Which event best explains why blood glucose levels may remain elevated after surgery in a patient with type 1 diabetes?

Which event best explains why blood glucose levels may remain elevated after surgery in a patient with type 1 diabetes?

• A. Increased insulin production by the pancreas
• B. Increased insulin sensitivity after anesthesia
• C. Rising stress hormones and metabolic demands
• D. Decreased hepatic glucose production

Answer: (C)

Surgical stress triggers a surge of counterregulatory hormones that push glucose up and make tissues less able to use it. Epinephrine, cortisol, glucagon, and growth hormone stimulate the liver to make more glucose (through gluconeogenesis and glycogenolysis) and promote insulin resistance in muscles and fat. In type 1 diabetes, there isn’t enough insulin to counter these effects, so blood glucose remains elevated after surgery despite the surgical stress. This combination of increased hepatic glucose production and reduced peripheral glucose uptake is why rising stress hormones and metabolic demands best explain the persistent hyperglycemia.

Surgical stress triggers a surge of counterregulatory hormones that push glucose up and make tissues less able to use it. Epinephrine, cortisol, glucagon, and growth hormone stimulate the liver to make more glucose (through gluconeogenesis and glycogenolysis) and promote insulin resistance in muscles and fat. In type 1 diabetes, there isn’t enough insulin to counter these effects, so blood glucose remains elevated after surgery despite the surgical stress. This combination of increased hepatic glucose production and reduced peripheral glucose uptake is why rising stress hormones and metabolic demands best explain the persistent hyperglycemia.