Medicinski Glasnik Specijalne Bolnice za Bolesti Štitaste Žlezde i Bolesti Metabolizma "Zlatibor" (Jan 2018)

Surgery and insulin resistance

  • Micić Dušan,
  • Polovina Snežana,
  • Mijatović Srđan,
  • Oluić Branislav,
  • Arsenijević Vladimir,
  • Lalić Nebojša,
  • Đukić Vladimir,
  • Micić Dragan

Journal volume & issue
Vol. 23, no. 70
pp. 29 – 39

Abstract

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Surgical intervention is an extremely high stress for the human body, leading to the occurrence of inflammation and insulin resistance. Insulin resistance is developing a few hours after the start of the operation, and the most pronounced right after its completion. Hyperglycemia and insulin resistance were recognized as a possible independent cause of complications in major abdominal surgery. Metabolic response to surgery or other types of trauma accelerating metabolism to the state of hypermetabolism, which implies an increase in oxidative processes and the acceleration of catabolic reactions, resulting in increased degradation of glycogen, fat and protein. Inflammatory response of the body in perioperative period is a protective mechanism which promotes better recovery, while excessive inflammatory response in severe tissue injury could contribute to development of complications and impaired wound healing. Tumor necrosis factor-α (TNF-α), Interleukin-6 (IL-6) and C-Reactive Protein (CRP) are, among the others, major regulators of the acute phase response to inflammation and tissue injury. Inflammatory response that is mediated by cytokines could be one of the molecular triggers for the metabolic response to surgery. Preoperatively reported insulin resistance, as a response to the starvation, in situations when food intake is reduced, insulin resistance is developed to provide limited supplies of carbohydrates used in tissues which depend of glucose intake, such as brain.