title: Stress-induced insulin resistance: recent developments.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Karolinska Institute, CLINTEC, Karolinska University Hospital, Huddinge, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Soop
authors.forename: Jonas
authors.initials: J
authors.lastname: Nygren
authors.forename: Anders
authors.initials: A
authors.lastname: Thorell
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007333:Insulin Resistance; D007430:Intraoperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000517:prevention & control; D013312:Stress, Physiological / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin