Original communication| Volume 105, ISSUE 1, P28-35, January 1989

Characterization of insulin resistance after surgery

  • Jörgen Nordenström
    From the Departments of Surgery and Medicine and the Research Center at the Huddinge Hospital Stockholm, Sweden

    From the Karolinska Institute, Stockholm, Sweden
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  • Tomas Sonnenfeld
    From the Departments of Surgery and Medicine and the Research Center at the Huddinge Hospital Stockholm, Sweden

    From the Karolinska Institute, Stockholm, Sweden
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  • Peter Arner
    Reprint requests: Peter Arner, MD, Department of Medicine, Huddinge Hospital, S-141 86 Huddinge, Sweden.
    From the Departments of Surgery and Medicine and the Research Center at the Huddinge Hospital Stockholm, Sweden

    From the Karolinska Institute, Stockholm, Sweden
    Search for articles by this author
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      The effects of insulin on glucose utilization were investigated in seven nonobese patients before and 24 hours after elective cholecystectomy. Surgery was followed by a significant increase in the circulating levels of glucose and insulin. The hypoglycemic action of insulin was reduced by one third (p < 0.01) after surgery. In isolated fat cells after surgery there was a significant overall reduction of 35% to 50% of the effects of insulin on 3-0-methylglucose transport and lipogenesis at 1μmol/L of glucose (where hexose transport is rate-limiting for insulin action). However, there was no change in insulin sensitivity in these cells. The effects of insulin on lipogenesis in adipocytes incubated with 100 μmol/L of glucose (where glucose metabolism is rate-limiting for insulin action) and adipocyte insulin receptor binding were not influenced by surgery. Insulin action in vivo and in vitro was not altered in five nonoperated control subjects 24 hours after they were given the same type of nutritional support as the cholecystectomy patients postoperatively. It was concluded that an elective moderate surgical trauma induces a rapid and marked insulin resistance that is not the result of postoperative nutritional restriction and involves a postreceptor binding alteration of glucose transport.
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        • Alberti KGMM
        • Batstone GF
        • Path MRC
        • Foster KJ
        • Johnston DG
        Relative role of various hormones in mediating the metabolic response to injury.
        J Parenter Ent Nutr. 1980; 4: 141-146
        • Carey LC
        • Lowery BD
        • Cloutier CT
        Blood sugar and insulin response in human shock.
        Ann Surg. 1970; 172: 342-350
        • Allison SP
        • Hinton P
        • Chamberlain MJ
        Intravenous glucose tolerance, insulin and free fatty acid levels in burn patients.
        Lancet. 1968; 2: 1113-1116
        • Wilmore DW
        • Mason Jr, AD
        • Pruitt BA
        Insulin response to glucose in hypermetabolic burn patients.
        Ann Surg. 1976; 183: 314-320
        • Wright PD
        • Henderson K
        • Johnston IDA
        Glucose utilization and insulin secretion during surgery in man.
        Br J Surg. 1974; 61: 5-8
        • Halter JB
        • Pflug AE
        Relationship of impaired insulin secretion during surgical stress to anesthesia and catecholamine release.
        J Clin Endocrinol Metab. 1980; 51: 1093-1098
        • Meguid MM
        • Brennan MF
        • Aoki TT
        • Muller WA
        • Ball MR
        • Moore FD
        Hormone-substrate interrelationships following trauma.
        Arch Surg. 1974; 189: 776-883
        • Hȧkansson E
        • Rutberg H
        • Jorfeldt L
        • Wiklund L
        Endocrine and metabolic responses after standardized moderate surgical trauma: influence of age and sex.
        Clin Physiol. 1984; 4: 461-473
        • Wolfe RR
        • Durkot MJ
        • Allsop JR
        • Burke JF
        Glucose metabolism in severely burned patients.
        Metabolism. 1979; 28: 1031-1039
        • Black PR
        • Brooks DC
        • Bessey PQ
        • Wolfe RR
        • Wilmore DW
        Mechanisms of insulin resistance following injury.
        Ann Surg. 1982; 196: 420-435
        • DeFonzo RA
        • Soman W
        • Sherwin RS
        • Hendler R
        • Felig P
        Insulin binding to monocytes and insulin action in human obesity, starvation and refeeding.
        J Clin Invest. 1978; 62: 204-213
