INSULIN-RESISTANCE AFTER ABDOMINAL-SURGERY

A study was carried out to determine the time course and degree of pos toperative insulin resistance in patients undergoing elective abdomina l surgery. Mean(s.e.m.) insulin sensitivity was determined before and on the first (n = 10), fifth, ninth and 20th (n = 5) days after electi ve open cholecystectomy using the normoglycaemic (4.(0.1) mmol/l), hyp erinsulinaemic (402(12) pmol/l) glucose clamp technique. Preoperative insulin sensitivity expressed as the M value varied from 2.3 to 8.2 mg per kg per min. The relative reduction in insulin sensitivity was mos t pronounced on the first day after surgery, at a mean(s.e.m) of 54(2) per cent. Thereafter, a large variation between individuals was found during the course of recovery, and insulin sensitivity returned to no rmal 20 days after operation. On the first day after surgery, plasma c oncentrations of glucose, C peptide, noradrenaline and glucagon were s lightly but significantly higher than before operation (P<0.05), where as insulin, growth hormone, cortisol and adrenaline levels were unalte red. Marked insulin resistance thus develops after elective upper abdo minal surgery and persists for at least 5 days after operation. Factor s other than simultaneous changes in levels of the hormones studied se em to regulate the maintenance of postoperative insulin resistance.