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. 2024 Feb 25:18:107-110.
doi: 10.1016/j.sopen.2024.02.012. eCollection 2024 Mar.

Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes

Cindy Bredefeld  1   2 , Amy Patel  1 , Shahidul Islam  3 , Virginia Peragallo-Dittko  1   2
Affiliations

Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes

Cindy Bredefeld et al. Surg Open Sci. .

Abstract

We assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received rapid acting insulin (Novolog®[insulin aspart]) prior to 50 g CHO-L on the day of surgery. Following CHO-L and the administration of insulin, no hypoglycemic episodes occurred with preoperative POC glucose values between 6.8 and 12.3 mmol/L (123 and 221 mg/dL). Our experience demonstrates that administering rapid acting insulin prior to CHO-L in patients with type 2 diabetes is feasible and targets the potentially negative influence CHO-L may impose on preoperative glycemia in this population. Important considerations of this approach are highlighted and an insulin dosing algorithm designed for non-specialty providers is suggested.

Keywords: Carbohydrate loading; Diabetes; Enhanced recovery after surgery (ERAS).

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Algorithm for insulin management prior to carbohydrate loading on the day of surgery. MDI: multiple daily injection.
See this image and copyright information in PMC

References

    1. Ljungqvist O., Nygren J., Thorell A., et al. Preoperative nutrition-elective surgery in the fed or the overnight fasted state. Clin Nutr. 2001;20(Suppl. 1):167–171. doi: 10.1054/clnu.2001.0462. - DOI - PubMed
    1. Fearon K.C., Ljungqvist O., Von Meyenfeldt M., et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466–477. doi: 10.1016/j.clnu.2005.02.002. - DOI - PubMed
    1. Ljungqvist O., Soop M., Hedström M. Why metabolism matters in elective orthopedic surgery: a review. Acta Orthop. 2007;78(5):610–615. doi: 10.1080/17453670710014293. - DOI - PubMed
    1. Rutan L., Sommers K. Hyperglycemia as a risk factor in the perioperative patient. AORN J. 2012;96(1):352–364. doi: 10.1016/j.aorn.2011.06.010. - DOI - PubMed
    1. Bilku D., Dennison A., Hall T., et al. Role preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014;96(1):15–22. doi: 10.1308/003588414x13824511650614. - DOI - PMC - PubMed

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