Summary: Surgery patients are usually told to stop eating the night before. But studies show this is tied to a higher risk of complications. Carbohydrate loading (eating extra carbs) a few days before surgery may cut problems after surgery.
After surgery, the body goes through big changes. Metabolism shifts, muscle wastes, immunity drops, and infection risk climbs. We know the stress of surgery causes many complications, return trips to the hospital, and even deaths. But how it does this is still poorly understood.
Stress is one reason people feel weak after surgery. But there is much more to it. Studies now show that the body becomes very insulin resistant after surgery. This insulin resistance can be as bad as in people with type 2 diabetes. Chronic pain specialists have seen that insulin resistance in surgery patients needs a targeted plan to improve recovery.
Too little is done to manage the stress, muscle breakdown, and insulin resistance that follow surgery. So many older adults never fully recover. Or they take years to get back to normal.
One problem is that the focus is on managing the condition, not preventing it. This insulin resistance cannot be prevented, because it comes from needed surgery. But steps can be taken to reduce its long-term harm.
So the first step is to see that stress causes major insulin resistance in surgery patients. It lasts from a few days to a few weeks. During this time, the body’s metabolism looks a lot like type 2 diabetes.
New studies also show this kind of insulin resistance can be reduced. But it takes a very different approach from treating type 2 diabetes. After all, these people do not have diabetes. Interventional pain management in St. Louis could benefit from using carb loading to handle the stress of surgery and improve patient outcomes.
So studies show that instead of overnight fasting, carb-rich drinks can greatly reduce insulin resistance after surgery. Clinical studies and a systematic review back this approach. Researchers have tested it in many settings, including burn patients and open-heart surgery. Carb loading before surgery cuts insulin resistance afterward and greatly lowers the risk of complications.
There are many ways to do this. Often, patients are not allowed to eat carb-rich food. In those cases, glucose (sugar) through an IV may be a good idea. Sometimes IV glucose is even given with insulin.
But there is even more to it. Most surgeries are planned ahead. So researchers say some steps, like carb loading, must start much earlier. Surgeons might say to eat nothing for 24 hours before major surgery. But patients may be told to carb load a few days before.
Carb loading has been used in sports for a long time. In competitive sports, it is a legal way to boost performance when athletes must cut food and fluids before an event. We can learn from that.
Studies show that carb loading before stress or surgery may help. More studies show that complex carbs are better for carbohydrate loading than simple carbs. That is because complex carbs stay in the system much longer.
Carb loading before surgery improves blood sugar control, immune function, muscle strength, and bowel function. In older adults, it may lower the risk of muscle wasting (sarcopenia) after surgery. Carb loading also cuts muscle loss, opioid use, anxiety, nausea and vomiting, and illness.
Frequently asked questions
What causes insulin resistance after surgery?
The stress of surgery does. An operation is a needed but invasive procedure. The stress it puts on the body causes major insulin resistance, sometimes as bad as in people with type 2 diabetes. It comes with other changes after surgery: muscle loss, weaker immunity and a higher risk of infection.
How long does insulin resistance last after surgery?
Insulin resistance after surgery lasts from a few days to a few weeks. During that time, the body’s metabolism looks a lot like type 2 diabetes, even in people who do not have diabetes. Steps taken before the operation, such as carb loading, can make it less severe.
How can you reduce insulin resistance after surgery?
Carb-rich drinks instead of overnight fasting greatly reduce insulin resistance after surgery. Most surgeries are planned, so carb loading can start a few days early. Complex carbs work better than simple carbs because they stay in the system longer. When a patient is not allowed to eat, IV glucose, sometimes with insulin, may be used.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
