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Stress-induced insulin resistance: recent developments
Karolinska Institute, CLINTEC, Karolinska University Hospital, Huddinge; Centre for Gastrointestinal Disease, Ersta Hospital, Stockholm; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Karolinska Institute, CLINTEC, Karolinska University Hospital, Huddinge; Centre for Gastrointestinal Disease, Ersta Hospital, Stockholm.
Karolinska Institute, CLINTEC, Karolinska University Hospital, Huddinge; Centre for Gastrointestinal Disease, Ersta Hospital, Stockholm.
Karolinska Institute, CLINTEC, Karolinska University Hospital, Huddinge; Centre for Gastrointestinal Disease, Ersta Hospital, Stockholm.ORCID iD: 0000-0003-2636-4745
2007 (English)In: Current opinion in clinical nutrition and metabolic care, ISSN 1363-1950, E-ISSN 1473-6519, Vol. 10, no 2, p. 181-6Article in journal (Refereed) Published
Abstract [en]

Purpose of review: Interest in stress-induced insulin resistance has increased during the past 5 years. Relevant clinical and mechanistic investigations during the past year will be reviewed.

Recent findings: Recent trials of intensive insulin therapy in intensive care units have brought attention to a high incidence of hypoglycemic episodes with such treatment. The clinical relevance of such hypoglycemia has been shown to be minor, however. Furthermore, animal and in-vitro work further supports the finding that glucose control, rather than glycemia-independent effects of insulin, is the primary mechanism of action of intensive insulin therapy. In elective surgery, cohort studies show an association between intraoperative hyperglycemia and postoperative morbidity. Beneficial effects of preoperative oral carbohydrate treatment on immunocompetence and cardiac contractility have been demonstrated. Laparoscopic segmental colectomy was associated with considerably attenuated derangements in glucose metabolism compared with conventional, open surgery.

Summary: Better methods of insulin dosing and administration and glucose monitoring are warranted to further minimize the risks of intensive insulin therapy. In elective surgery, perioperative measures such as preoperative oral carbohydrate treatment and laparoscopic techniques attenuate metabolic and other physiological derangements and such methods should be integrated into perioperative care protocols to minimize morbidity and enhance recovery.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2007. Vol. 10, no 2, p. 181-6
Keywords [en]
Glucose, insulin, intensive care, morbidity, perioperative care
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-40362DOI: 10.1097/MCO.0b013e32801481dfISI: 000244629900010PubMedID: 17285007Scopus ID: 2-s2.0-33846856161OAI: oai:DiVA.org:oru-40362DiVA, id: diva2:777200
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2017-12-05Bibliographically approved

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