PERIOPERATIVE INSULIN AND GLUCOSE-INFUSION MAINTAINS NORMAL INSULIN SENSITIVITY AFTER SURGERY

Elective surgery was performed after overnight fasting, a routine that may affect the metabolic response to surgery. We investigated the eff ects of insulin and glucose infusions before and during surgery on pos toperative substrate utilization and insulin sensitivity. Seven patien ts were given insulin and glucose infusions 3 h before and during surg ery (insulin group), and a control group of six patients underwent sur gery after fasting overnight. Insulin sensitivity and glucose kinetics (D-[6,6-H-2(2)]glucose) were measured before and immediately after su rgery using a hyperinsulinemic, normoglycemic clamp. Glucose infusion rates and whole body glucose disposal decreased after surgery in the c ontrol group (-40 and -29%, respectively), whereas no significant chan ge was found in the insulin group (+16 and +25%). Endogenous glucose p roduction remained unchanged in both groups. Postoperative changes in cortisol, glucagon, fat oxidation, and free fatty acids were attenuate d in the insulin group (vs. control). We conclude that perioperative i nsulin and glucose infusions minimize the endocrine stress response an d normalize postoperative insulin sensitivity and substrate utilizatio n.