Insulin Resistance, Glycemia and Cortisol Levels in Surgical Patients who Had Preoperative Caloric Load with Amino Acids

Abstract

Introduction: Surgical stress response, results in elevated levels of anti-insulin hormones and reduced insulin secretion. This hormonal state may be detrimental for surgical patients due to the presence of insulin resistance and hyperglycemia. Additionally, pre-operative fasting favors this conditions. The aim of this study is to analyze the impact of pre-operative caloric load, with 440kJ from amino acid infusions on the levels of glucose, cortisol and insulin resistance in surgical patients.

Material and Methods: The study included 20 female patients scheduled for mastectomy, aged 30-60 years without diabetes and BMI < 30 m2, divided into two groups. The study group A, the evening before the surgery, received 1000 ml amino acid infusions, while the control group B didn′t receive any infusion. In both groups glucose, C-peptide and cortisol levels were determinate preoperatively and postoperatively. From the obtained C-peptide and glucose values, with the help of computer model (HOMA2*), the insulin resistance (IR), functionality of beta cells (BETA) and insulin sensitivity (IS) were calculated.

Results: Postoperative values of insulin resistance (0.94 ± 0.12 vs 1.13 ± 0.2; p = 0.02) and glucose (4.79 ± 0.5 vs 5.77 ± 0.6; p = 0.002) were lower in the study group compared to control group. Postoperative cortisol levels in both groups were higher than the preoperative, but no significant difference was found. The study group showed higher values for BETA and IS. Percentage changes between the groups were significant for all parameters.

Conclusion: Pre-operative caloric load (amino acids) reduces the level of insulin resistance and glucose in the presence of elevated cortisol levels.

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  • 1. Desborough JP. The stress response to surgery. Br J Anaesth. 2000; 85: 109-17.

  • 2. Blebuyck JJ. The Metabolic Response to stress. An overview and update. Аnesthesiology. 1990; 73: 308-27.

  • 3. Burton D, Nicholson G, Hall G. Endocrine and metabolic response to surgery. Critical Care & Pain. 2004; 4: 144-147.

  • 4. Black PR, Brooks DC, Beasey PQ at al. Мechanisms of insulin resistance following injury. Ann Surg. 1984; 196: 420-435.

  • 5. Umpierrez GE, Isaacs SD, Bazargan N at al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002; 87: 978-982.

  • 6. Pomposelli JJ, Baxter JK III, Babineau TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr. 1998; 22: 77-81.

  • 7. Thorell A, Ljungqvist O, Efendic S, et al. Development of postoperative insulin resistance is associated with the magnitude of operation. Eur J Surg. 1993; 159: 593-599.

  • 8. Ljunqvist O. To fast or not to fast? Metabolic preparation for elective surgery. Scandinavian Journal of Nutrition. 2004; 48(2): 77-82.

  • 9. Ljunqvist O. Modulating postoperative insulin resistance by preoperative carbohydrate loading.Best Practice &Research Clinical Anesthesiology. 2003; 23: 401-409.

  • 10. Faria MS, de Aguilar-Nuscimento JE, et al. Preoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-chole cystectomy: randomized, controlled, clinical trial. World J Surg. 2009; 33: 1158-1164.

  • 11.Perrone F, da-Silva-Filho AC, Adôrno IF, et al. Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial. Nutrition journal 2011; 10: 2-68.

  • 12. Thorell A, Ljungqvist O Nygren N. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999; 2(1): 69-78.

  • 13. Van Loon Lj et al. Amino acid ingestion strongly enhances insulin secretion in patients with long-term type 2 diabetes. Diabetes Care. 2003; 26 (3): 625-30.

  • 14. Wright-Pascoe R, Mills J, Choo-Kang E, Morrison EY. The role of C-peptide in the classification of diabetes mellitus. West Indian Med J. 2000; 49(2): 138-42.

  • 15. Wallace MT, Levy JC, Mathews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004; 27(6): 1487-495.

  • 16. Nygren JO, Thorell A, Soop M, et al. Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery. Am J Physiol. 1998; 275: 140-8.

  • 17. Svanfeldt M, Thorell A, Hausel J, Soop M, Nygren J, Ljungqvist O: Effect of "preoperative" oral carbohydrate treatment on insulin action- a randomised cross-over unblinded study in healthy subjects. Clin Nutr. 2005; 24: 815-821.

  • 18. Wallin M, Selldén E, Eksborg S, еt al. Amino acid infusion during anesthesia attenuates the surgery induced decline in IGF-1 and diminishes the "diabetes of injury". Nutrition & Metabolism. 2007; 4: 86-9.

  • 19. Jingyi l et al.Insulin resistance and metabolism of branched-chain amino acid. Front. Med. 2013; 7; 53-59.

  • 20. Мaitra S, Кirtania J et al: Intraoperative blood glucose levels in non-diabetic patients undergoing elective major surgery under general anesthesia receiving different crystalloid solutions for maintenance fluid. Anesthesia Essays and Researches. 2013: 7(2): 183-188.

  • 21. Zhong J. Еffects of intraoperative amino acid infusion on blood glucose under general anesthesia combined with epidural block. Ann Nutr Metab. 2012; 61: 1-6

  • 22. Srceva M et al. Effects of preoperatively given amino acid infusion on blood glucose and C-peptide levels in surgical patients. Physioacta. 2015; 9(1): 131-141.

  • 23. Kee J, Baxter R, Smith R. Parenteral amino acid promotes anabolic action in rats. Amer.Journ of Physy. 1999: 277: 63-72.

  • 24. Preisssig CM, Hansen I, Roerig P, et al. A protocolised approach to identify and manage hyperglycemia in a pediatric critical care. Pediatr Crit Care Med. 2008; 9: 582-8.

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