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Effective reduction in stress induced postoperative hyperglycemia in bariatric surgery by better carb loading
Patrick Knight1, Jesse Chou1, Melissa Dusseljee1
1Western Michigan University Homer Stryker M.D. School of Medicine, Department of General Surgery, 1000 Oakland Dr, Kalamazoo, MI, 49008, USA.
Background:
Preoperative carbohydrate loading is a recommended component of enhanced recovery protocols (ERP's), however the impact on postoperative stress-induced insulin resistance remains poorly studied in both diabetics and non-diabetics.
Methods:
Using our ERP, a preoperative grape juice group (Grape) was compared to the use of 25 g maltodextrin/3 g citrulline (G.E.D.™, SOF Health, LLC) for carbohydrate loading.
Results:
The population included 171 patients (Grape n = 96; GED n = 75). Glycemic variability was significantly worse for the Grape group on POD 0 in both non-diabetic (70% vs 41%; p < 0.05) and diabetic patients (66% vs 34%; p < 0.05). Significantly more Grape patients required postoperative insulin regardless of diabetic status.
Conclusion:
Following bariatric surgery, the impact of stress induced hyperglycemia is primarily on POD 0 in non-diabetics whereas the effect extends into POD 1 for diabetics. Preoperative loading with G.E.D.™ versus grape juice is associated with a significantly lower rate of glycemic variation and postoperative insulin requirement, demonstrating that drink composition and treatment process reduces the severity of postoperative stress induced hyperglycemia in bariatric surgery patients.
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