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Pre‐operative carbohydrate loading may be used in type 2 diabetes patients
Author(s) -
GUSTAFSSON U. O.,
NYGREN J.,
THORELL A.,
SOOP M.,
HELLSTRÖM P. M,
LJUNGQVIST O.,
HAGSTRÖMTOFT E.
Publication year - 2008
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2008.01599.x
Subject(s) - medicine , gastric emptying , diabetes mellitus , insulin , insulin resistance , carbohydrate , glycated haemoglobin , type 2 diabetes , endocrinology , stomach , gastroenterology
Background: Post‐operative insulin resistance and hyperglycaemia are associated with an impaired outcome after surgery. Pre‐operative oral carbohydrate loading (CHO) reduces post‐operative insulin resistance with a reduced risk of hyperglycaemia during post‐operative nutrition. Insulin‐resistant diabetic patients have not been given CHO because the effects on pre‐operative glycaemia and gastric emptying are unknown. Methods: Twenty‐five patients (45–73 years) with type 2 diabetes [glycated haemoglobin (HbA1c) 6.2 ± 0.2%, mean ± SEM] and 10 healthy control subjects (45–72 years) were studied. A carbohydrate‐rich drink (400 ml, 12.5%) was given with paracetamol 1.5 g for determination of gastric emptying. Results: Peak glucose was higher in diabetic patients than in healthy subjects (13.4 ± 0.5 vs. 7.6 ± 0.5 mM; P <0.01) and occurred later after intake (60 vs. 30 min; P <0.01). Glucose concentrations were back to baseline at 180 vs. 120 min in diabetic patients and healthy subjects, respectively ( P <0.01). At 120 min, 10.9 ± 0.7% and 13.3 ± 1.2% of paracetamol remained in the stomach in diabetic patients and healthy, subjects respectively. Gastric half‐emptying time (T50) occurred at 49.8 ± 2.2 min in diabetics and at 58.6 ± 3.7 min in healthy subjects ( P <0.05). Neither peak glucose, glucose at 180 min, gastric T50, nor retention at 120 min differed between insulin (HbA1c 6.8 ± 0.7%)‐ and non‐insulin‐treated (HbA1c 5.6 ± 0.4%) patients. Conclusions: Type 2 diabetic patients showed no signs of delayed gastric emptying, suggesting that a carbohydrate‐rich drink may be safely administrated 180 min before anaesthesia without risk of hyperglycaemia or aspiration pre‐operatively.