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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 22 - 22
1 May 2012
PRELIMINARY PILOT STUDY: INSULIN RESISTANCE AND HYPERGLYCAEMIA FOLLOWING SURGERY IN FRACTURE NECK OF FEMUR PATIENTS
Abbas E Duru B Lui D Jawish O Bennett D
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Fracture neck of femur (NOF) is a significant morbidity in the elderly patient and a significant burden on the healthcare system. Surgery induces a stress response resulting in hyperglycaemia, insulin resistance, and glucose intolerance (Diabetic triad). Furthermore, fasting pre operatively establishes a catabolic state. This diabetic state can last up to 3 weeks following surgery and therefore could be associated with the morbidity of diabetes.

Methods

26 patients with fracture NOF were enrolled in this preliminary study. Exclusion criteria included diabetics. Each underwent hemiarthroplasty or Dynamic Hip Screw fixation. Pre and post operative serum glucose levels were taken. 15 patients were selected to have pre and post operative serum insulin levels because of the expensive nature of the test.

Results

Normal glucose range = 4-6 mmol/l. Normal insulin range = 17.8 – 173 pmol/l. 21 of 26 patients exhibited post operative hyperglycaemia (range 5 - 16.4mmol/l). 7 of 15 patients tested for insulin remained in our pilot study where pre and post insulin levels were obtained. Insulin is a technically difficult level to take and samples are easily discarded. 6 of 7 Insulin levels showed marked elevation post operatively (range 17.5 – 595.8).

Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 101 - 101
1 May 2011
THE EFFECTS OF ORAL PRE-OPERATIVE CARBOHYDRATE LOADING ON POSTOPERATIVE HYPERGLYCEMIA IN HIP FRACTURE PATIENTS: A RANDOMIZED CONTROL CLINICAL STUDY.
Lui D Duru B Jaweesh O Bandorf N Abaas W El Halaby R Koh P Ijaz A Sherif S Khattak S Ahmed H Bennett D
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Introduction: Surgery may cause a metabolic response leading to a diabetic state characterised by hyperglycaemia, insulin resistance and glucose intolerance. Metabolic stress may be worsened by the practice of Nulla Per Os (NPO).

Hip fracture patients are often subjected to fasting for extended periods. We hypothesise that a pre operative high carbohydrate drink permitted prior to surgery would mitigate the post operative diabetic state.

Methods: Ethical and Anaesthetic approval were obtained. 40 patients with hip fractures were enrolled over 4 months at Mayo General Hospital and were randomized to two groups. 20 were enrolled into Group A: control traditional NPO and Group B: Carbohydrate group. Data collection: Glucose and insulin serum levels were recorded regularly at: preadmission, post op and post op days 1 & 5; and weeks 2,3 & 6. Drink protocol: 800mls before midnight and 400mls on the morning of surgery. Exclusion criteria included diabetics and pregnancy. Hospital length of stay (HLOS), morbidity and readmissions were noted.

Result: Average age Group A: X Group B:Y. Hyperglycaemia post operatively noted in 70% of Group A vs 30% in Group B. Hyperinsulinaemia postoperatively noted in 75% of Group A vs 28% Group B. Group A and B had similar HLOS and post operative morbidity. However, we noted a higher readmission rate 45% in Group A.

Conclusion: Preoperative Carbohydrate loading significantly decreases post operative hyperglycemia and hyper insulinamia. This may show that converting a patient from fasted to a fed state prior to the insult of surgery prevents the patient entering a diabetic state and avoiding morbidity associated with same.