[Therapeutic inventions of perioperative metabolic care in diabetic patients]

Perioperative metabolism was evaluated in diabetic patients and animal models. Experimental model of diabetes mellitus (DM) model was obtained by streptozotocine injection. Each 14C-labeled substrates and combination of carbohydrates mixture was administered intravenously in a dose of 1 g/kg before and after laparotomy and cumulative curves of expired 14CO2 was calculated. Biochemical analysis in the liver, blood and urine were performed following infusion of two different solutions, GFX (glucose, fructose, xylitol) solution, 4:2:1 ratio by weight vs. glucose solution, with 12% amino acids solution. In a clinical study, incidence of DM in digestive surgery was examined in 3481 cases. Retrospective evaluation of GFX solution was performed in cases after total gastrectomy. Incidence of DM was 14% and it has been increased recently, Glucose metabolism in DM rats was disturbed after surgery. Amino acids (alanine and valine) and lipid metabolism was slightly suppressed after surgery in DM rats. The best combination of carbohydrate mixture was determined as GFX solution in animal and clinical experiments. GFX solution improved not only glucose metabolism but also lipid and amino acid metabolism in DM rats. Decreased insulin requirement and increased total caloric intake were observed in DM and borderline DM cases treated by GFX solution.