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Influence of operation on glucose metabolism and lipolysis in human adipose tissue: a microdialysis study
G Felländer1, J Nordenström, U Ungerstedt
1Department of Surgery, Huddinge Hospital, Sweden.
Objective:
To investigate the effect of an operation on metabolism in human adipose tissue.
Design:
Open study.
Setting:
Department of Surgery and the Research Centre at Huddinge Hospital.
Subjects:
13 non-obese patients who underwent elective cholecystectomy, and 5 control subjects.
Interventions:
Microdialysis of the extracellular compartment of abdominal subcutaneous adipose tissue was done before, during and after a 45-minute intravenous infusion of 20 g glucose before, and one day after, the operation.
Main Outcome Measures:
Concentrations of glycerol, glucose, lactate and pyruvate in the tissue dialysate and in venous plasma.
Results:
After operation, the baseline plasma insulin concentration doubled (p < 0.001) and the fasting glucose concentration rose from 4.4 (0.1) to 5.3 (0.2) mmol/l (p < 0.001). In response to the glucose infusion, the maximum increase in plasma insulin trebled (p < 0.01) and the integrated concentrations (area under the curve) of plasma glucose, lactate and pyruvate were significantly more pronounced (p < 0.02-p < 0.001) after than before operation. The suppression of plasma glycerol and free fatty acid concentrations was similar before and after operation (50-60%). The reduction in the concentrations of glycerol in adipose tissue, and the increases in the concentrations of glucose, lactate, and pyruvate, after intravenous infusion of glucose were not influenced by the operation.
Conclusion:
A moderately serious operation rapidly induces a deterioration in total body glucose homeostasis, partly as a result of peripheral insulin resistance. This does not affect the utilization of glucose by adipose tissue or the antilipolytic response to glucose infusion.