Preoperative Oral Carbohydrate Attenuates Immediate Postoperative Insulin Resistance

Thesis Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistanceObjective To evaluate the effects of preoperative oral carbohydrate on stomach gastric resection patients with postoperative insulin resistance, and analyze the mechanism of preoperative oral carbohydrate reduce the postoperative insulin resistance.Methods59patients scheduled for subtotal gastrectomy or total gastrectomy were recruited to this randomized controlled study and43patients completed it. They were randomized assigned to the treatment or control group. Patients in the treatment group(n=21)received1000ml of a carbohydrate-rich fluid on the evening before surgery and500ml of the same fluid2h preoperatively. Conversely, control group (n=22) underwent overnight fasting. Plasma glucose serum insulin and glucagon levels were obtained with1day before operation Surgery0.5h and12hours after surgery. The status of insulin resistance (HOMA-IR), basic function of pancreatic β cell (HOMA-β cell) and insulin sensitivity index (ISI) were assess by homeostasis model assessment (HOMA). Two groups of patients with mesenteric venous blood and peripheral venous blood glucose concentration were measured. Part of the intestinal mucosa and liver were incided when Jejunum intubation colostomy were performed and the and the expression of G-6-Pase and PEPCK were measured by Western Blot. Results are presented as mean±sd. with the use of Student’s t-test analyzed with SPSS16for windows, significance was accepted at the probability level of<0.05.Results There were no differences between the two groups of patient’s age, gender, preoperative blood glucose concentrations, blood insulin concentrations, anesthesia and surgery procedures. Two groups of patients with postoperative blood glucose concentrations, insulin concentration, and insulin resistance index is higher than preoperative, and the insulin sensitivity index was decresd(p<0.05).But the control group blood glucose, insulin concentration levels were found to remain significantly higher than patients who had received the carbohydrate-rich fluid(p<0.05). There was no statistical difference between the two groups with index of insulin secrete. Two groups of patients with mesenteric venous blood glucose concentration levels were higher than in peripheral venous blood glucose concentration (p<0.05). There were no differences between the peripheral venous blood glucose concentration. The control group difference between mesenteric venous blood glucose concentration and peripheral venous blood glucose concentration is lower than experimental group(p<0.05). Control group G-6-ase and liver PEPCK protein expression were higher than the experimental group (p<0.05). But small intestinal mucous membrane G-6-Pase PEPCK protein expression between the two groups had no statistical difference.Conclusions Preoperative oral carbohydrate and small intestine gluconeogenesis made the insulin inhibition of liver gluconeogenesis enhanced is may one of the mechanisms of preoperative oral carbohydrate-rich fluids attenuated postoperative insulin resistance.