title: The effect of perioperative glucose control on postoperative insulin resistance.
abstract: OBJECTIVE
  Postoperative insulin resistance and the consequent hyperglycemia affects clinical outcome. Insulin sensitivity may be modulated by preoperative nutrition, adequate pain management and minimal invasive surgery. This study aims to disclose the impact of perioperative glucose control on postoperative insulin resistance.
  
  
  METHODS
  Twenty patients scheduled for elective open hepatectomy were enrolled in this prospective, randomized study. In the treatment group (n = 9) insulin was administered intravenously to keep blood glucose between 6 and 8 mmol/l during surgery. The control group (n = 8) received insulin if blood glucose >14 mmol/l. Insulin sensitivity was measured by a hyperinsulinemic normoglycemic clamp (0.8 mU/kg/min), performed on all patients both on the day before surgery and immediately postoperatively. Plasma cortisol, insulin and C-peptide were measured.
  
  
  RESULTS
  There was a significant difference in mean glucose value during surgery. In the control group 8.8 mmol/l (SD 1.5) vs. 6.9 mmol/l (SD 0.4) in the treated group, p = 0.003. In the control group insulin sensitivity decreased to 21.9% ± 16.2% of the preoperative value and in the insulin treated group to 46.8 ± 15.5%, p < 0.005. Insulin levels were significantly higher in the treatment group as well as consequently lower C-peptide levels.
  
  
  CONCLUSIONS
  This trial revealed a significant difference in postoperative insulin resistance in the group treated with insulin during surgery.
authors.affiliation: Dept of Anaesthesia and Intensive Care, Karolinska University Hospital, Huddinge, Sweden Christina.Blixt@karolinska.se
authors.forename: Christina
authors.initials: C
authors.lastname: Blixt
authors.forename: Christian
authors.initials: C
authors.lastname: Ahlstedt
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
authors.forename: Bengt
authors.initials: B
authors.lastname: Isaksson
authors.forename: Sigridur
authors.initials: S
authors.lastname: Kalman
authors.forename: Olav
authors.initials: O
authors.lastname: Rooyackers
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D002096:C-Peptide / Q000097:blood; D005260:Female; D015309:Glucose Clamp Technique; D006498:Hepatectomy; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006943:Hyperglycemia / Q000517:prevention & control; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D006854:Hydrocortisone