolone dosing and the use therapeutic monitoring of free (active) prednisolone exposure may lead to a reduction in post-transplant hyperglycaemia. This project aimed to determine if BD dosing reduces hyperglycaemia versus daily (QD) and if free prednisolone exposure correlates with glycaemia, using a validated limited sampling strategy. Twenty subjects without diabetes were randomised to QD or BD prednisolone from the time of transplantation. In week 3, the total daily prednisolone dose was fixed and a continuous glucose monitor (iPro2®  Medtronic) applied for 5 days. Subjects continued randomised regimens for Days 1-2 before crossover (Day 3) to the alternate dosing regimen for Days 4-5 (the crossover day was disregarded). Mean glucose, peak glucose (time, level), exposure to hyperglycaemia (AUC>7.8mmol/L), Athens insomnia scale and free prednisolone exposure were assessed. Mean (SD) age was 50 (11) years and 75% were male. Mean daily prednisolone dose was 23.0 (2.5) mg. BD dosing was associated with decreased glucose (mean 7.95 vs 8.11mmol/L, p<0.0001), peak glucose (mean 10.69 vs 12.21mmol/L, p=0.0004), and exposure to hyperglycaemia (mean 12.37 vs 32.57mmol/L/hr, p=0.007). Mean time of day peak glucose occurred was 15:15h (QD) and 15:00h (BD) (Fig. 1). BD dosing did not significantly increase insomnia (mean QD 4.2 (3.6), BD 5.7 (4.4), p=0.08). Daily free prednisolone exposure did not differ between dosing regimens (mean QD 686 (264), BD 697 (200), p=0.69. Free prednisolone exposure correlated with peak glucose (r²=0.17, p=0.0087), mean glucose (r²=0.10, p=0.04) and exposure to hyperglycaemia (r²=0.15, p=0.01). We conclude free prednisolone exposure correlates with glycaemia and split dosing of prednisolone reduces hyperglycaemia post kidney transplantation.