Pre-operative carbohydrate loading may be used in type 2 diabetes patients
Article first published online: 7 MAR 2008
© 2008 The Authors. Journal compilation © 2008 The Acta Anaesthesiologica Scandinavica Foundation
Acta Anaesthesiologica Scandinavica
Volume 52, Issue 7, pages 946–951, August 2008
How to Cite
GUSTAFSSON, U. O., NYGREN, J., THORELL, A., SOOP, M., HELLSTRÖM, P. M., LJUNGQVIST, O. and HAGSTRÖM-TOFT, E. (2008), Pre-operative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiologica Scandinavica, 52: 946–951. doi: 10.1111/j.1399-6576.2008.01599.x
- Issue published online: 9 JUL 2008
- Article first published online: 7 MAR 2008
- Accepted for publication 20 November 2007
- Carbohydrate drink;
- gastric emptying;
- glucose control;
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.