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Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance
Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.ORCID iD: 0000-0003-2636-4745
Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
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1994 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, p. 329-336Article in journal (Refereed) Published
Abstract [en]

In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present after elective surgical treatment, more pronounced with increasingly greater magnitude of operation performed. Results of recent animal experiments have shown that even short periods of food deprivation, reducing carbohydrate reserves, alter responses to stress. This notion resulted in our questioning the rationale of carbohydrate depletion associated with overnight preoperative fasting. Twelve patients undergoing elective open cholecystectomy were randomly given no infusion (control group) or 5 milligrams per kilogram per minute of glucose infusion (glucose group) during preoperative overnight fasting. Insulin sensitivity (M value, milligram per kilogram per minute) was determined using the hyperinsulinemic normoglycemic clamp (plasma insulin level, 65 microunits per milliliter and blood glucose level, 4.5 millimoles per liter) before and the first postoperative day. Preoperative insulin sensitivity was similar in the two groups. Postoperatively, M values decreased by 55±3 percent (control group) and by 32±5 percent (glucose group) (p<0.01). Plasma levels of insulin, c- peptide, glucagon, growth hormone, catecholamines and cortisol in connection with clamps were similar in both groups preoperatively and postoperatively. The present results indicate that active preoperative carbohydrate preservation may improve postoperative metabolism because postoperative occurrence of insulin resistance was reduced with preoperative glucose infusion.

Place, publisher, year, edition, pages
1994. p. 329-336
National Category
Surgery Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-63845ISI: A1994NE86900003Scopus ID: 2-s2.0-0028279853OAI: oai:DiVA.org:oru-63845DiVA, id: diva2:1170940
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-02-05Bibliographically approved

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