Preoperative administration of oral carbohydrate-rich solutions: Comparison of glucometabolic responses and tolerability between patients with and without insulin resistance.
OBJECTIVE
Preoperative carbohydrate loading with clear fluids is thought to reduce surgery-related insulin resistance (IR). However, IR per se is already present in some patients scheduled for elective surgery. Data on the safety of preoperative oral carbohydrate loading in patients with IR undergoing surgery is lacking. We aimed to evaluate the effects of preoperative carbohydrate loading on the glucometabolic state and gastric content of patients with and without IR.


METHODS
Thirty-four non-diabetics received 800 mL of a special carbohydrate-containing drink on the evening before the operation and then 400 mL 2 h before surgery. Blood samples for glucose, insulin, and cortisol levels were taken immediately before the second dose, at 40 and 90 min after intake of the drink, and at the onset of surgery. Patients with a homeostasis model assessment IR score >2.5 were considered to have IR. The differences between patients with and without IR were then evaluated.


RESULTS
Eight of the 34 patients had IR and the remaining 26 did not. Glucose levels in the IR group were higher than those in the non-IR group, but the differences did not reach significance. The initially elevated insulin concentrations then tended to decrease to the corresponding levels detected in the non-IR group. The cortisol concentrations were similar in both groups.


CONCLUSIONS
Patients with IR receiving a carbohydrate-rich drink before surgery appear not to be affected adversely by the beverage. Furthermore, they also obtain the probable beneficial effects related to these drinks and, like patients without IR, can undergo surgery safely.
Gulhane Military Medical Academy, Department of Surgery, Surgical Nutrition Audit Team, Etlik, Ankara, Turkey.
Mehmet Fatih
MF
Can
Gokhan
G
Yagci
Birgul
B
Dag
Erkan
E
Ozturk
Semih
S
Gorgulu
Abdurrahman
A
Simsek
Turgut
T
Tufan
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002763:Cholecystectomy; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000378:metabolism*; D005260:Female; D005744:Gastric Acid / Q000737:chemistry; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006863:Hydrogen-Ion Concentration; D007328:Insulin / Q000097:blood* / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D013965:Thyroidectomy; D055815:Young Adult
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin; D006854:Hydrocortisone