Insulin Resistance

What is insulin resistance?

  • The hormone insulin normally acts on cell receptors causing glucose to enter cells

  • When insulin is less effective at taking glucose out of the blood, then insulin resistance is taking place

  • Surgery and starvation cause insulin resistance (see below)

  • The result is a rise in blood glucose even though the patient is not a diabetic patient

  • High levels of glucose floating around the circulation impairs phagocytes and the immune system7

  • Maltodextrin drinks taken preoperatively reduce the post-operative hyperglycaemic response28

 

 

What causes insulin resistance?
  1. Surgical intervention leads to a stress reaction (sympathetic, endocrine and metabolic) which causes hyperglycaemia and slows down recovery21,29. Dex was designed to stimulate release of anabolic hormones (insulin) before the operation, which counteracts this stress reaction during surgery.

  2. The starvation state is characterised by depletion of liver glycogen, and a reduced ability to respond to injury.23 Taking complex carbohydrates in the form of maltodextrin prior to surgery prevents this starvation state.

Why is insulin resistance a problem?

  1. It creates a hyperglycaemic state, which increases risk of wound infection and proteolysis (muscle weakness) 26

  2. Post-operative hyperglycaemia is an independent predictor of length of stay in hospital 22,24

 

 

How does Dex prevent insulin resistance?
  • Dex stimulates the pancreas to release a “meal level” of insulin

  • Sports drinks don’t release a “meal level” of insulin from the pancreas and contain MUCH less complex carbohydrate than Dex (this is the key difference between Dex and sports drinks)

  • Insulin is the main anabolic hormone in the body

  • Taking Dex before a procedure optimises the body for the traumatic event

  • The body is in an anabolic state when the procedure begins so the body immediately starts the healing process and opposes the surgical stress response

  • Hyperglycaemia is minimised