title: Single-dose carbohydrate treatment in the immediate preoperative phase diminishes development of postoperative peripheral insulin resistance.
abstract: OBJECTIVE
  Preoperative oral carbohydrate (CHO) treatment is known to reduce postoperative insulin resistance, but the necessity of a preoperative evening dose is uncertain. We investigated the effect of single-dose CHO treatment two hours before surgery on postoperative insulin sensitivity.
  
  
  METHODS
  Thirty two pigs (∼ 30 kg) were randomized to 4 groups (n = 8) followed by D-[6,6-(2)H2] glucose infusion and hyperinsulinemic-euglycemic step clamping. Two groups received a morning drink of 25 g carbohydrate (CHO/surgery and CHO/control). Animals in the other two groups were fasted overnight (fasting/surgery and fasting/control). Counter-regulatory hormones, free fatty acids (FFA) and liver and muscle glycogen content were measured serially.
  
  
  RESULTS
  Glucose infusion rates needed to maintain euglycemia were higher after CHO/surgery than fasting/surgery during low (8.54 ± 0.82 vs. 6.15 ± 0.27 mg/kg/min, P < 0.05), medium (17.26 ± 1.08 vs. 14.02 ± 0.56 mg/kg/min, P < 0.02) and high insulin clamping (19.83 ± 0.95 vs. 17.16 ± 0.58 mg/kg/min, P < 0.05). The control groups exhibited identical insulin sensitivity. Compared to their respective controls, insulin-stimulated whole-body glucose disposal was significantly reduced after fasting/surgery (-41%, P < 0.001), but not after CHO/surgery (-16%, P = 0.180). CHO reduced FFA perioperatively (P < 0.05) and during the clamp procedures (P < 0.02), but did not affect hepatic insulin sensitivity, liver and muscle glycogen content or counter-regulatory hormone profiles. A strong negative correlation between peripheral insulin sensitivity and mean cortisol levels was seen in fasted (R = -0.692, P = 0.003), but not in CHO loaded pigs.
  
  
  CONCLUSIONS
  Single-dose preoperative CHO treatment is sufficient to reduce postoperative insulin resistance, possibly due to the antilipolytic effects and antagonist properties of preoperative hyperinsulinemia on the suppressant actions of cortisol on carbohydrate oxidation.
authors.affiliation: Department of Digestive Surgery, University Hospital of North Norway, Tromsø, Norway; Laboratory of Surgical Research, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway. Electronic address: petter.fosse.gjessing@unn.no.
authors.forename: Petter Fosse
authors.initials: PF
authors.lastname: Gjessing
authors.affiliation: Laboratory of Surgical Research, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
authors.forename: Martin
authors.initials: M
authors.lastname: Hagve
authors.affiliation: Department of Laboratory Medicine, Institute of Medical Biology, University of Tromsø, Tromsø, Norway.
authors.forename: Ole-Martin
authors.initials: OM
authors.lastname: Fuskevåg
authors.affiliation: Department of Digestive Surgery, University Hospital of North Norway, Tromsø, Norway; Laboratory of Surgical Research, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
authors.forename: Arthur
authors.initials: A
authors.lastname: Revhaug
authors.affiliation: Department of Digestive Surgery, University Hospital of North Norway, Tromsø, Norway; Laboratory of Surgical Research, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Irtun
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000032:analysis; D003903:Deuterium; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D005215:Fasting; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005947:Glucose / Q000008:administration & dosage; D015309:Glucose Clamp Technique; D006003:Glycogen / Q000032:analysis; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008099:Liver / Q000737:chemistry; D009132:Muscles / Q000737:chemistry; D011183:Postoperative Complications / Q000517:prevention & control*; D057234:Preoperative Period; D013552:Swine
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D006003:Glycogen; D003903:Deuterium; D005947:Glucose
keywords: Cortisol; Free fatty acids; Glucose oxidation; Postoperative insulin resistance; Preoperative oral carbohydrate treatment