        • Bray GA
        Effect of diet and triiodothyronine on the activity of SN-glycerol-3-phosphate-dehydrogenase and on the metabolism of glucose and pyruvate by adipose tissue of obese patients.
        J Clin Invest. 1969; 48: 1413-1422
        • Pedersen O
        • Hjöllund E
        • Schwartz-Sörensen N
        Insulin receptor binding and insulin action in human fat cells: effects of obesity and fasting.
        Metabolism. 1982; 31: 884-895
        • Engfeldt P
        • Bolinder J
        • Östman J
        • Arner P
        Effect of fasting on insulin receptor binding and insulin action in different human subcutaneous fat depots.
        J Clin Endocrinol Metab. 1985; 60: 868-873
        • Gliemann J
        • Rees WD
        • Foley JA
        The fate of labeled glucose molecules in the rat adiopocyte. Dependence on glucose concentration.
        Acta Biochim Biophys Hung. 1984; 804: 68-76
        • Arner P
        • Engfeldt P
        Fasting-mediated alteration studies in insulin action on lipolysis and lipogenesis in obese women.
        Am J Physiol. 1987; 253: E193-E201
        • Coburn HJ
        • Carrol JJ
        Improved manual and automatic calorimetric determination of serum glucose with use of hexokinase and glucose-6-phosphate-dehydrogenase.
        Clin Chem. 1973; 19: 127-130
        • Wide L
        • Axén R
        • Porath J
        Radioimmunosorbent assay for proteins. Chemical couplings of antibodies to insoluble dextran.
        Immunochemistry. 1976; 4: 381-386
        • Arner P
        • Arner O
        • Östman J
        Effect of local anesthetic agents on lipolysis by human adipose tissue.
        Life Sci. 1973; 13: 161-169
        • Bolinder J
        • Östman J
        • Arner P
        Postreceptor effects causing insulin resistance in normoinsulinemic non-insulin-dependent diabetes mellitus.
        Diabetes. 1982; 31: 911-916
        • Rodbell M
        Metabolism of isolated fat cells. I. Effects of hormones on glucose metabolism and lipolysis.
        J Biol Chem. 1964; 239: 325-330
        • Moody AJ
        • Stan MA
        • Stan M
        • Gliemann J
        A simple tree fat cell by assay for insulin.
        Horm Metab Res. 1974; 6: 2-16
        • Whitesell RR
        • Gliemann J
        Kinetic parameters of transport of 3-O-methylglucose and glucose in adipocytes.
        J Biol Chem. 1979; 254: 5276-5283
        • Pedersen O
        • Gliemann J
        Hexose transport in human adipocytes: factors influencing the response to insulin and kinetics of methylglucose and glucose transport.
        Diabetologia. 1981; 20: 630-635
        • Ciaraldi TP
        • Kolterman OG
        • Olefsky JJ
        Mechanism of the post-receptor defect in insulin action in human obesity. Decrease in glucose transport system activity.
        J Clin Invest. 1981; 68: 875-880
        • Ciaraldi TP
        • Kolterman OG
        • Scarlett JA
        • Kao M
        • Olefsky JM
        Role of glucose transport in the postreceptor defect on non-insulin-dependent diabetes mellitus.
        Diabetes. 1982; 31: 1016-1022
        • Zawadski JK
        • Bogardus C
        • Foley JE
        Insulin action in obese non-insulin-dependent diabetes in their isolated fat cells before and after weight loss.
        Diabetes. 1987; 36: 227-236
        • Askanazi J
        • Carpentier YA
        • Elwyn DH
        • et al.
        Influence of total parenteral nutrition on fuel utilization in injury and sepsis.
        Ann Surg. 1980; 191: 40-46
        • Nordenström J
        • Carpentier YA
        • Askanazi J
        • Robin AP
        • Elwyn DH
        • Kinney JM
        Free fatty acid mobilization and oxidation during total parenteral nutrition in trauma and sepsis.
        Ann Surg. 1983; 198: 725-735
        • Kahn CR
        Insulin resistance, insulin sensitivity and insulin in responsiveness: a necessary distinction.
        Metabolism. 1978; 27: 1893-1902
        • Kaukinen S
        • Marttinen A
        • Vuorinen P
        • Koivula T
        Effect of surgical stress of the erytrocyte insulin receptor.
        Clin Nutr. 1984; 3: 191-195
        • Arner P
        • Lönnqvist F
        Interactions between receptors for insulin and catecholamines in fat cells.
        in: Berry EM Blondheim SH Eliakon HE Shafring E Recent advances in obesity research. V. John Libbey and Company, Ltd, London1987: 204-211
        • Kahn CR
        Molecular mechanism of insulin action.
        Ann Rev Med. 1985; 36: 429-451