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Glucose Disposal in Morbidly Obese Patients in the Early Post-operative Period
Obesity Surgery, 2001
Background: In surgical patients, operative stress causes protein catabolism, muscle mass loss, and impaired glucose tolerance. We investigated fuel metabolism and glucose and protein turnover in 15 obese subjects who underwent biliopancreatic diversion (BPD) by using stable labelled isotopes.
Carbohydrate three-carbon metabolism of adipose tissue during surgery
Nutrition (Burbank, Los Angeles County, Calif.), 1996
Carbohydrate metabolites were continuously measured in the extracellular space of adipose tissue with microdialysis in 24 patients during elective cholecystectomy. The metabolism of exogenously supplied glucose by adipose tissue was assessed by measuring changes in glucose, pyruvate, and lactate in this tissue and making comparisons with changes in the levels of these metabolites in blood. Twelve patients were randomized to receive glucose infusion (50 mg/mL, 216 mL/h) and another 12 patients to receive saline infusion (9 mg/mL, 3 mL* kg-'* h-l). The surgical trauma caused a typical stress response, including increased plasma catecholamine levels, hyperglycemia, and hyperinsulinemia. The relative increases in glucose during surgery were greater in plasma than in the adipose tissue of patients receiving glucose. The concentrations of lactate in the dialysate were similar in the glucose and saline groups. During surgery, the concentrations of pyruvate in blood and dialysate increased in the group receiving glucose. At the end of surgery, a higher than normal lactate to pyruvate (L:P) ratio in plasma was observed in blood (L:P = 18) but not in subcutaneous fat (L:P = 12). The origin of this increased level of lactate relative to pyruvate in the circulation is not known, but evidently it does not come from the subcutaneous fat. In conclusion, surgical trauma caused a typical stress response including increased plasma catecholamine levels, hyperglycemia, and hyperinsulinemia. Glucose uptake in adipose tissue, as indicated by the ratio of adipose tissue to plasma glucose, was reduced by trauma. Lactate concentrations in subcutaneous fat and plasma increased in response to surgery, and exogenous glucose, given in amounts corresponding to energy expenditure, had little effect on the lactate concentrations in plasma and in adipose tissue. Nutn'tion 1996; 12:589-594
PRILOZI, 2015
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 mResults: 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 BE...
Method for Estimating Rate of Fat Loss During Treatment of Obesity by Calorie Restriction
The Lancet, 1985
7. Hirata Y, Ishizu H. Elevated insulin-binding capacity of serum proteins in a case of spontaneous hypoglycemia and mild diabetes not treated with insulin. Tokohu J Exp Med 1972; 107: 277-86. 8. Foiling I, Norman N. Hyperglycemia, hypoglycemic attacks and production of antiinsulin antibodies without previous known immunisation. Diabetes 1972, 21: 814-26. 9. Goldman J, Baldwin D, Rubenstein AH et al. Characterisation of circulating insulin and pro-insulin binding antibodies in autoimmune hypoglycemia. J Clin Invest 1979; 63: 1050-59. 10. Palmer JP, Asplin CM, Clemons P, et al. Insulin antibodies in insulin-dependent diabetics before insulin treatment. Science 1983; 222: 1337-39. 11. Wilkin TJ, Nicholson S. Autoantibodies against human insulin. Br Med J 1984; 288: 349-52. 12. Reeves WG. Insulin antibody determination: Theoretical and practical considerations. Diabetologia 1983; 24: 399-403. 13. Spencer KM, Tarn A, Dean BM, Lister J, Bottazzo GF. Fluctuating islet-cell autoimmunity in unaffected relatives of patients with insulin-dependent diabetes. Lancet 1984; i. 764-66. 14. Wilkin TJ, Swanson Beck J, Gunn A, Newton RW, Isles TE, Crookes J. Autoantibodies in thyrotoxicosis. A quantitative study of their behaviour in relation to the course and outcome of treatment. J Endocrinol Invest 1980; 3: 5-14. 15. Wright R Immunology of gastrointestinal and liver disease London: Edward Arnold, 1977: 16-26.
Nutrition, 2008
Objective: Despite contrary evidence, the practice of overnight fasting before elective surgery maintains its place in tradition. However, prolonged starvation, by its catabolic action, may increase the detrimental effects of surgery. In this study, we evaluated the effects of preoperative carbohydrate loading on the gastric contents of patients and perioperative metabolism. Methods: Seventy patients scheduled for cholecystectomy or thyroidectomy randomly were assigned to the treatment or control group. Patients in the treatment group (n ϭ 34) received 800 mL of a carbohydrate-rich fluid on the evening before surgery and 400 mL of the same fluid 2 h preoperatively. Conversely, control patients (n ϭ 36) underwent overnight fasting. Plasma glucose and serum insulin levels were obtained across the perioperative period and during anesthesia induction. The volume and pH of preoperative residual gastric contents also were measured. Results: Preoperative plasma glucose levels were found to remain significantly higher in patients who had received the carbohydrate-rich fluid. Serum insulin levels that were elevated initially in the study group returned to control levels by the time of anesthesia induction. There was no statistical difference between the two groups with respect to gastric residue contents or gastric fluid pH. Conclusion: The preoperative intake of carbohydrate-rich fluids does not appear to alter the amount or pH of gastric contents, suggesting that this is a safe procedure, in terms of aspiration risk. Furthermore, the intake of such fluid might prevent energy malnutrition.