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Am J Physiol Endocrinol Metab 275: E140-E148, 1998;
0193-1849/98 $5.00
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Vol. 275, Issue 1, E140-E148, July 1998

Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery

Jonas O. Nygren1, Anders Thorell1, Mattias Soop1, Suad Efendic2, Kerstin Brismar2, Fredrik Karpe3, K. S. Nair4, and Olle Ljungqvist1

Departments of 1 Surgery and 2 Endocrinology and Diabetes and 3 Gustaf V Research Institute, Karolinska Hospital, S-171 76 Stockholm, Sweden; and 4 Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota 55905

Elective surgery was performed after overnight fasting, a routine that may affect the metabolic response to surgery. We investigated the effects of insulin and glucose infusions before and during surgery on postoperative substrate utilization and insulin sensitivity. Seven patients were given insulin and glucose infusions 3 h before and during surgery (insulin group), and a control group of six patients underwent surgery after fasting overnight. Insulin sensitivity and glucose kinetics (D-[6,6-2H2]glucose) were measured before and immediately after surgery using a hyperinsulinemic, normoglycemic clamp. Glucose infusion rates and whole body glucose disposal decreased after surgery in the control group (-40 and -29%, respectively), whereas no significant change was found in the insulin group (+16 and +25%). Endogenous glucose production remained unchanged in both groups. Postoperative changes in cortisol, glucagon, fat oxidation, and free fatty acids were attenuated in the insulin group (vs. control). We conclude that perioperative insulin and glucose infusions minimize the endocrine stress response and normalize postoperative insulin sensitivity and substrate utilization.

glucose metabolism; glucose-clamp technique; insulin resistance


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