posted 10/17/02
Preventing insulin resistance caused by any type of surgical
stress not only reduced mortality but improved outcomes.
Insulin resistance develops as a response to
virtually all types of surgical stress. There is an increasing body of evidence
that suggests that insulin resistance in surgical stress is not beneficial for
outcome.
A recent large study in intensive-care patients
showed that aggressive treatment of insulin resistance using intravenous insulin
reduced mortality and morbidity substantially. Similarly, in burn patients,
intensive insulin and glucose treatment has been shown to improve N economy and
enhance skin-graft healing. In surgical patients insulin resistance has been
characterized in some detail, and has been shown to have many similarities with
metabolic changes seen in patients with type 2 diabetes. This finding may be
important since insulin resistance has been shown to be one independent factor
that influences length of stay.
When patients about to undergo elective surgery
have been treated with glucose intravenously or a carbohydrate-rich drink
instead of overnight fasting, insulin resistance was reduced by about half. A
small meta-analysis showed that when post-operative insulin resistance was
reduced by pre-operative carbohydrates, length of hospital stay was shortened.
Overnight intravenous glucose at high doses improved post-operative N economy.
This type of treatment has also been shown repeatedly to reduce cardiac
complications after open-heart surgery. Furthermore, if the carbohydrates are
given as a drink pre-operatively, pre-operative thirst, hunger and anxiety are
markedly reduced.
In summary, preventing or treating insulin resistance in surgical stress influences outcome. Fasting overnight is not an optimal way to prepare patients for elective surgery. Instead, pre-operative carbohydrates have clinical benefits.
Source: Diabetes In Control Dot Com: Proceedings of the Nutrition Society, 08/2002 vol. 61, no. 3, pp 329-336.
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