Preoperative oral carbohydrates and postoperative insulin resistance

J. Nygren, M. Soop, A. Thorell, K. Sree Nair, O. Ljungqvist

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79 Scopus citations

Abstract

Infusions of carbohydrates before surgery have been shown to reduce postoperative insulin resistance. Presently, we investigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative insulin sensitivity. Methods: Insulin sensitivity and glucose turnover (16, 6, 2H2]-D-glucose) were measured using hyperinsulinemic, normoglycemic clamps before and after elective surgery. Sixteen patients undergoing total hip replacement were randomly assigned to preoperative oral carbohydrate administration (CHO-H, n = 8) or the same amount of a placebo drink (placebo, n = 8) before surgery. Insulin sensitivity was measured before and immediately after surgery. Patients undergoing elective colorectal surgery were studied before surgery and 24 h postoperatively (CHO-C (n = 7), and fasted (n = 7), groups). The fasted group underwent surgery after an overnight fast. In both studies, the CHO groups received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation (100 g carbohydrates), as well as another 400 ml (50 g carbohydrates) 2 h before the initiation of anesthesia. Results: Immediately after surgery, insulin sensitivity was reduced 37% in the placebo group (P < 0.05 vs. preoperatively) while no significant change was found in the CHO-H group (-16%, p = NS). During clamps performed 24 h postoperatively, insulin sensitivity and whole-body glucose disposal was reduced in both groups, but the reduction was greater compared to that in the CHO-C group (-49 ± 6% vs. -26 ± 8%, P < 0.05 fasted vs. CHO-C). Conclusions: Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity after surgery as compared to patients undergoing surgery after an overnight fast.

Original languageEnglish (US)
Pages (from-to)117-120
Number of pages4
JournalClinical Nutrition
Volume18
Issue number2
DOIs
StatePublished - Jan 1 1999

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Keywords

  • Fasting
  • Glucose clamp technique
  • Glucose metabolism
  • Insulin resistance
  • Stable isotopes
  • Surgery

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

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