The control of plasma glucose in the surgical patient

Abstract

Abstract In a controlled merabolic study of 18 surgical patients alterations in the relationship of plasma glucose to insulin and non-esterified fatty acids could be divided into two phases. In the immediate postoperative period insulin resistance allowed a simultaneous increase in glucose and fatty acids, a situation which does not occur in the normal subject. On subsequent days resistance subsided and the reciprocal relationship of glucose to fatty acids was restored. It is suggested that insulin resistance is an adaptive feature which permits an augmented supply of energy substrate to meet the demands of injury. In adequate amounts intravenous carbohydrate spares tissue protein and fat during recovery. This is mediated by a long term change in the relationship of insulin to the more stable plasma glucose.