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Insulin resistance after surgery: normalization by insulin treatment
L S Brandi1, M Frediani, M Oleggini
1Metabolism Unit, National Research Council (CNR) Institute of Clinical Physiology, University of Pisa, Italy.
Clinical Science (London, England : 1979)
|November 1, 1990
Summary
Major surgery causes significant insulin resistance in patients, requiring eight times more insulin post-operatively to maintain normal blood glucose levels. This highlights the body's altered metabolic response to injury.
Area of Science:
- Metabolic Surgery
- Endocrinology
- Physiology
Background:
- Tissue insensitivity to insulin is a known complication of injury.
- Patients undergoing major elective surgery often experience varying degrees of insulin resistance.
Purpose of the Study:
- To quantify insulin resistance in non-obese, glucose-tolerant patients following major elective surgery.
- To assess the impact of surgery on counter-regulatory hormones, protein oxidation, and energy expenditure.
Main Methods:
- Insulin resistance was measured using a glucose clamp technique during 24-hour total parenteral nutrition post-surgery.
- Plasma glucose was maintained at 5.6 mmol/l with variable exogenous insulin infusion.
- Measurements included glucose, insulin, counter-regulatory hormones, protein oxidation, and energy expenditure.
Main Results:
- Post-surgery, patients exhibited hyperglycemia with normal insulin levels, indicating insulin resistance.
- Counter-regulatory hormones, protein oxidation, and energy expenditure were significantly elevated after surgery.
- Eight times more insulin was required post-surgery compared to pre-surgery to maintain euglycemia.
Conclusions:
- Major elective surgery induces significant insulin resistance in patients.
- The metabolic response to injury involves increased counter-regulatory hormone activity and elevated energy expenditure.
- Despite insulin resistance, key metabolic pathways like carbohydrate oxidation and lipolysis remained responsive to insulin post-surgery.