January 1, 1999Current Opinion in Clinical Nutrition & Metabolic Care558 citations
View Full PaperInsulin resistance: a marker of surgical stress
Key Result
Pretreating elective surgical patients with carbohydrates instead of fasting can significantly reduce postoperative insulin resistance.
Structured PICO
Does pretreating with carbohydrates reduce postoperative insulin resistance in elective surgical patients compared to fasting?
P
Population
Elective surgical patients
I
Intervention
Pretreating with sufficient amounts of carbohydrates
C
Comparator
Fasting
O
Outcome
Postoperative insulin resistancesurrogate
Preoperative carbohydrate loading may mitigate the transient, stress-induced insulin resistance typically seen after elective surgery.
Limitations
- It is not clear which mediators are the most important for the development of insulin resistance after surgery.
Abstract
Elective surgery causes a marked, transient reduction in insulin sensitivity. The degree of the reduction is related to the magnitude of the operation. The type and duration of surgery performed, perioperative blood loss, and also the degree of postoperative insulin resistance have significant influences on the length of hospital stay. A novel approach to minimize insulin resistance after surgery is being presented and suggests that simply pretreating the elective surgical patient with sufficient amounts of carbohydrates instead of fasting can significantly reduce postoperative insulin resistance. It is not clear which mediators are the most important for the development of insulin resistance after surgery. Nevertheless, marked insulin resistance can develop after elective surgery without concomitant elevations in cortisol, catecholamines or glucagon. The main sites for insulin resistance seem to be extrahepatic tissues, probably skeletal muscle, where preliminary data suggest that the glucose transporting system is involved.