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my memory translated
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while carbohydrates, which provide glucose to the body to support metabolism, are crucial to the diet, inappropriate intake can lead to hyperglycemia, hypoglycemia, and glycemic fluctuations that are harmful to health outcomes (fig. 2). fig. 2. consequences of glucose imbalance. a. hyperglycemia (elevated blood glucose) may contribute to enhance adiposity and to muscle catabolism; in addition, hyperglycemia favors complications in acute disease conditions including surgery and critical illness. b. hypoglycemia (low blood glucose) can be fatal, especially in critically ill patients. glycemic variability with uncontrolled swings in blood glucose towards both hyperglycemia and hypoglycemia is associated with poor outcomes after surgery and can be fatal to those in critical conditions. 360 r. barazzoni et al. / clinical nutrition 36 (2017) 355e363 excess glucose ingestion interacts with the gut and its microbiome and ultimately affects a number of organs including skeletal muscle, adipose tissue, and the liver. excess glucose availability may induce expansion of adipose tissue and may favor ectopic fat deposition into liver and muscle tissues, which further exacerbates insulin resistance and glycemic imbalances. insulin resistance is associated with, and can promote progression of, metabolic syndrome and eventually t2d, and it represents a factor contributing to hyperglycemia, glucose variability, and poor outcomes in the critically ill or those recovering from surgery. optimal nutritional support for patients with obesity and t2d should limit glucose provision, and plasma glucose should be carefully monitored in order to avoid harmful glucose fluctuations. in the surgical situation, preoperative fasting should be avoided as part of eras protocols to optimize outcomes, particularly in abdominal surgical patients. in critical illness, limiting glucose content in enteral and parenteral nutrition formulas may provide benefits, although safety of higher lipid administration should also be assessed. it should be finally recognized that more high-quality trials specifically addressing optimal enteral and parenteral nutrition compositions aimed at avoiding or minimizing clinical consequences of insulin resistance and hyperglycemia are needed for optimal clinical recommendations in these important areas of patient treatment

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