The degree of PIR is proportional to the degree of surgical trauma. Although overcoming PIR by insulin infusion is one way of combating hyperglycemia, prevention of its development can also be achieved by preoperative oral carbohydrate instead of overnight fasting which proven in different kinds of surgery, such as in total hip replacement surgery, colorectal surgery and in elderly patients undergoing coronary artery bypass grafting. As a single intervention in patients given 2-3 hours before anaesthesia, the efficacy of preoperative oral carbohydrate has been shown to be equally as good as the intravenous infusion of glucose with regard to PIR, and attenuated the development of PIR by 50% measured on the first postoperative day after major abdominal surgery. In a placebo-controlled randomized controlled trial of 65 patients undergoing major abdominal surgery, patients who received preoperative oral carbohydrate lost 0.5 cm of the mid-arm circumference by discharge, while the placebo group had more than twice the reduction (1.1 cm). Furthermore, patients receiving the oral carbohydrate-rich beverage before colorectal surgery had a smaller reduction in their quadriceps muscle strength after the operation up to 1 month than those without carbohydrate-rich beverage. These studies suggest that whole-body protein balance, muscle function as well as the suppressive effect of insulin on endogenous glucose release are better maintained and enhanced when patients receive a carbohydrate-rich beverage before surgery. Moreover, in patients who undergo surgery of moderate to severe degree of PIR, the PIR can be overcome if a sufficient amount of insulin is infused to maintain euglycemia, and both glucose uptake and whole body substrate utilization could be normalized in the presence of elevated insulin concentrations. The intensive insulin treatment to maintain normoglycaemia in post-surgical patients in intensive care unit substantially reduces morbidity and mortality. These findings show that excessive insulin can compensate for the defects in insulin action as well, suggesting that PIR might be due to a block in intracellular mechanisms that lead to the decrease in glucose uptake.