Summary: Surgical patients are generally expected to stop eating the night before the procedure. However, studies show that this is associated with an increased risk of complications. On the contrary, carbohydrate loading initiated a few days before the surgery may reduce post-surgical complications.
The post-surgical phase is characterized by significant metabolic changes, muscle loss, decline in immunity, and increased infection risk. Although it is known that post-surgical stress causes many complications, rehospitalizations, and even deaths, its mechanism is still poorly understood.
Of course, one of the reasons for post-surgical weakness is stress. However, there is much more than that, and now studies show that the post-surgical phase is characterized by significant insulin resistance. This insulin resistance can be quite severe and comparable to those living with type 2 diabetes. Chronic pain specialists have observed that insulin resistance in surgical patients requires a targeted approach to improve recovery outcomes.
Since inadequate steps are being taken to manage post-surgical stress, catabolism, and insulin resistance, many older adults never fully recover, or they take years to make a complete recovery.
One of the issues is that much of the focus is on managing the condition rather than its prevention. Of course, this post-surgical insulin resistance is unpreventable as it occurs due to essential invasive procedures, but steps can be taken to reduce its long-term impact.
So, the first step in managing this condition is realizing that stress causes significant insulin resistance in surgical patients. This insulin resistance lasts from a few days to a few weeks. During this phase, metabolic changes are quite similar to type 2 diabetes.
Additionally, new studies show that this kind of insulin resistance can be reduced. However, reducing its severity requires a very different approach to managing type 2 diabetes. After all, individuals experiencing this issue are not living with diabetes. Interventional pain management St. Louis could benefit from adopting carbohydrate loading techniques to address post-surgical stress and improve patient outcomes.
Hence, studies show that instead of overnight fasting, recommending carbohydrate-rich drinks can significantly reduce post-operative insulin resistance. Clinical studies and their systemic review have supported this approach. Researchers have tested this in different clinical scenarios, in burn patients, in those undergoing open-heart surgery, and more. Preoperative carbohydrate loading reduces post-operative insulin resistance and significantly lowers the risk of post-surgical complications.
There can be many approaches to this. In many instances, patients are not allowed to consume carb-rich food. In such cases, considering intravenous glucose may be a good idea. In some instances, even IV glucose with insulin may be used.
However, there is even more to it. Researchers are now saying that since most surgeries are elective, some of the steps, like carbohydrate loading, must begin much earlier. Although surgeons might recommend not eating anything 24 hours before major surgery, patients may be recommended carbohydrate loading a few days before surgery.
Carbohydrate loading has been in use in sports for a long. In competitive sports, it is one of the legal ways to boost performance, where participants may need to reduce food and fluid intake before competition. This means that we can also learn from this experience.
Studies show that carbohydrate loading before stress or surgical procedures may help. Further studies show that complex carbs are better for carbohydrate loading than simple carbs. This is because complex carbs stay in the system for much longer.
Preoperative carbohydrate loading improves glucose control, immune function, muscle strength, and bowel function. In older adults, it may reduce the risk of post-operative sarcopenia or muscle wasting. Carbohydrate loading also reduces muscle loss, opioid use, anxiety, nausea and vomiting, and morbidity.
