Modulation of Post-operative Insulin Resistance by Pre-operative Carbohydrate Loading Improves Outcomes

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. Proceedings of the Nutrition Society, 08/2002 vol. 61, no. 3, pp 329-336

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Special News Bulletin 

FDA Approves New Hypertension Drug. Inspra^®

Pharmacia Corp. said on Monday that it has received approval from the FDA to market its hypertension drug eplerenone (Inspra), which is expected to work in a broad range of patients.

Eplerenone is the first drug designed to selectively block the hormone aldosterone, a key component within the renin angiotensin aldosterone system (RAAS), which has been shown in pre-clinical and clinical studies to play a role in the regulation of the cardiovascular system.