Glucose tolerance and insulin response during and after elective skeletal surgery.

Six patients undergoing elective femoral osteotomy were subjected to a series of intravenous glucose tolerance tests and plasma insulin determinations in a study of the way in which a standard operation affects carbohydrate metabolism. The glucose tolerance of all patients assumed a diabetic pattern; this was already observable in the test made on admission to the operating theater and was still evident during the last test on the second postoperative day. The changes were most profound during and four hours after the operation. Insulin secretion was suppressed on the day of operation, but exceeded preoperative values in the postoperative period. Urinary excretion of catecholamines was determined in 4 patients; there was no correlation between the degree of insulin suppression and the catecholamine output. The assumption that the hyperglycemic response and insulin suppression are mediated along splanchnic neural pathways was not confirmed in a quadriplegic patient, who responded to an intravenous glucose tolerance test soon after the injury with hyperglycemia, insulin suppression and a low catecholamine output. It is concluded that the hyperglycemia and insulin suppression observed after trauma represent a complex and purposeful metabolic response, in which several causative factors are involved.