Get access

Pre-operative carbohydrate loading may be used in type 2 diabetes patients

Authors

  • U. O. GUSTAFSSON,

    1. Department of Clinical Science, Intervention and Technology, Centre for Gastrointestinal Disease, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden,
    Search for more papers by this author
  • J. NYGREN,

    1. Department of Clinical Science, Intervention and Technology, Centre for Gastrointestinal Disease, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden,
    Search for more papers by this author
  • A. THORELL,

    1. Department of Clinical Science, Intervention and Technology, Centre for Gastrointestinal Disease, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden,
    Search for more papers by this author
  • M. SOOP,

    1. Department of Clinical Science, Intervention and Technology, Centre for Gastrointestinal Disease, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden,
    Search for more papers by this author
  • P. M HELLSTRÖM,

    1. Department of Medicine, Gastroenterology Unit, Karolinska University Hospital, Solna, Sweden
    Search for more papers by this author
  • O. LJUNGQVIST,

    1. Department of Clinical Science, Intervention and Technology, Centre for Gastrointestinal Disease, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden,
    Search for more papers by this author
  • E. HAGSTRÖM-TOFT

    1. Department of Clinical Science, Intervention and Technology, Centre for Gastrointestinal Disease, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden,
    2. Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
    Search for more papers by this author

Address:
Ulf Gustafsson
Department of Clinical Science, Intervention and Technology, Centre for Gastrointestinal Disease, Ersta Hospital, 116 91, Box 4622 Stockholm
Sweden
e-mail: ulf.gustafsson@erstadiakoni.se

Abstract

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.

Get access to the full text of this article

Ancillary